指数加权移动平均法质控图在宫内人工授精精液优化处理质量控制中的应用效果

Application analysis of EWMA quality control chart in quality control of IUI semen optimization process

目的分析采用宫内人工授精(IUI)治疗的患者优化后的精液指标,并绘制指数加权移动平均法(EWMA)质控图,以期改进IUI精液优化处理工作。方法选取2018年1月至2020年12月邢台市第三医院生殖医学中心收治的实施IUI的患者的临床资料进行回顾性分析,共210对患者399个治疗周期。观察指标为优化后精子密度、优化后精子活率、优化后前向运动精子率、回收率和优化后前向运动精子总数。采用R语言绘制EWMA质控图,查找优化后精液指标失控数据,计算并比较下限失控率,再对失控数据进行原因分析和改进。结果优化后精液指标中超过控制下限的指标有:优化后精子活率9例,其中8例为精子活率低于50%;优化后前向运动精子率20例,其中16例为前向运动精子率低于40%;回收率10例,其中操作者1占7例,操作者2占3例,共计下限失控标本39例。妊娠组和非妊娠组优化后精液指标下限失控率分别为1.56%和11.64%,差异具有统计学意义(P<0.05)。结论EWMA质控图用于精液优化处理过程质量评价,既能回顾性分析以往失控数据,有助于分析失控原因和质量改进;又能对实际工作中精液处理质量进行连续监控。EWMA质控图可作为IUI精液优化处理质量控制的简单而有效的工具。

Objective To analyze the semen parameters of patients undergoing intra-uterine insemination(IUI),and use the exponentially weighted moving average(EWMA)quality control chart to improve semen optimization.Methods Clinical data of patients undergoing intrauterine insemination admitted to Reproductive Medicine Center of the Third Hospital of Xingtai City from January 2018 to December 2020 were retrospectively analyzed,including 210 pairs of patients with 399 treatment cycles.The observation indexes were optimized sperm density,optimized sperm motility rate,optimized forward motility sperm ratio,recovery rate and optimized forward motility sperm total number.EWMA quality control chart was drawn with R language,and optimized semen parameter out-of-control data was searched,the lower limit out-of-control rate was calculated and compared,and then analyze and improve the out-of-control data.Results Among the optimized semen indexes,9 cases exceeded the lower limit of control,of which 8 cases were patients whose sperm viability was less than 50%.After optimization,the proportion of forward motile sperm was 20 cases,of which 16 cases were patients,and the proportion of forward motile sperm was less than 40%.The recovery rate was 10 cases,including 7 cases of operator 1 and 3 cases of operator 2,with a total of 39 samples.The lower limit out of control rates of semen indexes in pregnancy group and non pregnancy group were 1.56%and 11.64%respectively(P<0.05).Conclusions EWMA quality control chart is used to evaluate the quality of semen optimization process,which can not only retrospectively analyze the previous out-of-control data,but also help to analyze the causes of out-of-control and improve the quality.It can also continuously monitor the quality of semen optimization in real time.EWMA quality control chart can be used as a simple and effective tool for quality control of IUI semen optimization process.