肌内注射维生素K3导致局部疼痛的原因分析及处理对策

[目的]探讨肌内注射维生素K3导致局部疼痛的原因,并提出相应的处理对策。[方法]将60例注射维生素K3导致局部疼痛的患儿分为观察组和对照组,每组30例,观察组常规注射法出现疼痛后采用50%硫酸镁湿热敷及红外线烤灯照射,连续3 d,每天2次;对照组常规注射法出现疼痛后采用观察局部情况,下次注射时更换部位,比较两组患儿疼痛减轻的疗效。[结果]观察组患儿疼痛减轻率为96.7%,对照组为20.0%,差异有统计学意义(P<0.01)。[结论]采取50%硫酸镁湿热敷及红外线烤灯照射减少注射维生素K3导致局部疼痛的效果优于常规法。     

肌内注射维生素K1出现过敏反应2例

维生素K1为止血药,肝脏利用其合成凝血酶原因子Ⅶ、Ⅸ、Ⅹ[1],临床常用于治疗肝胆疾患。2006年6月本院收治2例亚急性重型肝炎的患者,肌内注射维生素K1,并且进行了多次血浆置换术治疗,拔除股静脉二腔管后3d均出现双侧肌内注射部位皮下淤斑和米粒大小红色丘疹,伴瘙痒、硬结、微热、手感皮肤有凸起。经专家会诊、分析、讨论,制定治疗护理措施,很快控制了病情,丘疹消失,皮肤恢复正常。1临床资料例1,女,48岁,因患甲状腺功能亢进,间断口服他巴唑及中草药治疗3年余,入院诊断为药物性肝炎,亚急性重型。进行血浆置换术治疗3次,肌内注射维生素K120mg…     

减轻肌内注射疼痛护理措施的探讨

肌内注射是临床最常用的给药途径之一，比口服皮下注射发生疗效更迅速，在临床上通过采用不同的护理措施，我们发现可以减轻病人疼痛，现报告如下。     

新生儿肌内注射致局部硬结的预防

对成人肌内注射所致硬结的防治研究较多，但对新生儿肌内注射的方法及硬结预防方面研究较少。在基层医院，新生儿预防性使用抗生素及止血剂经常采用肌内注射。新生儿的臀部肌肉尚未充分发育，肌内注射不易吸收，极易形成硬结。2002年8～12月，本科通过对46例新生儿肌内注射方法进行改进，取得了较好的效果，现将结果报道如下。     

合理护理对减轻肌内注射时疼痛的作用

分析肌内注射疼痛的原因，开展全程优质服务。加强护理技术操作，注射前了解药物性质、作用及副作用，选择适当的针头、正确的注射部位，掌握无痛性注射方法，使用安慰语言，是减轻肌内注射时局部疼痛的重要手段。     

心理干预减轻门诊肌内注射时疼痛的应用

目的 探讨心理干预对减轻门诊肌内注射中疼痛的作用。方法 将60例门诊注射病人随机分为对照组（30例）和观察组（30例），对照组常规操作，观察组加用心理干预。结果 观察组疼痛程度明显低于对照组（P〈0．05）。结论 心理干预是减轻肌内注射疼痛行之有效的方法。     

维生素K3、阿托品足三里注射缓解肾绞痛的临床应用

突发性阵发性肾绞痛是肾、输尿管结石的最突出症状。往往患者疼痛难忍,辗转不安,少数甚至出现疼痛性休克。临床上常用肌肉注射阿托品解痉止痛,效果不佳,需多次注射,且疼痛易复发。我们从１９９９年开始采用维生素Ｋ３、阿托品两药合用进行足三里注射,疗效显著。     

臀部肌内注射并发症及其护理对策

肌内注射是临床上常用的给药技术之一，药物吸收迅速、安全，疗效可靠；注射部位最常选用臀大肌。尽管肌内注射操作简便，但由于局部的物理及化学刺激作用或操作不当易致注射部位产生感染或硬结等并发症，增加了患者的痛苦和经济负担，特别是儿童更为常见。为此，笔者参考有关文献，对臀部肌内注射的并发症及其护理对策进行了总结和探讨。     

臀部肌内注射并发症及其护理对策

肌内注射是临床上常用的给药技术之一,药物吸收迅速、安全,疗效可靠;注射部位最常选用臀大肌.尽管肌内注射操作简便,但由于局部的物理及化学刺激作用或操作不当易致注射部位产生感染或硬结等并发症,增加了患者的痛苦和经济负担,特别是儿童更为常见[1].为此,笔者参考有关文献,对臀部肌内注射的并发症及其护理对策进行了总结和探讨.     

