氟尿嘧啶配置后输液在输液泵中的稳定性考察

摘 要 目的：考察氟尿嘧啶（5 FU）配置后输液在输液泵中的稳定性。 方法: 模拟临床实际情况,将由奥沙利铂或伊立替康/亚叶酸/5 FU组成的化疗方案（mFOLFOX6或FOLFIRI）中常用量的氟尿嘧啶注射液以氯化钠注射液或葡萄糖注射液稀释至230 ml的溶液置于一次性配套储药袋中,观察溶液在不同温度下（4 ℃冰箱内、25 ℃室内不避光和37 ℃室内不避光）72 h内是否出现外观变化,同时测定溶液的不溶性微粒、pH和含量变化。 结果: 储药袋中的5 FU溶液在不同温度下72 h内的外观和pH均无明显改变,不溶性微粒符合输液标准,5 FU相对初始含量均大于95.0%。结论: 在临床常见情况下,5 FU配置后输液在输液泵中稳定性良好,可满足输液泵持续泵入46 h的临床要求。     

输液泵应用过程中的药学服务指导

目的:促进输液泵在临床治疗过程中的合理应用。方法:通过临床药师查房,应用药动学、药效学以及临床药理学知识对输液泵应用进行指导。结果与结论:临床药师通过对输液泵应用进行药学服务指导,可以提高输液泵输液的安全性和有效性,减少不良反应的发生。     

靶控输注与微泵输注丙泊酚用于小肠镜检查的比较研究

目的观察靶控输注与微泵输注丙泊酚用于双气囊小肠镜检查的效果和安全性。方法 40例ASAⅠ^Ⅱ级拟行双气囊小肠镜检查的患者,年龄22Ⅱ级拟行双气囊小肠镜检查的患者,年龄22⁶0岁,体质量4560岁,体质量45⁷0 kg,随机分为靶控组(TCI泵)和微泵组(恒速微泵),每组20例。分别采用靶控输注和微泵输注两种方式输注丙泊酚。靶控组以血浆药物浓度为靶目标进行靶控输注丙泊酚,靶浓度为2.570 kg,随机分为靶控组(TCI泵)和微泵组(恒速微泵),每组20例。分别采用靶控输注和微泵输注两种方式输注丙泊酚。靶控组以血浆药物浓度为靶目标进行靶控输注丙泊酚,靶浓度为2.5⁴μg/mL。微泵组以丙泊酚44μg/mL。微泵组以丙泊酚4⁸ mg/(kg?h)恒速输注。两组术中均视体动、呛咳反应调整输出血浆靶浓度。记录患者给药前(T0)、给药后1 min(T1)、给药后5 min(T2)术中1 h(T3)和苏醒时(T4)的HR、MAP、RR、SpO2的变化;观察诱导时间、苏醒时间、镜检时间、丙泊酚总用量、不良反应发生率及满意度。结果所有患者均能完成操作,微泵组给药后1 min(T1)MAP、HR、RR较给药前(T0)下降(P<0.05),靶控组MAP、HR、RR下降轻,两组比较有统计学意义(P<0.05)。给药后5 min(T2)术中1 h(T3)和苏醒时(T4)两组的HR、MAP、RR比较无统计学意义(P>0.05)。两组SpO2、诱导、苏醒时间、镜检时间及满意度无统计学意义(P>0.05)。靶控组丙泊酚总用量及不良反应发生率少于微泵组(P<0.05)。结论靶控输注丙泊酚麻醉诱导平稳,术中麻醉效果好,可减少丙泊酚的用量和不良反应。     

犬无束缚静脉输注给药的实现

目的建立犬无束缚静脉给药方法。方法将犬无束缚静脉给药装置(背心,输液保护套管,套管连接构件,精密微量输液监控器)组装,然后将该装置与埋植好留置针的犬连接,建立完整的输液通路给药开始。结果成功建立了犬无束缚静脉给药方法。结论设计合理、动物穿着舒适的给药装置,是犬无束缚静脉给药成败的关键因素。     

Optimizing Smart Pump Technology by Increasing Critical Safety Alerts and Reducing Clinically Insignificant Alerts

Background:

Alerts generated by intravenous (IV) infusion pump safety software prevent life-threatening situations that might otherwise go unnoticed. However, when alerts are often clinically insignificant, health care workers may become desensitized and discount their importance, resulting in potentially dangerous situations. Little research has been devoted to visual alert desensitization.

Method:

This paper describes how the Carolinas HealthCare System decreased the number of nonclinically relevant infusion pump alerts by analyzing alert data that were formatted into scatter plots. This in turn enabled the identification of the medications associated with the most meaningful alerts and those associated with the least meaningful alerts.

