临床静脉给药存在的问题分析与对策

目的:通过对医院临床静脉给药过程中存在的问题进行分析,寻找安全使用静脉药物的策略。方法:对医院静脉给药过程中存在的两大主要问题:给药错误、输液污染,举例并对成因进行分析。结论:通过完善医院给药系统,改变给药流程,让药师参与到药品使用环节中,采用新科技产品等诸多手段,可有效减少给药错误,确保医院静脉用药的安全。     

基于循证实践的化疗静脉给药的评估

文章从化疗静脉给药评估的现状出发,总结提出基于循证实践的评估内容及评估质量的控制方法,以期为临床护士进行化疗静脉给药的全面评估提供参考依据。     

时点静脉用药规范管理的效果

目的探讨时点静脉用药规范管理在临床护理工作中的应用效果。方法制作时点用药标识,专柜放置时点静脉用药,合理调配护理人员,规范时点静脉用药流程。结果治疗室考核评分提高(P0.05);操作前静脉用药核对时间缩短(P0.01),护士满意度提高(P0.01);规范管理后,未发生静脉用药不良事件。结论时点静脉用药规范管理提高了护理工作效率,保证了患者安全、有效用药,值得临床推广。     

Errors in the administration of intravenous medication in Brazilian hospitals

Aim. To verify the frequency of errors in the preparation and administration of intravenous medication in three Brazilian hospitals in the State of Bahia. Background. The administration of intravenous medications constitutes a central activity in Brazilian nursing. Errors in performing this activity may result in irreparable damage to patients and may compromise the quality of care. Design. Cross‐sectional study, conducted in three hospitals in the State of Bahia, Brazil. Methods. Direct observation of the nursing staff (nurse technicians, auxiliary nurses and nurse attendants), preparing and administering intravenous medication. Results. When preparing medication, wrong patient error did not occur in any of the three hospitals, whereas omission dose was the most frequent error in all study sites. When administering medication, the most frequent errors in the three hospitals were wrong dose and omission dose. Conclusions. The rates of error found are considered low compared with similar studies. The most frequent types of errors were wrong dose and omission dose. The hospitals studied showed different results with the smallest rates of errors occurring in hospital 1 that presented the best working conditions. Relevance to clinical practice. Studies such as this one have the potential to improve the quality of care.     

不同静脉给药方法治疗破伤风患者的临床效果研究

目的:探讨不同静脉给药方法治疗破伤风患者的临床效果.方法:将30例破伤风患者随机分为治疗组16例和对照组14例,治疗组采用冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注,对照组采用冬眠Ⅰ号合剂静脉输液治疗.观察两组患者的治疗效果及感受.结果:治疗组在静脉推注定时给药后1～5min内抽搐症状得到控制,对照组在静脉输液后5～12min内抽搐症状得到缓解,且治疗组患者家属满意度高于对照组(P<0.05),治疗组护士的支持率明显高于对照组(P<0.05).结论:冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注法效果明显优于静脉输液治疗法.     

Torsade de pointes associated with the administration of intravenous haloperidol

Torsade de pointes is a malignant dysrhythmia that has been reported in a variety of clinical settings and associated with several pharmacologic agents. Patients with a prolonged QTc for heart rate are at higher risk for the development of this arrhythmia. We review the literature supporting the relationship of haloperidol to the development of this malignant dysrhythmia. Clinicians in the critical care setting should be aware of potentially lethal drug-induced ventricular tachydysrhythmias such as torsade de pointes.     

小剂量秋水仙碱联合得宝松治疗急性痛风性关节炎的疗效分析

目的分析总结小剂量秋水仙碱联合得宝松(复方倍他米松)肌肉注射治疗急性痛风性关节炎的临床疗效及安全性。方法回顾性分析2012年1月至2015年12月第三军医大学大坪医院收治的61例急性痛风性关节炎患者临床资料,其中治疗组38例采用小剂量秋水仙碱联合单次得宝松肌肉注射治疗方案,对照组23例采用大剂量秋水仙碱治疗方案,治疗1周后复查红细胞沉降率(ESR)、C反应蛋白(CRP)等实验室指标并评估关节肿胀、疼痛改善情况,对两种治疗方案的临床疗效及不良反应进行分析。结果与治疗前比较,治疗1周后治疗组ESR、CRP均明显下降,对照组CRP明显下降,差异均有统计学意义(P0.05),ESR下降不明显,差异无统计学意义(P0.05);两组白细胞计数(WBC)和中性粒细胞计数(NEUT)均显著下降;两组患者肿胀关节数(SJC)、压痛关节数(TJC)、受累关节总数及VAS疼痛评分均明显减少,差异均有统计学意义(P0.05)。两组患者治疗后ESR及CRP下降情况比较,治疗组较对照组下降更明显,差异具有统计学意义(P0.05)。两组患者治疗后SJC、TJC、受累关节总数及VAS疼痛评分情况比较,差异无统计学意义(P0.05)。不良反应发生率,对照组为56.52%,治疗组为15.79%,两组比较差异具有统计学意义(P0.05)。结论小剂量秋水仙碱联合单次得宝松肌肉注射与大剂量秋水仙碱均能有效治疗急性痛风性关节炎,小剂量秋水仙碱联合单次得宝松肌肉注射治疗方案的不良反应率更低,耐受性更好,安全性更高。     

