苄星青霉素肌内注射方法的改进及效果评价

发布时间：2018-07-14 11:22

【摘要】：研究背景苄星青霉素亦称长效青霉素,属二苄基乙二胺盐与混悬剂、缓冲剂混合制成的白色结晶状粉末;苄星青霉素具良好的抑制细菌细胞壁合成作用,进而达到杀菌功效。苄星青霉素在注射部位形成贮存库,然后缓慢释放并水解为青霉素,故作用与青霉素相同。苄星青霉素的药效作用时间更久,但由于产生的青霉素浓度较低,因此只适用于对青霉素高度敏感的微生物感染,梅毒螺旋体对青霉素敏感,所以治疗梅毒苄星青霉素作为首选药物。由于苄星青霉素极难溶于水,且易造成针头堵塞,不利于在静脉滴注中应用,故肌内注射被视为临床治疗过程中的首选用药方法。但是苄星青霉素颗粒大,溶于水后形成白色稠厚、乳状液体,临床进行注射操作过程中经常出现针头堵塞情况。为防止针头堵塞,避免重复注射,护理人员经常采取8号或9号粗针头、大剂量溶媒(5 ml)以及操作时快速推注方法进行注射,此种操作成功率虽高但给患者带来极大疼痛感以及恐惧感,且由于苄星青霉素吸收缓慢,会增加注射部位疼痛持续时间以及硬结形成。在用苄星青霉素注射疗程中,有患者因难以忍受疼痛而选择终止治疗;部分患者反映注射后疼痛比注射中疼痛程度更甚,于是对注射质量产生不满,导致护理满意度下降。护理人员对此深感压力,唯恐注射失败及疼痛导致患者不满而产生纠纷。因此,降低针头堵塞率、减轻疼痛、减少硬结形成是护理人员在注射苄星青霉素过程中亟待解决问题。目的通过对苄星青霉素肌内注射方法改良的研究,探讨苄星青霉素的临床注射质量,以期为减轻患者局部注射过程中疼痛和注射后疼痛,缩短疼痛持续时间,降低注射后硬结发生率等提供更多的借鉴。方法选择2015年2月~2016年3月期间就诊于阜阳市人民医院,178例需注射苄星青霉素240万U患者为研究资料。采用自身对照法,苄星青霉素分两侧肌内注射,每侧注射120万U。常规组:300例次患者左侧注射,均于髂前上棘与尾骨连线外上1/3处予以常规注射法;改良组:300例次患者右侧注射,均于臀中肌无痛区域处予以改良肌内注射法。观察记录两侧一次性注射成功率和注射过程中、注射后疼痛程度、疼痛持续时间以及注射后硬结发生情况。结果改良组一次性注射成功297例次,成功率为99.0%(297/300),失败3例次,失败率1.0%(3/300);常规组一次性注射成功257例次,成功率85.7%(257/300),失败43例次,失败率14.3%(43/300);组间差异具有统计学意义(?~2=30.423,P0.001);改良组注射中疼痛程度、注射后30 min疼痛程度均明显低于常规组,组间差异具有统计学意义(P0.05);改良组疼痛持续时间明显小于常规组,组间差异具有统计学意义(P0.05);改良组硬结发生9例次,发生率为3.0%(9/300),常规组硬结发生29例次,发生率为9.7%(29/300),组间差异具有统计学意义(?~2=9.900,P=0.002)。结论采用多途径联合控制苄星青霉素注射过程中影响因素,可全面提升一次注射成功率,且有效减轻患者注射中和注射后疼痛程度、疼痛持续时间,最大程度地降低了注射后硬结发生率;该改良方法可极大地提高临床苄星青霉素的注射质量。
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

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