Conclusion:

By revising drug library limits for specific medications, it was possible to decrease the number of less clinically meaningful alerts, reduce alert fatigue, and thereby increase the effectiveness of the smart infusion pumps. This added another layer of safety to patient care.     

输液污染与输液自净器的临床价值

本文通过实验论述了输液污染的危害，同时证明“输液自净器”能够有效地阻截病房空气中的粉尘和细菌进入输液，杜绝输液的潜在危害。使用与不使用输液自净器对输液的微粒数有非常显著性的差异，因此使用输液自净器是临床预防输液污染的一种有效方法。     

Plasma Concentration Clamping in the Rat Using a Computer-Controlled Infusion Pump

We have developed a computer-controlled infusion pump to achieve rapidly and then maintain stable plasma thiopental concentrations in rats. Initially we derived the parameters of a triexponential pharma-cokinetic model for thiopental, administered as a brief infusion to 10 rats, using nonlinear regression and standard pharmacokinetic equations. These parameters were incorporated into the pharmacokinetic model of a computer-controlled infusion pump. In a second group of animals this device was used to maintain three consecutive target thiopental concentrations ranging from 5 to 100 µg/ml in a stepwise fashion. Arterial blood gases were kept normal through controlled ventilation when necessary. The plasma thiopental concentrations in this second group of animals were generally higher than the target concentrations. The bias in pump performance (median prediction error) was +25%, and the inaccuracy (median absolute prediction error) was 26%. We fit the parameters of a three-compartment model to the plasma thiopental concentrations observed in the second group of animals. This produced a second set of thiopental pharmacokinetic parameters with the unique characteristic of having been derived from a computer controlled infusion study. These parameters were tested prospectively with a computer-controlled infusion pump in a third group of animals. This second set of thiopental pharmacokinetic parameters performed better, with a median prediction error of 0% and a median absolute prediction error of 15%. This study shows that it is possible to achieve rapidly and maintain steady plasma thiopental concentrations in the rat. Our results suggest that it is feasible to derive robust pharmacokinetic parameters from unusual drug dosing approaches, such as employed by a computer-controlled infusion pump. The ability rapidly to clamp plasma drug concentrations at desired targets in small laboratory animals will facilitate research into the relationship of plasma and tissue concentration to drug effect.     

泵输注舒芬太尼用于ERCP麻醉的观察

目的观察泵输注舒芬太尼在ERCP的麻醉效果,并与手控输注舒芬太尼进行比较.方法全部病人诱导都推注舒芬太尼和异丙酚,接着泵输注异丙酚,P组泵输注舒芬太尼,而M组手控输注舒芬太尼.结果P组用药后2 min、胆管造影时HR减慢,用药后2min SpO2降低;M组用药后2minHR下降,用药后2min、胆管造影时SpO2降低.两纽比较,胆管造影时P组HR减慢,而M组SpO2降低;P组清醒时间短且躁动少.结论泵输注舒芬太尼和异丙酚、手控输注舒芬太尼 泵输注异丙酚皆可实施ERCP的麻醉,但前者过程更平稳.     

抗菌药物静脉滴注给药方案的设计原理和方法

目的设计抗菌药物静脉滴注给药方案。方法依据药物动力学和抗菌药物药效动力学原理，采用文献报道相关参数设计阿米卡星、环丙沙星和青霉素G静脉滴注给药方案。结果铜绿假单胞菌呼吸道感染患者给予阿米卡星380．64mg，静脉滴注速率33滴／min，每天给药1次；铜绿假单胞菌感染患者给予环丙沙星311．85mg，静脉滴注速率52滴／min，14h后给予第二剂量；化脓性链球菌感染患者给予青霉素G480万U，静脉滴注速率33滴／min，给药时间间隔12h。结论依据药物动力学和抗菌药物药效动力学原理，结合相关试验数据，可以设计静脉滴注给药方案。     

丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压的影响

目的:比较丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压(ICP)的影响。方法:选取择期行颅脑手术患者60例,随机分为2组,每组30例:T组(丙泊酚靶控输注组),麻醉诱导采用丙泊酚4μg·mL-1靶控输注,给予芬太尼3～5μg·kg-1、咪达唑仑0.05mg·kg-1、罗库溴铵0.9mg·kg-1,丙泊酚维持用量为2～3μg·mL-1靶控输注;C组(丙泊酚持续泵注组),丙泊酚诱导剂量为2mg·kg-1,丙泊酚维持量为4～6mg·kg-1·h-1,余同T组。记录2组不同时点的腰部脑脊液压力(CSFP)以及手术结束时丙泊酚使用量。结果:2组患者麻醉诱导前(基础值)CSFP比较无统计学差异(P>0.05);切开硬膜前、切开硬膜后2组患者CSFP均较基础值低,且T组较C组降低更加明显,差异有统计学意义(P<0.05);在关硬膜后和手术结束时2组患者CSFP无统计学差异(P>0.05);T组丙泊酚使用量较C组明显降低(P<0.05)。结论:丙泊酚的靶控输注静脉麻醉在降低颅内压方面的作用优于丙泊酚的持续泵注。     

