【摘要】：研究背景芐星青霉素亦稱(chēng)長(zhǎng)效青霉素,屬二芐基乙二胺鹽與混懸劑、緩沖劑混合制成的白色結(jié)晶狀粉末;芐星青霉素具良好的抑制細(xì)菌細(xì)胞壁合成作用,進(jìn)而達(dá)到殺菌功效。芐星青霉素在注射部位形成貯存庫(kù),然后緩慢釋放并水解為青霉素,故作用與青霉素相同。芐星青霉素的藥效作用時(shí)間更久,但由于產(chǎn)生的青霉素濃度較低,因此只適用于對(duì)青霉素高度敏感的微生物感染,梅毒螺旋體對(duì)青霉素敏感,所以治療梅毒芐星青霉素作為首選藥物。由于芐星青霉素極難溶于水,且易造成針頭堵塞,不利于在靜脈滴注中應(yīng)用,故肌內(nèi)注射被視為臨床治療過(guò)程中的首選用藥方法。但是芐星青霉素顆粒大,溶于水后形成白色稠厚、乳狀液體,臨床進(jìn)行注射操作過(guò)程中經(jīng)常出現(xiàn)針頭堵塞情況。為防止針頭堵塞,避免重復(fù)注射,護(hù)理人員經(jīng)常采取8號(hào)或9號(hào)粗針頭、大劑量溶媒(5 ml)以及操作時(shí)快速推注方法進(jìn)行注射,此種操作成功率雖高但給患者帶來(lái)極大疼痛感以及恐懼感,且由于芐星青霉素吸收緩慢,會(huì)增加注射部位疼痛持續(xù)時(shí)間以及硬結(jié)形成。在用芐星青霉素注射療程中,有患者因難以忍受疼痛而選擇終止治療;部分患者反映注射后疼痛比注射中疼痛程度更甚,于是對(duì)注射質(zhì)量產(chǎn)生不滿,導(dǎo)致護(hù)理滿意度下降。護(hù)理人員對(duì)此深感壓力,唯恐注射失敗及疼痛導(dǎo)致患者不滿而產(chǎn)生糾紛。因此,降低針頭堵塞率、減輕疼痛、減少硬結(jié)形成是護(hù)理人員在注射芐星青霉素過(guò)程中亟待解決問(wèn)題。目的通過(guò)對(duì)芐星青霉素肌內(nèi)注射方法改良的研究,探討芐星青霉素的臨床注射質(zhì)量,以期為減輕患者局部注射過(guò)程中疼痛和注射后疼痛,縮短疼痛持續(xù)時(shí)間,降低注射后硬結(jié)發(fā)生率等提供更多的借鑒。方法選擇2015年2月~2016年3月期間就診于阜陽(yáng)市人民醫(yī)院,178例需注射芐星青霉素240萬(wàn)U患者為研究資料。采用自身對(duì)照法,芐星青霉素分兩側(cè)肌內(nèi)注射,每側(cè)注射120萬(wàn)U。常規(guī)組:300例次患者左側(cè)注射,均于髂前上棘與尾骨連線外上1/3處予以常規(guī)注射法;改良組:300例次患者右側(cè)注射,均于臀中肌無(wú)痛區(qū)域處予以改良肌內(nèi)注射法。觀察記錄兩側(cè)一次性注射成功率和注射過(guò)程中、注射后疼痛程度、疼痛持續(xù)時(shí)間以及注射后硬結(jié)發(fā)生情況。結(jié)果改良組一次性注射成功297例次,成功率為99.0%(297/300),失敗3例次,失敗率1.0%(3/300);常規(guī)組一次性注射成功257例次,成功率85.7%(257/300),失敗43例次,失敗率14.3%(43/300);組間差異具有統(tǒng)計(jì)學(xué)意義(?~2=30.423,P0.001);改良組注射中疼痛程度、注射后30 min疼痛程度均明顯低于常規(guī)組,組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05);改良組疼痛持續(xù)時(shí)間明顯小于常規(guī)組,組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05);改良組硬結(jié)發(fā)生9例次,發(fā)生率為3.0%(9/300),常規(guī)組硬結(jié)發(fā)生29例次,發(fā)生率為9.7%(29/300),組間差異具有統(tǒng)計(jì)學(xué)意義(?~2=9.900,P=0.002)。結(jié)論采用多途徑聯(lián)合控制芐星青霉素注射過(guò)程中影響因素,可全面提升一次注射成功率,且有效減輕患者注射中和注射后疼痛程度、疼痛持續(xù)時(shí)間,最大程度地降低了注射后硬結(jié)發(fā)生率;該改良方法可極大地提高臨床芐星青霉素的注射質(zhì)量。
[Abstract]:Benzyl penicillin, also known as long acting penicillin, is a white crystalline powder made of two benzyl diamine salts and suspending agents and buffers; benzyl penicillin has a good inhibitory effect on bacterial cell wall synthesis to achieve germicidal efficacy. Benzylpenicillin forms a storage tank at the injection site and then slowly releases and hydrolyze to green. Mycin, so the effect is the same as penicillin. Benzylpenicillin has a longer drug effect. But because of the low concentration of penicillin, it is only suitable for highly sensitive microorganism infection to penicillin. The Treponema pallidum is sensitive to penicillin, so it is the first choice for the treatment of benzyl penicillin. Water, which is easy to cause needle blockage, is not conducive to the application of intravenous drip, so intramuscular injection is considered as the first choice for clinical treatment. But benzylstar penicillin granules are large and are dissolved in water and form a thick white and emulsion liquid. The needle blockage often occurs during the injection operation. Repeated injections, nurses often take 8 or 9 thick needles, large doses of solvent (5 ml) and a rapid injection method for injection. This operation has a high success rate but brings great