Valproate protein binding following rapid intravenous administration of high doses of valproic acid in patients with epilepsy

OBJECTIVE: To characterize protein binding in patients with epilepsy who achieve transient high (>150 mg/L) total plasma concentrations following rapid valproate infusion at very high doses. METHODS: Patients with epilepsy (n = 40) were administered 20 or 30 mg/kg loading doses (6 or 10 mg/kg/min) of undiluted valproate sodium injection. Total and unbound valproic acid (VPA) concentrations were used to assess VPA binding to plasma albumin. One- and two-binding site models were explored in a nonlinear mixed effects population analysis framework. The relative importance of weight, age, sex, race and enzyme-inducing comedications on the binding site association constant (K) was examined using the likelihood ratio test. Intersubject and intrasubject variabilities were characterized using exponential or proportional error models. RESULTS: Optimal characterization of the data was achieved using the one-binding site model. Population binding parameter estimates (standard error) for number of binding sites (N) and K were 1.98 (0.0865) and 15.5 [2.28 (1/mM)], respectively. No significant covariates were identified for VPA protein binding. The intersubject and intrasubject coefficients of variation were 32% and 14%, respectively. CONCLUSIONS: A one-binding site model without any significant covariates for binding constants optimally described VPA protein binding. As the estimated dissociation constant (1/K, 64.5 microm or 9.3 mg/L) was within the therapeutic range (5-15 mg/L) for unbound VPA concentrations, protein binding was nonlinear. Although the range of unbound fraction and VPA concentrations were much higher than previous studies, the dissociation constant was consistent with historical data in normal healthy adults and epilepsy patients receiving lower doses.     

护理人员静脉输液相关知识掌握程度的调查分析

目的通过调查了解护理人员对静脉输液治疗技能相关知识的掌握情况,分析原因并提出建议。方法 2010年9—12月采用自行设计的护理人员静脉输液治疗技能相关知识试卷,对377名临床护理人员进行闭卷笔试。结果护理人员静脉输液治疗技能知识总分为(71.27±6.18)分,掌握程度属于一般偏低。各分类项目中,静脉输液治疗相关并发症预防与处理得分明显低于其他各部分;不同科室的护理人员对静脉输液治疗技能相关知识掌握程度不同,妇产科和输液室得分较低。结论护理人员静脉输液治疗技能相关知识的掌握程度有待巩固和提高,护理管理者应从各科室的薄弱环节入手,开展有针对性、系统化、多层次和多样化的培训,以提高临床静脉输液治疗的质量。     

Comparison of intravenous valproate with intravenous lysine-acetylsalicylic acid in acute migraine attacks

OBJECTIVE: The study compared efficacy and tolerability of intravenous valproate (iVPA) with intravenous lysine-acetylsalicylic acid (iLAS) in acute migraine attacks. Background.-iLAS has been proven to be a highly effective treatment in acute migraine attacks, but it is not available in many countries and contraindicated in patients with asthma or peptic ulcers. Current data suggest that iVPA may be effective in the treatment of acute migraine attacks. DESIGN/METHODS: In this randomized, double-blind, parallel-group phase-II study, 40 patients with acute migraine attacks (onset <5 hours, severe or moderate headache on a four-point IHS scale) alternately received iVPA 800 mg or iLAS 1000 mg. Primary outcome criteria were the percentage of patients reporting pain relief after 1 hour and patients who remained sustained pain free for 24 hours following drug administration. Secondary outcome criteria were relief of pain and associated migrainous symptoms (nausea, photophobia, and phonophobia) at 1, 2, 24, and 48 hours following drug administration. RESULTS: There were no significant differences in demographic and clinical features between both treatment groups. Percentage of pain relief after 1 hour in the iVPA and iLAS groups were 25% and 30%, respectively, and of sustained pain free for 24 hours were 20% and 30%, respectively, without significant differences (P = 1 and P= .72, respectively). Both drugs improved associated migrainous symptoms without significant differences at the different time points, but again with a trend in favor of iLAS. No adverse events were observed. CONCLUSION: Both drugs were effective in acute migraine attacks with a trend in favor of iLAS. As both drugs were well tolerated, further studies with higher doses of iVPA for the treatment of acute migraine attacks are recommended.     

直型和Y型留置套管针的输液效果比较

目的观察直型留置针与Y型留置针在临床静脉输液中的应用效果。方法将180例患者分为直型留置针组和Y型留置针组,各90例,观察两组一次穿刺成功率、堵管率、留置时间、并发症发生率和患者舒适度。结果两组一次穿刺成功率、患者舒适度、留置时间和堵管率差异均具有统计学意义(P<0.01或P<0.05)。结论直型留置针较Y型留置针穿刺成功率高、堵管率低、留置时间长、患者舒适度好,能更安全地应用于临床,值得推广使用。     

Incidence of infusion-site reactions associated with peripheral intravenous administration of fosaprepitant

Purpose

Fosaprepitant is known to cause infusion-site reactions. However, there is limited data regarding these reactions including the effect of peripheral intravenous administration or other potential factors on their incidence. This single-institution retrospective study was undertaken to investigate the incidence of infusion-site reactions with single-dose intravenous (IV) fosaprepitant when given through a peripheral line prior to administration of chemotherapy. Risk factors for the development of infusion-site reactions with fosaprepitant were also explored.

