靜脈留置針持續(xù)輸注鹽酸胺碘酮注射液致靜脈炎的實驗研究
發(fā)布時間：2018-08-22 16:26
【摘要】：目的:經(jīng)靜脈留置針持續(xù)輸注鹽酸胺碘酮注射液,觀察兔耳緣靜脈靜脈炎發(fā)生情況、早期靜脈炎組織形態(tài)學改變及C-反應蛋白的變化趨勢,探討胺碘酮注射液的持續(xù)輸注時間與發(fā)生靜脈炎的相關(guān)性,為臨床應用留置針持續(xù)輸注pH5的同類藥物提供理論參考。方法:通過對臨床護理工作的調(diào)查,選擇臨床工作中靜脈炎發(fā)生率高的幾種常用藥物,經(jīng)藥性分析及pH值測定,最終確定以臨床常用于治療心律失常的急救用藥鹽酸胺碘酮注射液作為研究用藥,其pH值為2.5-4.0,且種種原因中心靜脈置管不可實施,臨床實際工作中多用靜脈留置針持續(xù)輸注給藥。選取健康日本大耳白兔60只適應性喂養(yǎng)一周后,遵循完全隨機分配原則分為實驗組(胺碘酮組)和對照組(生理鹽水組),每組各30只,再運用完全隨機分配方法將實驗組和對照組各隨機分為5小組,即1h組、2h組、3h組、4h組、5h組,每小組各6只。本研究分為兩個階段。第一階段:以右耳外耳緣靜脈為抽血檢測兔C-反應蛋白濃度值的實驗血管,靜脈留置針穿刺置管后根據(jù)所屬組別持續(xù)輸注給藥(實驗組參考鹽酸胺碘酮注射液指南推薦給藥方案,在保證相同給藥濃度的前提下,通過人和動物間等效劑量比值換算確定給藥劑量,即:前10min給藥8mg/kg配于5.33ml/kg的5%葡萄糖溶液中,藥液濃度為1.5mg/ml;隨后6h給藥20mg/kg配于11.11ml/kg的5%葡萄糖溶液中,藥液濃度為1.8mg/ml。對照組持續(xù)輸注生理鹽水,滴速為40滴/min),輸注完畢48h后,于右耳外耳緣靜脈抽取2~3ml血液,室溫下自然凝固30min后放入離心機中離心,收集上清,用ELISA法對血清中的兔C-反應蛋白濃度值進行檢測。抽取靜脈血后,在右耳外耳緣靜脈相應位置涂抹喜療妥軟膏,并用50%硫酸鎂紗布濕敷,每天30min,連敷5天,之后再繼續(xù)適應性喂養(yǎng)30天。第二階段:30天后,以左耳外耳緣靜脈為持續(xù)輸注給藥后靜脈炎病理切片的實驗血管,靜脈留置針穿刺置管后根據(jù)所屬組別持續(xù)輸注給藥(給藥劑量同上),輸注完畢后肌肉注射鹽酸賽拉嗪注射液(0.1~0.2ml/kg)麻醉狀態(tài)下留取活體標本,即以穿刺血管為中線左右兩側(cè)各寬0.5cm,共1cm,以穿刺點為標記點,遠心端取0.5cm,近心端取3.0cm,共長約3.5cm的矩型活體標本,固定24h,常規(guī)脫水,石蠟包埋,每個標本分別切片3張,分別為穿刺點近心端0.5cm處、留置針尖端處和留置針尖端近心端0.5cm處,he染色后交由專業(yè)病理科醫(yī)師進行光鏡觀察。結(jié)果:1兩組crp濃度值均隨著持續(xù)輸注時間的增加而呈現(xiàn)出上升的趨勢,在4h時crp濃度值相比較差異開始有統(tǒng)計學意義(p0.05)。2兩組持續(xù)輸注相同時間,胺碘酮組的炎癥反應重于生理鹽水組,在4h時差異開始有統(tǒng)計學意義(χ2=8.326,p0.05),血栓形成情況雖有不同,但并無統(tǒng)計學差異(p0.05)。3同一組3個不同切片位置中,兩組標本均以留置針尖端處的炎癥反應最為嚴重,且胺碘酮組在留置針尖端處與留置針尖端近心端0.5cm處的炎癥反應相比較差異有統(tǒng)計學意義(χ2=9.179,p0.05),血栓形成情況方面,胺碘酮組以留置針尖端處的血栓形成率最高,但差異無統(tǒng)計學意義(p0.05),生理鹽水組無血栓形成。4同組持續(xù)輸注不同時間,靜脈炎癥反應和血栓形成情況不同,隨著輸注時間的延長,靜脈炎癥反應均逐漸加重,血栓形成的血管數(shù)逐漸增多。胺碘酮組差異有統(tǒng)計學意義(炎癥反應p0.05;血栓形成p0.05);生理鹽水組炎癥反應程度差異有統(tǒng)計學意義(p0.01),無血栓形成。結(jié)論:1靜脈炎的發(fā)生與輸入藥物的化學性質(zhì)有關(guān),輸注ph5藥物是發(fā)生靜脈炎的重要因素。2靜脈炎的發(fā)生與留置針對血管的機械性刺激有關(guān),留置針尖端處的炎癥反應和血栓形成率高,血管炎性損傷程度最嚴重。3靜脈炎的發(fā)生與持續(xù)輸注時間有關(guān),持續(xù)輸注時間越長,血管炎性損傷程度越嚴重。4在外周靜脈經(jīng)留置針持續(xù)輸鹽酸注胺碘酮注射液時,同一靜脈持續(xù)輸注給藥的時間一般以2h為宜,最多不宜超過3h,若持續(xù)給藥時間超過3h,則應建立2條以上靜脈通路交替使用,為靜脈的自我修復提供充足時間,從根本上做到對靜脈炎的預防。
[Abstract]:Objective: To observe the occurrence of ear venous phlebitis, the histomorphological changes of early phlebitis and the change trend of C-reactive protein (CRP) by continuous infusion of amiodarone hydrochloride through intravenous indwelling needle, and to explore the correlation between continuous infusion time of amiodarone hydrochloride injection and phlebitis. Methods: Through the investigation of clinical nursing work, several commonly used drugs with high incidence of phlebitis in clinical work were selected, and the drug property analysis and pH value determination were carried out. Finally, amiodarone hydrochloride injection, which is commonly used in clinical emergency treatment of arrhythmia, was selected as the research drug. The pH value of amiodarone hydrochloride injection was 2.5-4.0, and all kinds of drugs were determined. Sixty healthy Japanese white rabbits were randomly divided into experimental group (amiodarone group) and control group (normal saline group) after a week of adaptive feeding. Each group had 30 rabbits in each group, and then were randomly divided into two groups. The experimental group and the control group were randomly divided into 5 groups: 1 hour group, 2 hours group, 3 hours group, 4 hours group and 5 hours group, each group had 6 rabbits. The recommended dosage regimen for amiodarone hydrochloride injection is to determine the dosage by converting the equivalent dose ratio between humans and animals on the premise of ensuring the same dosage concentration, i.e. 8 mg/kg in 5% glucose solution of 5.33 ml/kg in the first 10 minutes, 1.5 mg/ml in the solution, and 20 mg/kg in 5% glucose solution of 11.11 ml/kg in the next 6 hours. In the control group, normal saline was continuously infused at a dripping rate of 40 drops per minute. After 48 hours of infusion, 2-3 ml of blood was extracted from the vein of the outer ear margin of the right ear. After 30 minutes of natural coagulation at room temperature, the supernatant was centrifuged