| Objective:In this study,three kinds of drugs with physical and chemical properties,KabivenTM Pl,KabivenTM Pl + alanylglutamine + potassium aspartate and 0.9% sodium chloride solution,were continuously infused through peripheral vein.The early pathological changes and the change trend of inflammatory factor concentration of these three kinds of drugs were observed during each period of continuous infusion through rabbit ear vein.The occurrence of these three kinds of drugs was discussed.The study on the relationship between phlebitis and the time of continuous infusion can improve the risk of phlebitis time for clinical nurses,and provide reference for the limit time of phlebitis of such physicochemical drugs.Method:(1)First of all,through the questionnaire survey,referring to the 2016 ins standar d,searching PubMed,CNKI,Wanfang and other databases to design the questionnair e,distributing the basic principles and drug names of clinical investigation medicalsta ff for the use of clinical drugs,preliminarily screening the drug catalog,and then hro ugh the osmotic pressure test instrument,pH value test instrument,measuring the pH value and osmotic pressure of drugs,screening the drug names that meet the inc lusion criteria,Finally,KabivenTM Pl(pH 4.84,osmolarity 815mOsm/L),KabivenTM Pl+alanamide+potassium aspartate(TNA,pH 5.17,osmolarity 800mOsm/L)were selected to meet the inclusion criteria of the test drug;(2)Animal experimental research method:healthy white rabbits were selected and included in the standard:the body weight was similar to the age(2.5-3.0kg),the skin of the vein at the outer ear edge of the rabbit was intact and ruddy,the puncture blood vessel was thick,straight and elastic,and the filling degree was full;exclusion s tandard:malformation of the vein at the ear edge,subcutaneous at the point,induration,scar mass.The experiment is in line with Chinese animal welfare standards and has been approved by the ethics committee of Shanxi Medical University.It was compl eted in the animal experimental research center of Shanxi Medical University.72 Ne w Zealand white rabbits were randomly divided into three groups:the control group(0.9%NaCl solution),the experimental group(KabivenTM Pl),the experimental group(KabivenTM Pl+alanamide+potassium aspartate)(TNA total nutrient mixture),24 in ea ch group.First,the external ear vein on one side of the rabbit ear was used as the p uncture blood tube,and then the three groups were randomly divided into four grou ps,namely 3h group,4h group,5h group and 6h group,each group was 6 in each gro up Only.In consideration of the physical and chemical properties of the drug and it s compliance with the basic infusion requirements,the experimental group was infuse d with a single channel injection pump through the peripheral vein of the rabbit ea r at a rate of 4ml/(kg.h),while the control group was infused with 0.9%NaCl soluti on continuously at a rate of 40 drops/min.Before the continuous infusion of drugs,the venous blood on one side of the ear vein of the rabbit was taken to measure CRP and CRP by enzyme-linked immunosorbent assay The basic concentration value of TNF-α inflammatory factor was selected,and then another side of rabbit ear edge was transfused via PVC vein.The venous blood was taken again at 2hours and 48 hours after the end of the four time periods of 3 hours,4 hours,5 hours and 6hours,respectively.2 hours was used to measure the change trend of TNF-α inflammatory factor concentration,48 hours was used to measure the change trend of CRP inflammatory factor concentration,and then 4 weeks after adaptive feeding Continue to infuse0.9%sodium chloride solution,KabivenTM Pl,KabivenTM Pl+alanamide+potassium aspartate,and also inject lidocaine hydrochloride(4.5mg/kg)2h subcutaneously after the end of four periods of administration in KabivenTM Pl,KabivenTM Pl+alanamide+potassium aspartategroup and 0.9%NaCl solution group.When the puncture site and its surrounding tissues have no response to pain stimulation,make blood vessel samples,The area is1.5cm×3.5cm,that is to say,taking the selected vein as the standard horizontal line,dividing0.75 cm to the left and 0.75 cm to the right,that is to say,the width is 1.5cm,taking the place where the vein indwelling needle enters as the starting point,the place where the PVC cannula is cut off is 1cm near the heart end,and the length is 3.5cm,soaking in formalin to keep the standard activity for 24 h generally,processing the blood vessel specimen according to the experimental technique,and then immersing the blood vessel specimen The sections were made at the place where the venous indwelling needle entered,the place where the cannula was cut off and the place where the cannula was 1 cm away from the cardiac end.A total of 216 pieces were examined qualitatively by he.The early pathological changes,the degree of damage to the blood vessel wall and the morphology of the vascular endothelial cells were analyzed by immunohistochemistry.Results:(1)Compared with the same time period of continuous infusion of PVC,the inflammatory reaction in the experimental group was significantly heavier than that in the control group.When the continuous administration time was up to 4 hours,the inflammatory factors in the experimental group and the control group were statistically significant,with significant differences.CRP(F=18.793,P<0.001)and TNF-α(F=6.594,P<0.05).At the same time,he staining and immunohistochemistry analysis were performed The results also showed that when the administration time was up to 4 hours,the pathological changes of vascular intima and vascular endothelial cells in the experimental group gradually increased,and the vascular intima was slightly incomplete,the vascular wall was slightly swollen,and a small amount of inflammatory cell infiltration began toappear in the vascular cavity;(2)At the same time,the results of HE staining light microscopy and immunohistochemical staining showed that when the infusion time was up to 4h,the intima of blood vessels inKabivenTM Pl,KabivenTM Pl+alanamide+potassium aspartate group began to be slightly incomplete,the walls of blood vessels were slightly swollen,and a small amount of inflammatory cells began to infiltrate into the lumen of blood vessels;with the prolongation of PVC retention time,the disease of intima and endothelial cells of blood vessels occurred The change of the physical and histological morphology was gradually aggravated;(3)Compared with the different periods of continuous infusion of PVC,the inflammatory response in the experimental group was significantly different and statistically significant.With the extension of infusion time,the inflammatory response gradually increased.The CRP concentration in the TNA group of the experimental group,F=39.458,P<0.05,TNF-α,F=38.684,P<0.05,and the CRP concentration in the KabivenTM Pl group,F = 75.266,P < 0.001,TNF-α concentration value,F = 52.229,P <0.001;with the prolongation of PVC retention time in the control group,there was no statistical significance in the comparison of inflammatory response in each time period,the difference was not obvious,CRP concentration value F= 0.195,P = 0.677,P > 0.05,TNF-αconcentration value F= 4.144,P = 0.097,P > 0.05.Conclusions:(1)When using two kinds of physicochemical drugs,KabivenTM Pl and TNA,which are continuously administered by PVC,the safe time of continuous intravenous infusion is within 3 hours,and the limit time is 4 hours.If the time exceeds 4 hours,there will be a risk of potential complications,so as to improve the time early warning of phlebitis in clinical nurses,reduce the inflammatory reaction of blood vessels and the incidence of phlebitis;(2)When using the two kinds of drugs,KabivenTM Pl and TNA,the most serious part of phlebitis is the cut-off of the catheter.It is suggested that the cut-off of the catheter should be the most important part of the treatment of phlebitis in the clinical nursing treatment plan... |
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