Trung tm o to v pht trin sc k

(EDC-HCM)




BN THU HOCH C NHN
MY IN GII 5 THNG S
(Convergys ISE Electrolyte Analyzer)




Ngi thc hin: Nguyn Mnh c



HCM, ngy 24 thng 6 nm 2014
NI DUNG
I. S lc v cht in gii
II. Tng quan v my in gii (Convergys ISE Electrolyte
Analyzer)
1. Gii thiu chung
2. c im k thut ca my
2.1 Thng s k thut ca my
2.2 chnh xc v phn gii
2.3 Cc ha cht chnh hng s dng vi my
3. Cu trc mt my
3.1 Thuc th
3.2 M-un in cc
3.2.1 My d cht kh/cht lng
3.2.2 in cc tham chiu
3.3 Bm nhu ng
3.4 Mu d
III. Nguyn l lm vic
1. S khi
2. Nguyn l lm vic
III. Vn hnh:
1. Pha, ha cht v cch o mu
2. Thao tc vn hnh my
IV. Xc nh kt qu ca my
1. Xc nh ngun gc sai s
2. Kim tra kt qu









I. S LC V CHT IN GII

- Cht in gii l phn t tch in dng hoc in m gi l ion,
c tm thy trong cc t bo ca c th v dch ngoi t bo
(extracellular fluids), bao gm huyt tng (blood plasma).
- Cht in gii c nhiu vai tr trong duy tr cc chc nng ca c th:
Duy tr p sut thm thu trong kim sot cht lng phn b
trong c th (lin quan n mc natri).
Duy tr pH thch hp cho c th
iu ha chc nng ca tim v cc c khc (other muscles)
H tr trong phn ng truyn electron
Tham gia vo cc phn ng enzyme.
- Mt vi bnh lin quan n mt cn bng cht in gii bao gm:
Suy tim xung huyt (Congestive heart failure)
Nhim kim h hp (Respiratory alkalosis) (xy ra khi pH trong
mu trn 7.35)
i tho nht (Diabetes insipidus) (mt nc bi thn).
Bnh tiu ha v bnh thn (Gastrointestinal and kidney
diseases)
- Cc bc s thng cp n mt mc in gii thp vi tin t
"hypo_" v n mt mc in gii cao vi tin t "hyper_".
- Bi v cc cht in gii bt thng c th do nhiu ri lon khc nhau,
nn vic phn tch mu bnh phm l mt yu t quan trng trong chn
on v iu tr bnh
- My phn tch in gii o nhng cht in gii trong huyt tng,
huyt thanh v nc tiu.
II. TNG QUAN V MY IN GII (Convergys ISE Electrolyte
Analyzer)
1. Gii thiu chung:
Cc thng s o c: K+, Na+, Cl-, Ca++, Li+, pH.
Cc ch tiu c th xt nghim:
- in gii (K+, Na+, Cl-) (Q28)
- nh lng Ca++ trong mu
- Calci ion ha
- in gii (K+, Na+, Cl-) niu
Th tch ht mu l 100 L, s dng mu
mu ton phn, huyt thanh, huyt
tng, nc tiu hoc CSF
Cng sut 60 mu/ gi
My in nhit t thn trong ca my
T ng calibrate (hiu chun) 2 im
Hai mc qun l kim sot cht lng
QC
Mn hnh chm cm ng LCD 128 x 64
D s dng vi giao din phm mm
B lu tr d liu ln, lu c 250 kt
qu
Ch ra c 2 mode (ch ) song
song y bng khng kh v dung dch ra trnh tc nghn in
cc

2. c im k thut ca my:
2.1. Thng s k thut ca my:
Cc thng s o
c:
K+, Na+, Cl-, Ca++, Li+, pH
Nguyn l o:
ISE da trn s phn tch in gii xc nh nng
ca cc ion K+, Na+, Cl-, Ca++, Li+, pH
Cng sut chy mu 60 mu/ gi

H thng thuc
th:
Dung dch thuc th hiu chun-1, Dung dch thuc
th hiu chun-2, Dung dch lm sch, Dung dch lm
y in cc ISE v Ref
Phng php ly
mu
H thng ht mu bn t ng, s dng khay/ cc
cha mu, Capillary hoc ng dn chn mu
Dung tch mu 100 L
Loi mu Mu mu ngi: Mu ton phn; Huyt thanh; Huyt
tng; Nc tiu hoc CSF
Phng cch ra Lm sch bung o bng ha cht v lm sch h
thng ng gn bng dung dch ra.