静脉输液技术发展沿革

目的:综述静脉输液的技术进展,旨在为静脉药物集中配置的建设和临床安全用药提供参考。方法:收集相关最新发表的文献,对静脉输液的技术进展进行回顾。结果与结论:静脉输液的包装形式经历了开放式、半开放式和密闭式的发展,包装材料也从玻璃瓶、塑料瓶发展到了非PVC输液软袋。     

某院住院患者质子泵抑制剂的应用分析

目的：研究质子泵抑制剂的临床应用及其主要的不良反应。方法采用回顾性的分析方法,调查我院2012年10月至2013年3月使用质子泵抑制剂的患者病历,对其结果进行分析讨论。结果质子泵抑制剂在我院各住院科室均有应用,预防性使用（75%）比例高于治疗性使用（25%）,使用品种为奥美拉唑和泮托拉唑,使用次数主要为2次/d,给药途径全部为静脉滴注,用药时间1~45d,平均用药天数为（9.13±5.34）d,奥美拉唑不良反应发生率高于泮托拉唑。结论我院质子泵抑制剂在用药指征、使用品种、用药次数、给药途径和用药时间上均存在不合理现象,针对不合理原因,采取有效措施,提高质子泵抑制剂的合理应用,避免不良反应发生。     

2000例镇痛泵临床应用经验

疼痛是肌体对体内外异常物理化学刺激的特殊痛苦感受 ,疼痛的轻重取决于异常刺激的强度和肌体对刺激的反应程度。解除和减轻病人疼痛的方法很多 ,利用镇痛泵镇痛是其中的一种。我院自 2 0 0 0年 6月 2 0 0 3年 2月应用硬膜外阻滞后接镇痛泵进行术后镇痛 2 0 0 0例 ,取得了良好的效果 ,现报告如下。1　临床材料及结果术后镇痛病人 2 0 0 0例 ,其中男 5 0 0例 ,女 15 0 0例。胸外、普外、骨外和泌外病人共 30 0例 ,其余均为妇产科病人。 2 0 0 0支镇痛泵中 ,美国百特泵 12支 ,北京科联泵 30支 ,其余均为日本尼普洛尔泵。药物配方 :10 0ml泵中…     

输液泵注射阿托品救治急性重度有机磷农药中毒35例

目的探讨输液泵注射阿托品救治急性重度有机磷农药中毒的临床疗效。方法 35例急性重度有机磷中毒患者随机分为观察组、对照组两组。在均达到阿托品化后,观察组使用输液泵持续静脉泵入阿托品,对照组按常规用法间断静推阿托品。结果观察组治愈18例,死亡1例,病死率5.6%;对照组治愈17例,死亡3例,病死率17.6%。结论用输液泵输注阿托品救治急性重度有机磷中毒操作简便,减轻抢救工作量,且便于根据病情调整阿托品用量,抢救成功率高于常规给药方法。     

不同输液材料中硫酸阿托品微泵给药时含量变化研究

目的:考察输液材料对硫酸阿托品的吸附性。方法:模拟临床硫酸阿托品微泵给药环境,以0.9氯化钠溶液制备浓度为0.5μg.mL-1硫酸阿托品溶液,加入内标物非那西丁,以常用流速5mL.h-1连续泵10h,分别在0、1、2、4、6、8、10h时于聚丙烯(PP)注射器口、玻璃注射器口、PP注射器+聚氯乙烯(PVC)延长管口及玻璃注射器+PVC延长管口取样,稀释5倍后采用高效液相色谱法进行硫酸阿托品的含量测定。结果:硫酸阿托品经微泵给药10h内4种流出液样品含量与0h比较变化不明显(P>0.05)。结论:微泵给药中的PP和PVC输液材料10h内对硫酸阿托品无吸附作用。     

An Implantable Pump for Intrarenal Infusion of Immunosuppressants in a Canine Autotransplant Model