Methods

Medical records of patients with cancer receiving IV fosaprepitant through a peripheral line were reviewed. The primary objective of this study was to estimate the incidence of infusion-site reactions at our institution. Data collection included demographics, fosaprepitant infusion information, and grading of reactions.

Results

We found a 15 % incidence of infusion-site reactions among all peripherally administered doses of fosaprepitant. The 50 reactions occurred in 43 unique patients representing an incidence per patient of 28.7 % (43/150; 95 % confidence interval (CI) 21.6–36.6). Factors found to be associated with infusion-site reactions included age [odds ratio (OR) 0.97 (95 % CI 0.94–0.99)], location of IV line [OR forearm vs. hand 0.41 (95 % CI 0.20–0.85); OR antecubital fossa vs. hand 0.31 (95 % CI 0.11–0.87)], and simultaneous maintenance IV fluid rate ≥100 mL/h during fosaprepitant infusion [OR 0.19 (95 % CI 0.08–0.44)].

Conclusions

The incidence of infusion-site reactions with peripherally administered fosaprepitant as seen in this study is higher than that reported in the package insert. Risk factors for developing infusion-site reactions in our patient population include age, location of IV line, and simultaneous maintenance IV fluid rate of <100 mL/h.     

Mechanism of Action of Colchicine in the Treatment of Gout

Purpose

The aims of this article were to systematically review the literature about the mechanism of action of colchicine in the multimodal pathology of acute inflammation associated with gout and to consider the clinical utility of colchicine in other chronic inflammatory diseases.

Methods

The English-language literature on PubMed was searched for articles published between 1990 and October 2013, with a cross-reference to citations across all years. Relevant articles pertaining to the mechanism of action of colchicine and the clinical applications of colchicine in gout and other inflammatory conditions were identified and reviewed.

Findings

The molecular pathology of acute inflammation associated with gouty arthritis involves several concurrent pathways triggered by a variety of interactions between monosodium urate crystals and the surface of cells. Colchicine modulates multiple pro- and antiinflammatory pathways associated with gouty arthritis. Colchicine prevents microtubule assembly and thereby disrupts inflammasome activation, microtubule-based inflammatory cell chemotaxis, generation of leukotrienes and cytokines, and phagocytosis. Many of these cellular processes can be found in other diseases involving chronic inflammation. The multimodal mechanism of action of colchicine suggests potential efficacy of colchicine in other comorbid conditions associated with gout, such as osteoarthritis and cardiovascular disease.

Implications

Colchicine has multiple mechanisms of action that affect inflammatory processes and result in its utility for treating and preventing acute gout flare. Other chronic inflammatory diseases that invoke these molecular pathways may represent new therapeutic applications for colchicine.     

秋水仙碱中毒患者30例临床荟萃分析

目的 探讨秋水仙碱药物中毒的临床特征、治疗和预后,提高临床对该药物中毒的认识和重视。方法 结合我院近期收治的1例大剂量秋水仙碱中毒患者,检索近年来有关秋水仙碱中毒的文献资料（2003-2019年）共21篇,秋水仙碱中毒患者29例,共30例。结果 秋水仙碱中毒男性16例（53.3%）,女性14例（46.7%）;中毒原因为自杀19例（63.3%）,长期服药治疗痛风11例（36.7%）。26例（86.7%）患者临床第一阶段表现为消化道症状;21例（70%）患者第二阶段表现为骨髓抑制及多器官功能障碍;19例（63.3%）患者度过危险期最终好转。检查结果示26例（86.7%）患者血常规、血凝常规、肝功能、肾功能指标异常。经过积极对症支持治疗,最终完全康复19例（63.3%）,死亡11例（36.7%）。结论 如果药物剂量不适宜将会出现严重的中毒反应甚至死亡,也有一些人口服该药物自杀。     

静吸复合与全凭静脉2种麻醉方式对乳腺癌炎性细胞因子的影响

目的探讨静吸复合麻醉及全凭静脉麻醉2种麻醉方式对乳腺癌患者炎性细胞因子的影响。方法选取2011年11月-2012年10月在本院乳腺外科行手术治疗132例乳腺癌患者,随机分为A（静吸复合组,n=66）、B（全凭静脉组,n=66）2组,分别给予静吸复合麻醉与全凭静脉麻醉,于麻醉前、术后4h、术后6h进行血白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）检测并对比分析。结果2组患者IL-6、TNF-α水平均显著增高（P〈0．05）,术后6hA组IL-6显著高于B组（P〈0．01）,术后4h、6hA组TNF-α均显著高于B组（P〈0．01）。结论全凭静脉麻醉在乳腺癌患者中能够更好地抑制术后血清IL-6及TNF-α等炎性细胞因子的增高,避免过度应激反应,值得推广。