Kim tra cht lng:
2 mc kim sot cht lng. Cc thng s kim sot
cht lng bao gm bng chn lc c s d liu QC
ring bit ca tt c cc thng s o c


Hiu chun:
C hai ch calibaration (hiu chun), l my t
ng calibrate hoc calibrate bng tay
Ch ch: Hiu chun t ng trc khi iu chnh
Giao din: D s dng, bng giao din s dng phm mm

Vic chn on:
Chn on theo chc nng t kim tra vi nhng thng
tin d hiu
Ngn ng: Ting Anh
Dung lng d liu: 250 kt qu
Giao din my tnh
ch:
RS-232 nhiu chui ng dn ti d liu

My in bn trong:
My in nhit Stationary Head Graphical, cun giy
rng 58 mm. In bo co y .

Hin th:
128 x 64 im chm tng phn v n nn cm
ng LCD cao
Ngun in: 100-120 hoc 200-240 VAC, 50-60 Hz
Cng sut tiu th: 60W/h

iu kin hot ng:

15-30
0
C, 59-86
0
F (Nhit ti u l 25
0
C, 77
0
F), 20%
- 80% RH
Kch thc v trng
lng:

(Di x Rng x Cao): 300 x 290 x 275 mm, ca. 6 kg

2.2. chnh xc v phn gii:
CHT
IN GII
KHON KIM
TRA
PHN GII SD CV
K
+
2 - 10 mmol/L 0.01 mmol/L <0.08 <2%
Na
+
80 - 180 mmol/L 0.1 mmol/L < 3.00 <1%
Cl
-
50 - 150 mmol/L 0.1 mmol/L < 2.00 <2%
Ca
++
0.5 - 3.5 mmol/L 0.01 mmol/L < 0.05 <2%
Li
+
0.1 4 mmol/L 0.01 mmol/L < 0.06 <3%
pH 6.5 - 8.5 0.01 < 0.05 <1%



2.3. Cc ha cht chnh hng s dng vi my:
S tham kho Tn sn phm M t (My phn tch in gii
bn t ng)
1100-1035 Convergys@ ISE comfort
Analyzer MO3
My phn tch in gii bn t
ng, K+, Na+, Cl-
1100-1036 Convergys@ ISE comfort
Analyzer MO3
My phn tch in gii bn t
ng, K+, Na+, Li+
1100-1037 Convergys@ ISE auto
Analyzer MO3
My phn tch in gii bn t
ng, K+, Na+, Cl-, Ca++, pH
1100-1912 Convergys@ ISE Calibrator-1
(480 ml)
Dung dch Calibrator-1 tiu chun
(Dung dch hiu chun tiu chun
1)
1100-1913 Convergys@ ISE Calibrator-2
(200 ml)
Dung dch Calibrator-2 tiu chun
(Dung dch hiu chun tiu chun
2)
1100-1911 Convergys@ ISE Cleaning
solution (20 ml)
Dung dch ra tiu chun

3. Cu trc mt my:



- Thnh phn ca my bao gm:
Thuc th (Reagents)
M-un in cc
(Electrode Module)
Bm nhu ng
(Peristaltic Pump)
Mu d
(Sample Probe)
Bung cht thi
(Waste Chamber)



3.1. Thuc th (Reagents)
- cp n dung dch Calibrator-1 tiu chun (caliration solution),
dung dch Calibrator-2 tiu chun (slope solution), dung dch ra
tiu chun (waste liquid).
- Cal and Slope solutions l hai dung dch hiu chun vi nng
khc nhau c s dng trong sut hiu chun hai im (Two Point
Calibration).
- Dung dch ra tiu chun c th xem nh mt gii php x hoc
ra dung dch; n gip lm sch v sc li ng sau mi ln phn
tch.
3.2. M-un in cc (electrode module)
- C th gi nh mt dng in di ng (Flow cell) hoc chui in
cc (electrode train)
- y l ni:
My d cht kh/cht lng (Air/fluid detector)
o nhng in cc
in cc tham chiu (Reference electrode)









3.2.1. My d cht kh/cht lng (Air/fluid detector):
- My d nm li vo v li ra ca m-un in cc
- Nhm xc minh s hin din ca cht lng hoc cht kh trong ng
mu (sample tubing)
- Khi , mt ngun sng nh chiu xuyn qua ng vo trong b tch
sng quang hc (photodetector)
- B tch sng quang hc c theo di bi cc P v ghi nhn
my d cht kh/cht lng nn my d s xc nh c khi no bt
u v kt thc.







