静脉留置针持续输注盐酸胺碘酮注射液致静脉炎的实验研究
发布时间：2018-08-22 16:26
【摘要】：目的:经静脉留置针持续输注盐酸胺碘酮注射液,观察兔耳缘静脉静脉炎发生情况、早期静脉炎组织形态学改变及C-反应蛋白的变化趋势,探讨胺碘酮注射液的持续输注时间与发生静脉炎的相关性,为临床应用留置针持续输注pH5的同类药物提供理论参考。方法:通过对临床护理工作的调查,选择临床工作中静脉炎发生率高的几种常用药物,经药性分析及pH值测定,最终确定以临床常用于治疗心律失常的急救用药盐酸胺碘酮注射液作为研究用药,其pH值为2.5-4.0,且种种原因中心静脉置管不可实施,临床实际工作中多用静脉留置针持续输注给药。选取健康日本大耳白兔60只适应性喂养一周后,遵循完全随机分配原则分为实验组(胺碘酮组)和对照组(生理盐水组),每组各30只,再运用完全随机分配方法将实验组和对照组各随机分为5小组,即1h组、2h组、3h组、4h组、5h组,每小组各6只。本研究分为两个阶段。第一阶段:以右耳外耳缘静脉为抽血检测兔C-反应蛋白浓度值的实验血管,静脉留置针穿刺置管后根据所属组别持续输注给药(实验组参考盐酸胺碘酮注射液指南推荐给药方案,在保证相同给药浓度的前提下,通过人和动物间等效剂量比值换算确定给药剂量,即:前10min给药8mg/kg配于5.33ml/kg的5%葡萄糖溶液中,药液浓度为1.5mg/ml;随后6h给药20mg/kg配于11.11ml/kg的5%葡萄糖溶液中,药液浓度为1.8mg/ml。对照组持续输注生理盐水,滴速为40滴/min),输注完毕48h后,于右耳外耳缘静脉抽取2~3ml血液,室温下自然凝固30min后放入离心机中离心,收集上清,用ELISA法对血清中的兔C-反应蛋白浓度值进行检测。抽取静脉血后,在右耳外耳缘静脉相应位置涂抹喜疗妥软膏,并用50%硫酸镁纱布湿敷,每天30min,连敷5天,之后再继续适应性喂养30天。第二阶段:30天后,以左耳外耳缘静脉为持续输注给药后静脉炎病理切片的实验血管,静脉留置针穿刺置管后根据所属组别持续输注给药(给药剂量同上),输注完毕后肌肉注射盐酸赛拉嗪注射液(0.1~0.2ml/kg)麻醉状态下留取活体标本,即以穿刺血管为中线左右两侧各宽0.5cm,共1cm,以穿刺点为标记点,远心端取0.5cm,近心端取3.0cm,共长约3.5cm的矩型活体标本,固定24h,常规脱水,石蜡包埋,每个标本分别切片3张,分别为穿刺点近心端0.5cm处、留置针尖端处和留置针尖端近心端0.5cm处,he染色后交由专业病理科医师进行光镜观察。结果:1两组crp浓度值均随着持续输注时间的增加而呈现出上升的趋势,在4h时crp浓度值相比较差异开始有统计学意义(p0.05)。2两组持续输注相同时间,胺碘酮组的炎症反应重于生理盐水组,在4h时差异开始有统计学意义(χ2=8.326,p0.05),血栓形成情况虽有不同,但并无统计学差异(p0.05)。3同一组3个不同切片位置中,两组标本均以留置针尖端处的炎症反应最为严重,且胺碘酮组在留置针尖端处与留置针尖端近心端0.5cm处的炎症反应相比较差异有统计学意义(χ2=9.179,p0.05),血栓形成情况方面,胺碘酮组以留置针尖端处的血栓形成率最高,但差异无统计学意义(p0.05),生理盐水组无血栓形成。4同组持续输注不同时间,静脉炎症反应和血栓形成情况不同,随着输注时间的延长,静脉炎症反应均逐渐加重,血栓形成的血管数逐渐增多。胺碘酮组差异有统计学意义(炎症反应p0.05;血栓形成p0.05);生理盐水组炎症反应程度差异有统计学意义(p0.01),无血栓形成。结论:1静脉炎的发生与输入药物的化学性质有关,输注ph5药物是发生静脉炎的重要因素。2静脉炎的发生与留置针对血管的机械性刺激有关,留置针尖端处的炎症反应和血栓形成率高,血管炎性损伤程度最严重。3静脉炎的发生与持续输注时间有关,持续输注时间越长,血管炎性损伤程度越严重。4在外周静脉经留置针持续输盐酸注胺碘酮注射液时,同一静脉持续输注给药的时间一般以2h为宜,最多不宜超过3h,若持续给药时间超过3h,则应建立2条以上静脉通路交替使用,为静脉的自我修复提供充足时间,从根本上做到对静脉炎的预防。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472
本文编号：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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472
【参考文献】
相关期刊论文 前10条
1 范雪茹;周蓉;;静脉输液工具选择所存问题及其对策的研究分析[J];中国医学创新;2016年27期
2 兰大华;张曦;孙爱华;曾东风;贾春燕;彭欣;;静脉留置针肝素钠封管与生理盐水封管效果比较的Meta分析[J];重庆医学;2016年03期
3 裔雅萍;刘烨;谢欢;孙志琴;;集束化护理在应急外周静脉使用胺碘酮输液治疗中的应用[J];江苏医药;2016年02期
4 侯田芬;;运用品管圈降低外周静脉留置针留置期间静脉炎的发生率[J];全科护理;2016年01期
5 郑钰;;可达龙致静脉炎的主要影响因素及预防对策[J];中国医药指南;2016年01期
6 周莲;王黎;李利华;李秋香;董姝媛;温姗霖;;美皮康联合美清佳预防盐酸胺碘酮注射液致静脉炎效果观察[J];第三军医大学学报;2016年02期
7 常芸;宋萍;黄天熠;;多磺酸黏多糖乳膏外用联合冰片湿敷防治胺碘酮相关静脉炎效果观察[J];护理研究;2015年29期
8 蒙凯凤;陈伟梅;谭治双;陈少英;;施肤宁联合硫酸镁外敷预防胺碘酮致静脉炎疗效观察[J];护士进修杂志;2015年19期
9 郭金玉;杨洁;周颖;王秋;;留置针在静脉输液治疗中的应用进展[J];中华护理杂志;2015年10期
10 方雪娥;傅咏华;胡佩华;邹志易;汤燕颖;王燕;顾雪华;严怡;李秀财;;胺碘酮致静脉炎防治的循证护理[J];护理学杂志;2015年15期
相关会议论文 前1条
1 杨小芳;;胺碘酮所致静脉炎的观察及护理干预[A];中华护理学会全国静脉治疗护理学术交流暨专题讲座会议论文汇编[C];2010年
相关硕士学位论文 前2条
1 章飞飞;化疗性静脉炎动物模型的建立及给药方式对化疗性静脉炎影响的研究[D];广西医科大学;2010年
2 路颜羽;静脉留置针对血管损伤的实验研究[D];河南大学;2010年
，本文编号：2197670
本文链接：https://www.wllwen.com/yixuelunwen/mazuiyixuelunwen/2197670.html
最近更新
教材专著