pain and fear to the patients, and the slow absorption of benzyl penicillin will increase the duration of pain and the formation of hard knot. During the course of injection of benzyl penicillin, the patient chose to terminate the treatment for unbearable pain. Some patients showed that the pain after the injection was more painful than that in the injection, so the quality of the injection was dissatisfied and the nursing satisfaction decreased. The nurses were deeply stressed, lest the injection failure and pain caused dissatisfaction to the patient. Therefore, to reduce the needle blockage rate, reduce the pain and reduce the hard knot formation is the problem that the nurses need to solve in the process of injection of benzyl penicillin. Objective to study the clinical injection quality of benzylin penicillin by improving the intramuscular injection of benzyl penicillin to reduce pain and injection during local injection. Post pain, shorten the duration of pain and reduce the incidence of induration after injection. Methods in February 2015 ~2016 March period in Fuyang People's Hospital, 178 cases of benzylpenicillin 2 million 400 thousand U patients needed to be injected into the study data. By self control, benzyl penicillin was injected into two sides of the penicillin, and each side was injected 1 million 200 thousand U. Routine group: 300 cases were injected with the left side of the left side of the anterior superior iliac spine and the tail bone on the upper 1/3. The improved group: 300 cases were injected on the right side with improved intramuscular injection at the pain free region of the middle gluteal muscle. The success rate and the injection process of both sides of the gluteus medius were observed and the pain degree and pain continued during the injection. Results 297 cases of one time injection were successful, the success rate was 99% (297/300), 3 cases failed and the failure rate was 1% (3/300); the routine group was successfully injected with 257 times, the success rate was 85.7% (257/300), the failure 43 times and the failure rate 14.3% (43/300); the difference between the groups was statistically significant (~2=30.423, P0.0 01) 01) the pain degree in the improved group was significantly lower than that of the conventional group (30 min), and the difference between the groups was statistically significant (P0.05); the duration of pain in the improved group was significantly smaller than that of the conventional group (P0.05); 9 cases in the modified group, 3% (9/300), and 29 cases in the conventional group. The occurrence rate was 9.7% (29/300). The difference between the groups was statistically significant (~2=9.900, P=0.002). Conclusion the combined control of the factors affecting the injection of benzyl penicillin can improve the success rate of the first injection in an all-round way, and effectively reduce the pain degree, duration of pain and the maximum reduction of injection. The improved method can greatly improve the quality of Benzylpenicillin Injection.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R472

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