into a centrifuge. The concentration of C-reactive protein in the serum was detected by ELISA. Hirudoid ointment was applied to the right external ear vein, and 50% magnesium sulfate gauze was applied to the right ear vein. The ointment was applied 30 minutes a day for 5 consecutive days, and then fed for 30 days. After intramuscular injection of Celazine Hydrochloride (0.1-0.2 ml/kg) anesthesia, the living specimens were taken. The puncture vessels were 0.5 cm in width on the left and right sides of the median line. The puncture point was used as the marking point, the distal end was 0.5 cm, the proximal end was 3.0 cm, and the length was about 3.5 cm. 24 hours later, the samples were routinely dehydrated and embedded in paraffin. Each specimen was sliced into 3 pieces, 0.5 cm near the puncture point, 0.5 cm near the tip of the indwelling needle and 0.5 cm near the tip of the indwelling needle. He staining was handed over to a professional pathologist for light microscopic observation. CRP concentration at 4 hours compared with the beginning of a statistically significant difference (p0.05). 2 the two groups continued to infuse the same time, amiodarone group inflammation was more severe than saline group, at 4 hours the difference began to have statistical significance (_2 = 8.326, p0.05), thrombosis, although different, but no statistical difference (p0.05). 3 the same group of three different slices of the location Among the two groups, the inflammation at the tip of indwelling needle was the most serious, and the inflammation at the tip of indwelling needle and 0.5 cm near the tip of indwelling needle in amiodarone group was significantly different (2 = 9.179, p0.05). The thrombosis rate at the tip of indwelling needle in amiodarone group was the highest, but the difference was significant. There was no significant difference (p0.05). There was no thrombosis in normal saline group. 4 There were different inflammation and thrombosis in the same group at different time of continuous infusion. Conclusion: 1. The occurrence of phlebitis is related to the chemical nature of the drug, and the infusion of pH5 is an important factor in phlebitis. 2. The occurrence of phlebitis is related to the mechanical stimulation of the indwelling needle tip, and the inflammation of the indwelling needle tip is reversed. The occurrence of phlebitis is related to the duration of continuous infusion. The longer the duration of continuous infusion, the more serious the degree of vasculitis injury. 4 In the continuous infusion of amiodarone hydrochloride by indwelling needle into peripheral vein, the duration of continuous infusion of amiodarone hydrochloride injection in the same vein is generally 2 hours, at most not. If the duration of administration is longer than 3 hours, more than 2 venous pathways should be established alternately to provide sufficient time for venous self-repair and fundamentally prevent phlebitis.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R472
本文編號：2197670
[Abstract]:Objective: To observe the occurrence of ear venous phlebitis, the histomorphological changes of early phlebitis and the change trend of C-reactive protein (CRP) by continuous infusion of amiodarone hydrochloride through intravenous indwelling needle, and to explore the correlation between continuous infusion time of amiodarone hydrochloride injection and phlebitis. Methods: Through the investigation of clinical nursing work, several commonly used drugs with high incidence of phlebitis in clinical work were selected, and the drug property analysis and pH value determination were carried out. Finally, amiodarone hydrochloride injection, which is commonly used in clinical emergency treatment of arrhythmia, was selected as the research drug. The pH value of amiodarone hydrochloride injection was 2.5-4.0, and all kinds of drugs were determined. Sixty healthy Japanese white rabbits were randomly divided into experimental group (amiodarone group) and control group (normal saline group) after a week of adaptive