We developed a canine renal allograft model utilizing implantable infusion pumps and biocompatible catheters to investigate the pharmacokinetics of local immunosuppressive drug administration. Seven mongrel dogs underwent bilateral nephrectomy and autotransplantation of one kidney to the iliac vessels. The proximal end of an infusion catheter directed into the iliac artery was tunneled to a subcutaneously placed programmable pump. A second, sampling catheter was placed with its tip in the iliac vein. Simultaneous regional (iliac vein) and systemic (jugular vein) venous concentrations of 6-mercaptopurine (6-MP), the immunosuppressive metabolite of azathioprine, were determined during a continuous 24-h intraarterial infusion (10 mg/kg/24 hr). The gradient between regional and systemic 6-MP concentrations was maximal initially when the pump was turned on, continuously decreased until steady state was reached, and disappeared immediately after the pump was turned off. The mean ratio of steady-state iliac vein to systemic 6-MP concentrations was 5.0 ± 1.4, demonstrating a pharmacokinetic advantage of continuous intraarterial 6-MP infusion to the autotransplanted kidney. The novel canine renal allograft model described herein overcomes the technical limitations of earlier models and represents a foundational step in the design of intrarenal infusion patterns of immunosuppressive agents which we expect to prolong survival of the allotransplanted kidney with minimal systemic drug exposure and side effects.     

Chemical Stability of Artesunate Injection and Proposal for its Administration by Intravenous Infusion

Artesunate, the only artemisinin analogue that can be given intravenously, produces rapid parasite and fever clearance in falciparum malaria. A significant therapeutic problem is a high, late recrudescence rate, probably due to short half-lives of both artesunate and its active metabolite dihydroartemisinin relative to conventional dosing intervals. One method of extending the duration of action of artesunate could be to administer the drug by infusion rather than bolus injection, provided that it is chemically stable at ambient temperature. Artesunate was found to be stable in 0m?9% w/v sodium chloride at 9°C, 23°C and 36m?5°C for 130, 10m?6 and 1m?6 h, respectively. Interpolating from an Arrhenius plot, artesunate should be stable for approximately 4 h at 30°C, a temperature representative of ambient conditions in tropical countries. Exposure to light did not affect the degradation rate. Single compartment pharmacokinetic modelling was used to evaluate potential differences in artesunate and dihydroartemisinin plasma concentrations following administration of artesunate by intravenous bolus or infusion. A bolus injection of artesunate at a dose of 4 mg kg^?1 gives a peak concentration of 5m?3 mg L^?1, falling to 0m?005 mg L^?1 at 5 h. The same dose infused over 4h results in a peak concentration of 0m?92 mg L^?1 falling to 0m?005 mg L^?1 at 8h. Simultaneous modelling of dihydroartemisinin showed that while its peak plasma concentration was reduced by 27% and the peak delayed by 2.5 h following artesunate administration by infusion, substantially higher concentrations were maintained compared with those predicted after bolus artesunate. These data indicate that artesunate can be administered as a high-dose intravenous infusion, thus avoiding high plasma concentrations. This strategy also has the potential to prolong the duration of antimalarial effect and reduce toxicity, and consequently improve clinical outcome in seriously ill patients.     

对尼莫地平注射液在4种常用输液中的稳定性探讨

尼莫地平(Nimodipine,NMDP)可用于治疗缺血性脑血管病。鉴于本品在输液中的稳定性尚无报道,本文作者以HPLC内标法测定NMDP为主要手段,研究了其在4种常用输液中的稳定性及其对光稳定性。结果表明:NMDP对漫射光、避光条件下在5％GS和NS输液中较稳定,漫射光与避光对其稳定性影响无差异(p>0.1),而在6％右旋糖酐40葡萄糖注射液和6％低分子羟乙基淀粉氯化钠注射液中稳定性较差;阳光照射下NMDP在4种输液中均不稳定,光解较快,光解反应呈表观一级反应,相关系数r>—0.9900。上述结果提示:临床应用含NMDP输液,选用5％GS和NS为宜,并应尽量避开阳光。     

PVC材质一次性输注泵在常用局麻药应用中的安全性研究

目的考察一次性使用输注泵与常用局麻药的相容性,评定其在临床常用局麻药物使用中的安全性。方法3种常用局麻药分别与2种液体（生理盐水及乳酸林格氏液）按临床使用浓度配伍,在不同时间点分别采用LC-MS／MS法、光阻法、高效液相色谱法测定邻苯二甲酸二-（2-乙基己基）酯（DEHP）含量、不溶性微粒和药物浓度。结果DEHP含量低于LC-MS／MS测定方法定量下限（0．072gg·mL^-1）,更低于考核标准静脉晶体溶液输注成年人（70kg）DEHP剂量上界估算值（0．005mg·kg^-1·d^-1）;48h内各实验药物在一次性使用输注泵中药物含量相对0h均〉96．0％,受试输注泵与各种药物在48h内未见明显吸附;输注泵中溶液稳定,0h每1mL粒子直径≥10μm粒子数（n=30）（35．13±14．4）粒;每1mL粒子直径≥25μm粒子数（n=30）（0．61±0．49）粒,符合中国药典2010版标准。结论研究表明本一次性使用输注泵应用于3种常用局麻药物较为稳定,其DEHP溶出、不溶性微粒及药物吸附性等方面符合安全使用要求。