临床药师对1例静脉输液中不明絮状物的分析

Analysis of a Case of Unknown Floss in Intravenous Drug Infusion by Clinical Pharmacists

目的:通过分析1例马来酸桂哌齐特输液中不明絮状物进而解决用药纠纷,为临床药师参与临床用药实践提供新思路。方法:将马来酸桂哌齐特输液过程中出现的不明絮状物在无菌条件下分离,分别利用营养琼脂低温培养,倒置显微镜下形态观察,以及低温干燥后进行红外光谱扫描等手段,确定絮状物成分,并分析原因。结果:红外光谱分析显示该絮状物具有糖类、蛋白质、脂肪酸和核酸的典型结构特征。琼脂培养基也培养出了成簇的丝状真菌,倒置显微镜下可见该培养物与不明絮状物性状相同,均现黑色交错丝状菌丝,其上还有膨出的孢子,进而从形态学上进行了辅助证明。该絮状物为真菌。结论:为避免临床输液意外,每组药物输注间歇应适当冲管,同时推荐使用精密过滤输液器。

OBJECTIVE： To provide new strategy for clinical pharmacists participating in clinic medication practice to deal with medication dispute caused by unknown floss in infusion of cinepazide maleate. METHODS： The unknown floss was isolated during infusion of cinepazide maleate under sterile condition, and then cultured in agar medium under low temperature. The un- known floss was observed under inverted microscope, and the components were determined by infrared spectroscopy scanning after low temperature drying. The components of unknown floss were determined, and its reasons were analyzed. RESULTS： Infrared spectroscopy scanning showed that the floss displayed classic structural characteristics of saccharide, protein, fatty acid and nucleic acid. Clustering filamentous fungi were seen in the agar culture. Both the floss and the floss culture showed black cross-linked hy- pha with torous spores under the microscope. The morphology observation assisted to prove that fungi contamination existed in the cinepazide maleate infusion. The m^nown floss was fungi. CONCLUSIONS： In order to avoid infusion accident, precision filter in- fusion set should be used and the infusion tube should be rinsed routinely in the interval of two infusions.