feeding. Each group had 30 rabbits in each group, and then were randomly divided into two groups. The experimental group and the control group were randomly divided into 5 groups: 1 hour group, 2 hours group, 3 hours group, 4 hours group and 5 hours group, each group had 6 rabbits. The recommended dosage regimen for amiodarone hydrochloride injection is to determine the dosage by converting the equivalent dose ratio between humans and animals on the premise of ensuring the same dosage concentration, i.e. 8 mg/kg in 5% glucose solution of 5.33 ml/kg in the first 10 minutes, 1.5 mg/ml in the solution, and 20 mg/kg in 5% glucose solution of 11.11 ml/kg in the next 6 hours. In the control group, normal saline was continuously infused at a dripping rate of 40 drops per minute. After 48 hours of infusion, 2-3 ml of blood was extracted from the vein of the outer ear margin of the right ear. After 30 minutes of natural coagulation at room temperature, the supernatant was centrifuged into a centrifuge. The concentration of C-reactive protein in the serum was detected by ELISA. Hirudoid ointment was applied to the right external ear vein, and 50% magnesium sulfate gauze was applied to the right ear vein. The ointment was applied 30 minutes a day for 5 consecutive days, and then fed for 30 days. After intramuscular injection of Celazine Hydrochloride (0.1-0.2 ml/kg) anesthesia, the living specimens were taken. The puncture vessels were 0.5 cm in width on the left and right sides of the median line. The puncture point was used as the marking point, the distal end was 0.5 cm, the proximal end was 3.0 cm, and the length was about 3.5 cm. 24 hours later, the samples were routinely dehydrated and embedded in paraffin. Each specimen was sliced into 3 pieces, 0.5 cm near the puncture point, 0.5 cm near the tip of the indwelling needle and 0.5 cm near the tip of the indwelling needle. He staining was handed over to a professional pathologist for light microscopic observation. CRP concentration at 4 hours compared with the beginning of a statistically significant difference (p0.05). 2 the two groups continued to infuse the same time, amiodarone group inflammation was more severe than saline group, at 4 hours the difference began to have statistical significance (_2 = 8.326, p0.05), thrombosis, although different, but no statistical difference (p0.05). 3 the same group of three different slices of the location Among the two groups, the inflammation at the tip of indwelling needle was the most serious, and the inflammation at the tip of indwelling needle and 0.5 cm near the tip of indwelling needle in amiodarone group was significantly different (2 = 9.179, p0.05). The thrombosis rate at the tip of indwelling needle in amiodarone group was the highest, but the difference was significant. There was no significant difference (p0.05). There was no thrombosis in normal saline group. 4 There were different inflammation and thrombosis in the same group at different time of continuous infusion. Conclusion: 1. The occurrence of phlebitis is related to the chemical nature of the drug, and the infusion of pH5 is an important factor in phlebitis. 2. The occurrence of phlebitis is related to the mechanical stimulation of the indwelling needle tip, and the inflammation of the indwelling needle tip is reversed. The occurrence of phlebitis is related to the duration of continuous infusion. The longer the duration of continuous infusion, the more serious the degree of vasculitis injury. 4 In the continuous infusion of amiodarone hydrochloride by indwelling needle into peripheral vein, the duration of continuous infusion of amiodarone hydrochloride injection in the same vein is generally 2 hours, at most not. If the duration of administration is longer than 3 hours, more than 2 venous pathways should be established alternately to provide sufficient time for venous self-repair and fundamentally prevent phlebitis.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R472
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