3.2.2. in cc tham chiu (Reference electrode)
- Cung cp mt dng in th lin tc s dng nh mt tham
chiu nhm o c in th sn sinh ra t cc ion in cc (ion
electrode)
- in th c nh l 756Mv
3.3. Bm nhu ng (Peristaltic Pump)
- y cc dung dch thuc th va mu bnh phm qua ng n mu
d v m-un in cc ra ngoi bnh nc thi (waste bottle)
- Dung dch c ht vo my phn tch (analyzer) khi cc ng dn
b lc p bi cc trc ln (rollers) ca my bm v ht qua ng
thng qua vic p ca cc trc ln trn ng





3.4. Mu d (Sample probe)
- Ht dung dch vo trong my phn tch thng qua bm nhu ng
- u d (probe) chp nhn dung dch trong v tr STAT trn v t
ng v tr di (automatic position down).
- V tr STAT:
Thc hin vi u
d v tr ln
Mu d chp nhn
mu cm tay
(handheld sample)
cho mt phn tch
n




- V tr t ng:
Thc hin vi u
d v tr cui
u d t ng chp
nhn mu t ng
nghim hoc cuvette
trong mt khay hoc
bng chuyn.
y l v tr ca u
d trong sut qu
trnh vn hnh bnh
thng.
Cui cng, chun b mu cho cc thit b:

















IV. NGUYN L LM VIC:
1. S khi:










- in cc tham chiu bn ngoi v o in cc tip xc vi mu dung
dch, kh nng mu dung dch c o lin quan ti tham chiu bn
ngoi
- Cht m in p sinh ra bi in cc ion chn lc bng b khuych
i hot ng
- Tng tc vi nhiu b knh tn hiu (multiplexer) c la chn.
- B chuyn i (AID1) chuyn tn hiu thnh min k thut s
(digital domain)
- Micro-processor da trn my tnh iu khin chc nng c hc ca
my phn tch.
- My hnh LCD hin th kt qu, thng bo v cc cu hi.
- Motor driver quay a D.C motor
- D.C motor quay v thc y bm nhu ng (peristaltic pump)
- B tm bong bng (bubble detector) xc nh s hin din ca cht
kh hoc cht lng trong ng dn mu.
- B chuyn i (AID2) truyn tn hiu t b tm bong bng thnh
tn hiu k thut s hin th trn my tnh.

2. Nguyn l lm vic:
- Nguyn tc phn tch in phn (electrolytic analysis) da trn
phng php trc tip thng qua lu lng ca in cc Ion chn
lc (ISE - Ion Selective Electrode)
Nguyn l: Phng php ny o in p c pht trin gia bn
trong v bn ngoi b mt ca in cc Ion chn lc. Hu ht cc
my phn tch in gii u s dng phng ISE trong cc
php o ca hot ng Ion trong dung dch bng cch s dng mt
in cc tham chiu bn ngoi (external reference electrode) v
mt ISE gm mt in cc tham chiu bn trong (internal
reference electrode)









Mt in cc tham chiu bn ngoi v mt ISE tip xc vi mu
dung dch cha bit (unknown sample solution), v mu dung dch
c o da trn in cc tham chiu.
Khi cc Ion chuyn bit di phn tch in cc c la chn cc
lin kt rng buc vi ISE, in cc tham chiu bn trong (internal
reference electrode) d tm s khc nhau gia dung dch hiu
chun v dung dch mu v s khc nhau gia in cc tham chiu
bn ngoi (external reference electrode) & ISE. y l mt chc
nng hot ng ring bit ca cc Ion nhm khuych i v hin
th vi n v l millimoles/liter.
H thng ISE c hiu chun vi dung dch c nng cht
phn tch c bit. T , nng ca dung dch cha bit
c ly bng cch so snh vi dung dch bit nng .
Mu c th c pha long trc khi phn tch theo "phng php
gin tip" hoc phn tch khng cn pha long theo "phng php
trc tip."
Cc loi ISE khc nhau cung cp cc php o cho cht phn tch
c th.
in cc Na
+
c lm bng knh ring bit c nhy cao
vi ion Na
+

in cc K
+
bao gm polyvinyl clorua PVC tm vi
valinomycin nhn bit ion K
+

in cc Cl
-
gm mt mng cht lng cha cc amine bc
bn v c h tr PVC nhn bit ion Cl
-

Calcium ISE c s dng mt cm bin ion Ca
2+

Mt vi li thng xy ra:
Tiu chun hiu chun c ngh gim thiu
lch chun trong phn tch ISE khc nhau.
III. VN HNH:
1. Pha, ha cht v cch o mu:
2. Thao tc vn hnh my:

IV. Xc nh kt qu ca my
1. Xc nh ngun gc sai s
Cc sai s c th xy ra trong qu trnh xt nghim thng l do bnh nhn,
trong khu ly bnh phm, v qu trnh lm xt nghim.
a. Bnh nhn
- Tui v gii tnh
- Stress
- Nhit
- Thc n a vo c th
- iu tr thuc
- S bin i theo tng c th
b. Mu o mu
Ch c th c c kt qu xt nghim vi cht lng cao khi nhn c
bnh phm c ly tt nht. Cn phi lu n mt s yu t khi ly mu xt
nghim
* Cht chng ng v cht bo qun.
- Ly huyt tng lm xt nghim th cn phi c cht chng ng. Cn thn
khi chn cht ng
- Cht chng ng EDTA thng c dng ly mu xt nghim huyt hc ch
khng dng ly mu o Ca hay K
- Chn lc mt lng d tha Heparin trong mu mu ng mch c th lm sai
lch ng k kt qu o kh mu. o kh muth ch nn dng heparin lm cht
chng ng v lithium tr thnh cht chng ng chun o khia mu. EDTA
hay citirat c th lm thay i pH ng k ca mu mu
- Heparin c th gy sai s do pha long mu mu o kh nhng c th khc phc
bng cch lm ng kh Heparin trong bm tim.
* Lu gi mu
- Khong thi gian ngn trc khi mu c phn tch c th lm cht lng mu
mu
- Mu o kh mu nu khng c gi trong nc s b gim cht lng
ng k trong vng 15 pht. Lu gi nhit phng s lm gim ng k PH,
PCO2 v tng PO2
- Mu ly o Gluc khng c cht bo qun s b gim cht lng khong 7%
trong gi u sau khi ly mu. Cng di th cng lm hng mu
- Chm tch hng cu khi huyt thanh s lm cho cc thnh phn trong hng cu
thot ra huyt thanh hoc huyt tng. iu ny c bit quan trng khi o kali v
mu phi c li tm, trnh c s chm tr qu ng
* Tan mu
- Tan mu do ly mu khng tt lm tng cc thnh phn ca hng cu (kali,
Phosphat, AST, LD v ...v) trong huyt thanh v huyt tng v lm tng
Hemoglobin
- Hemoglobin c th gy nhiu trong mt vi phng php phn tch m hp
th c o bc sng gn vi hp th ti a ca Oxyhemoglobin (410, 540,
580 nm)
* Thnh phn c trong mu
- Bnh phm mu c th cha cc mc bt thng cht phn tch m bnh thng
ch c mc thp
- Th d c th tng lipt mu v lm kt qu ca Na gim i nu o bng phng
php quang k ngn la.
- Mc bilirubin cao c th lm cho mt s phng php c th c vn
- Acetoacetat trong mu bnh nhn tiu ng c toan mu do cht xetn nh
hng ng k n vic o creatinin bng phn ng Jafe
* My phn tch
- o to i ng k thut vin c tm quan trng tt c c kt qu xt
nghim cht lng cao. Hin nay nhiu mu tng i d vn hnh tuy nhin i
ng cn b k thut vin cn c hun luyn y v vn hnh v hiu bit v
my v cc phng php xt nghim.
- chng minh c l cc phng xt nghim ln lm tt cng vic hn cc
phng xt nghim nh
- Tt c cc phng php u c sai s ngu nhin. C th lm gim nhng sai s
ny bng vic la chn cn thn my v cc phng php lm xt nghim. Cn ch
n nhng chi tit nh ti liu v cc bc ca phng php, tiu chun ho
ngv vic s dng cc phng php c n gin ho s lm gim cc sai s
ngu nhin.
Nh vy sai s c th xy ra t khu ly mu lm xt nghim v ghi kt qu.
iu quan trng l nh sinh ho lm sng cn hiu r nhng sai s nm khu
no v c th nhn ra cc sai s v hiu chnh li khi c sai s.
2. Kim tra kt qu:
- Phi thc hin hiu chun my nh k mi ngy:
Hiu chun 2 im (Two point calibration):
'Hai im Cal' thng c hiu chun y chy trn mt
c s d liu hng ngy thit lp hiu chun v dc
cho mi in cc (slope for each electrode).
Hai cht chun bit sn nng c phn tch.
Mi in cc o nng cht phn tch trong c hai tiu
chun c c ng cong dc in cc (electrodes
slope curve).
Hiu chun mt im (One point calibration):
c s dng gim st v sa cha thit b ca in cc
lch (electrode drift).
in cc lch l s thay i dn dn in p in cc, v c
nh hng tiu cc n hiu sut in cc (electrode
performance).
Thng thng, KTV phi thc hin hiu chun trc khi
lm tt c cc phn tch v chy cc ch tiu hiu chun
thng qua cc thit b.
- Ngoi ra, cn kim tra kt qu da trn:
a. Xt nghim mu bnh phm phi c tin hnh song song vi cc mu
chng do nh sn xut cung cp v do n v iu phi v m bo cht
lng cung cp (nu c iu kin) kim sot cht lng xt nghim.
b. Kt qu ca cc mu chng phi nm trong gii hn cho php ca nh
sn xut a ra, khng c tr kt qu xt nghim khi kt qu ni kim
khng t.