ICU患者并联输注多种药物致静脉导管堵塞的体外药物配伍研究

In-vitro study on multi-drug compatibility for an ICU patient happened with intravenous catheter blockage

目的:探讨1例ICU患者采用三通阀输液器并联输注多种静脉药物致导管堵塞的原因,为临床药师重点关注ICU患者静脉联用多种药物的安全性提供实践参考。方法:取患者同时在用的4种药物:氯化钾注射液、丙泊酚中/长链脂肪乳注射液、间羟胺注射液和地佐辛注射液,进行体外药物配伍试验,经整体混合及分别混合(丙泊酚与其他3种药物分别配伍),在电子显微镜下观察配伍后不同时间段药液的变化情况。结果:4种药液混合后,丙泊酚由最初匀质的小粒径乳滴(0.43μm)逐渐聚集增大,稳定性下降,最大乳滴粒径为3.45μm。进一步分别配伍试验证明了丙泊酚与间羟胺配伍时,乳滴蓄积与融合速度最快,4 h乳滴粒径达10.36μm,已超过毛细血管平均直径;与氯化钾配伍时,乳滴蓄积与融合速度居中;与地佐辛配伍时,蓄积与融合速度最慢。结论:丙泊酚与间羟胺存在严重的配伍禁忌,应避免同时使用;与其他药物配伍时,其稳定性也会不同程度下降,建议采用双腔或多腔静脉导管单独一路输注丙泊酚中/长链脂肪乳。

OBJECTIVE To discuss the reason of catheter blockage caused by co-administration of multiple intravenous medicines in an ICU patient, and to offer a useful reference for clinical pharmacists to focus on the safety of intravenous transfusion in ICU patients.METHODS Take 4 drugs simultaneously used by the patient: potassium chloride injection, propofol medium/long chain fat emulsion injection, metaraminol injection and dizocine injection for in vitro drug compatibility test.After overall mixing and separate mixing(propofol and other 3 drugs are separately mixed),observe the changes of drug solution at different time periods after compatibility under electron microscope.RESULTS After mixing the four drugs, propofol emulsion droplets gradually aggregated from 0.43 μm to 3.45 μm.Further experiments proved that propofol was incompatible with metaraminol.Emulsion droplets aggregated rapidly and the diameter of biggest particle reached 10.36 μm in 4 hours which exceeded the average diameter of capillaries.Propofol emulsion also became unstable when mix it with potassium chloride or dezocine injection.CONCLUSION Propofol is incompatible with metaraminol, and co-administration of these two drugs should be avoided.The stability of the propofol emulsion will also decrease when it is infused with other drugs.Separate intravenous infusion of propofol is recommended.