不同推药时间对肌内注射疼痛的影响

目的 探讨肌内注射过程不同推药时间对患者疼痛程度及持续时间的影响.方法 采用自身对照交叉设计试验,40例患者连续2d各接受一次肌内注射甲钴胺,两次推药时间分别为10,20 s.结果 两种注射时间患者疼痛评分差异有统计学意义（F=18.031,P＜0.05）,采用20 s推药法时患者疼痛评分低于10s法,两阶段间疼痛评分差异无统计学意义（F=0.596,P＞0.05）,个体间疼痛评分差异有统计学意义（F=6.175,P＜0.05）;在注射结束后5,10,15 min时疼痛程度均低于10 s法（Z分别为-2.858,-2.272,-2.129;P＜0.05）,注射后疼痛持续时间短.结论 延长肌内注射过程中推药时间可减轻患者疼痛及疼痛持续的时间,为临床工作提供了理论依据.     

减轻注射绒毛膜促性腺激素局部疼痛反应的探讨

[目的 ]探讨缓解注射绒毛膜促性腺激素 (HCG)局部疼痛的有效途径。 [方法 ]采用分组对照法 ,比较生理盐水和注射用水作为绒毛膜促性腺激素溶媒肌肉注射时的疼痛程度。 [结果 ]用生理盐水作为溶媒肌肉注射较用注射用水作为溶媒肌肉注射疼痛程度减轻 (P <0 .0 0 1)。 [结论 ]绒毛膜促性腺激素采用生理盐水作溶媒 ,可减轻病人注射时的局部疼痛。     

缓解肌肉注射时疼痛的方法

综述了缓解肌肉注射时疼痛的方法，如改进技术操作或通过音乐疗法、暗示疗法、认知疗法、默想法来缓解疼痛。对于肌肉注射刺激性大的药物可通过稀释药液、局部皮肤处理等缓解疼痛。     

缓解肌肉注射时疼痛的方法

综述了缓解肌肉注射时疼痛的方法如改进技术操作或通过音乐疗法、暗示疗法、认知疗法、默想法来缓解疼痛。对于肌肉注射刺激性大的药物可通过稀释药液局部皮肤处理等缓解疼痛。     

3种肌内注射缩宫素方法对患者疼痛程度的影响

目的观察3种肌内注射缩宫素方法对患者疼痛程度的影响。方法将90例患者随机分为3组,每组各30例及各100例次,分别采用常规注射法、留置气泡注射法、0.9%生理盐水稀释注射法对3组患者进行肌内注射缩宫素。比较3组患者注射后疼痛程度和局部反应情况。结果 3组患者肌内注射缩宫素疼痛程度比较,P〈0.01,差异具有统计学意义,其中采用0.9%生理盐水溶液稀释法比其他两组肌内注射时疼痛程度明显减轻,但是3组患者肌内注射缩宫素局部反应比较,P〉0.05,差异无统计学意义。结论采用0.9%生理盐水溶液稀释法肌内注射缩宫素能有效缓解患者疼痛程度,且安全可靠,不影响药物疗效,患者满意,值得临床推广应用。     

Nonnutritive sucking and oral sucrose relieve neonatal pain during intramuscular injection of hepatitis vaccine

Context

Newborns are subject to pain during routine invasive procedures. Pain caused by immunization injections is preventable, but remains untreated in neonates.

Objectives

The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on newborns’ pain, physiological parameters, and cry duration before, during, and after hepatitis B intramuscular (IM) injection.

Methods

In this prospective, randomized clinical trial, we enrolled 165 newborns (gestational age, ≥36 weeks). The infants received IM injections and were randomized to three treatment groups: nonnutritive sucking (NNS), 20% oral sucrose, or routine care. Pain was measured by the Neonatal Facial Coding System, physiological signals by electrocardiogram monitors, and cry duration using a stopwatch.

Results

Pain was significantly lower among infants in the NNS (B = −11.27, P < 0.001) and sucrose (B = −11.75, P < 0.001) groups than that in controls after adjusting for time effects, infant sleep/wake state, number of prior painful experiences, and baseline pain scores. Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls. Cry duration of infants receiving sucrose was significantly shorter than those in the NNS (Z = −3.36, P < 0.001) and control groups (Z = −7.80, P < 0.001).

Conclusion

NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection. Sucrose orally administered two minutes before injection more effectively reduced newborns’ pain during injection than NNS. Both nonpharmacological methods more effectively relieved newborns’ pain, stabilized physiological parameters, and shortened cry duration during IM hepatitis injection than routine care.     

非药物干预缓解成人肌内注射引起注射部位疼痛的网状Meta分析

目的:对多种缓解成人肌内注射引起的注射部位疼痛的非药物干预方法进行效果评估。方法:计算机检索PubMed、the Cochrane Library、EMbase、Web of Science、PsycINFO、万方、中国知网和中国生物医学文献数据库中有关非药物干预缓解成人肌内注射疼痛的随机对照试验,检索时间均为建库至2020年3月31日。按照纳入和排除标准筛选文献、评价纳入研究的偏倚风险并从中提取数据,采用Stata 14.0展现各研究之间的网状关系,并进行发表偏倚分析;通过累积排序概率图下面积呈现每个干预方法成为最佳干预的可能性。结果:共纳入15项RCT,涉及1180例病人、12种非药物干预措施。Meta分析结果显示,在减轻成人注射过程中疼痛方面,穴位按压优于常规注射。其余10种干预方法(两针头法、指压、使用shot blocker、Z径路、留置气泡、使用buzzy、综合干预、注射体位、伪穴按压、Z路径+留置气泡)的相关研究较少,尚不能确定其改善注射疼痛效果;但根据潜在有效性优劣结果排序提示,使用buzzy工具>使用shot blocker工具>皮肤牵拉、加压伴肌肉快速松解综合干预>伪穴按压>Z路径+留置气泡>两针头法>注射体位>注射点指压>Z径路法>留置气泡>常规注射。结论:现有证据表明穴位按压是缓解成人肌内注射部位疼痛的有效方式,但尚不能确定其余10种干预方法在缓解成人肌内注射引起的注射部位疼痛的有效性,建议开展更多研究以证实其潜在效果。     

苄星青霉素肌内注射方法的探讨

目的：探讨减轻患者肌内注射苄星青霉素的痛苦、提高注射成功率的方法。方法：将121例肌内注射苄星青霉素患者随机分为观察组和对照组,观察组采用利多卡因稀释药液,对照组采用灭菌注射用水稀释药液。比较两组患者一次注射成功率及注射后的疼痛程度。结果：两组患者一次注射成功率无显著差异（P〉0.05）,观察组的疼痛程度较对照组明显减轻,差异有显著性（P〈0.05）。结论：利多卡因稀释药液能有效减轻患者疼痛,提高注射成功率,安全易操作,值得推广。     

Compounding of vitamin A, D3, E and K3 supplements for cystic fibrosis patients: formulation and stability study

BACKGROUND AND OBJECTIVE: Cystic fibrosis (CF) patients suffer from malabsorption of fat-soluble vitamins (A, D, E and K). These vitamins are available as water-dispersible (A, D(3) and E) or water-soluble grades (K(3)), which is favoured in CF patients as they fail to absorb oil-based products. The objective of this study was to determine stability of these raw materials after opening the original package and to develop a compounded formulation of acceptable quality, stability and taste, allowing flexible dose adaptation and being appropriate for administration to children and elderly people. METHODS: The raw materials were stored after opening their original package for 8 months at 8 degrees C and room temperature (RT). Stability was assessed using a validated HPLC method after extraction of the vitamin from the cold water-soluble matrix (vitamin A acetate, D(3) and E) or using a spectrophotometrical method (vitamin K(3)). These materials were mixed with an appropriate lactose grade (lactose 80 m for vitamins A and D(3); lactose 90 m for vitamin E, lactose very fine powder for vitamin K(3)) and filled in hard gelatin capsules. Mass and content uniformity were determined and stability of the vitamins in the capsules was assessed after 2 months storage at 8 degrees C and RT. RESULTS: All raw materials showed good stability during storage in the opened original package for 8 months storage at 8 degrees C as well as RT (>95% of the initial content). The compounded formulations complied with the requirements of the European Pharmacopoeia for mass and content uniformity and can be stored for 2 months at 8 degrees C or RT while maintaining the vitamin content between 90% and 110%. CONCLUSIONS: As these fat-soluble vitamins are not commercially available on the Belgian market, compounded formulations are a valuable alternative for prophylactic administration of these vitamins to CF patients, i.e. a stable formulation, having an acceptable taste, allowing flexible dose adaptation and being appropriate for administration to children and elderly people.