Xyoo 1851, tus kws kho mob Lavxias los ntawm tsev kho mob tub rog hauv Vladikavkaz tau ua thawj zaug txhaj tshuaj subcutaneous ntawm daim ntawv ntau npaum. Rau kev txhaj tshuaj, ib daim ntawv ua kua ntawm cov tshuaj tau siv. Txij li thaum tsis muaj cov koob txhaj tshuaj nyob rau hauv daim ntawv uas peb tau siv los pom lawv niaj hnub no, nws tau siv ib feem ntawm lub raj barometric nrog lub piston. Nyob rau hauv lub dawb kawg yog tsau ib tug ntsis ntawm nyiaj, zoo li tus koob. Ib xyoos tom qab, ib lub koob txhaj tshuaj tsim los ntawm kws kho mob los ntawm Czech koom pheej - Pravac pib siv rau kev txhaj tshuaj.
Definition, txiaj ntsig ntawm kev xaiv
Raws li lub ntsiab lus ntawm ntau npaum li cas cov ntaub ntawv rau kev txhaj tshuaj, nws yog ib txwm ua kom nkag siab cov hmoov thiab aqueous sterile, oily daws, emulsions thiab ncua kev kawm ntawv, ntsiav tshuaj uas yuav tsum xub yaj. Lawv tau nkag mus rau hauv lub cev nrog lub koob txhaj tshuaj, ua txhaum kev ncaj ncees ntawm daim tawv nqaij. Yog hais tias lub ntim ntawm cov tshuaj yog loj heev (ntau tshaj 100 ml), cov tshuaj yog muab los ntawm infusion, infusion method.
Cov txiaj ntsig tseem ceeb ntawm kev siv cov ntaub ntawv ua kua rautxhaj tshuaj:
- Kev ua tam sim (cov nyhuv tshwm sim sai li sai tau thaum cov tshuaj nkag mus rau hauv lub cev).
- Daim ntawv txhaj tshuaj tsis cuam tshuam rau lub plab zom mov, daim siab, tsis txhob ua txhaum cov tshuaj pharmacological ntawm lwm cov tshuaj (hormones, tshuaj tua kab mob, insulin).
- Koj tuaj yeem muab tshuaj rau tus neeg tsis nco qab.
- Cov tshuaj feem ntau tsis qab thiab tsis hnov tsw.
Disadvantages of application
Ntau tus neeg nco txog qhov tsis xis nyob thaum lawv yuav tsum tau txhaj tshuaj. Txhua yam kev puas tsuaj rau daim tawv nqaij ua rau mob. Qhov no yog qhov laj thawj tseem ceeb ntawm kev tsis kam kho nrog kev txhaj tshuaj. Koj yuav tsum tsis txhob cais qhov kev pheej hmoo ntawm kev kis kab mob nkag mus rau hauv cov hlab ntsha, tsim cov hematomas, pob. Nws yog ib qho tseem ceeb uas yuav tau mus rau txoj kev no ntawm kev tswj hwm ntawm daim ntawv ntau npaum li cas hauv ib lub tsev kho mob tshwj xeeb. Qhov no yog qhov tsim nyog yuav tsum tau ua kom zoo, vim tias ib qho ntawm qhov tsis xav tau yog qhov nkag ntawm cov pa npuas lossis cov khoom siv rau hauv lub cev, qhov kev pheej hmoo ntawm kev kis kab mob HIV thiab kab mob siab.
Nrog rau kev qhia txog qee cov tshuaj kho mob rau kev txhaj tshuaj, tej zaum yuav muaj qhov kub hnyiab, mob hnyav, tsis tshua muaj tshwm sim, febrile tshwm sim. Txij li thaum cov tshuaj tau muab faib mus rau hauv lub circulatory system, yog hais tias tus txheej txheem yog nqa tawm nyob rau hauv ib tug maj, nrog rau ib tug ua txhaum ntawm cov tshuaj dilution txheej txheem, kiv taub hau, ib tug txo nyob rau hauv cov ntshav siab, thiab txawm fainting tej zaum yuav tshwm sim. Nyob rau hauv ib chav tsev tsis muaj cuab kav, nyob rau hauv qhov tsis muaj cov neeg ua haujlwm tsim nyog, thawjkev pab kho mob.
Kua daws
Tshuaj tuaj yeem tsim hauv ampoules lossis vials, tsim los ntawm cov chaw tsim khoom tshwj xeeb. Txhawm rau txiav txim siab cov tshuaj ntawm daim ntawv ntau npaum li cas rau kev txhaj tshuaj, cov ntaub ntawv siv hais txog lub npe, ntim, concentration, hnub tsim khoom thiab hnub tas sij hawm.
Nrog kev pab los ntawm kev kho mob diluent (xws li dej distilled, roj rog, cawv), cov tshuaj tuaj yeem npaj rau kev siv tom qab. Cov ntaub ntawv hmoov ntau rau kev txhaj tshuaj yog diluted nrog sodium chloride, qabzib, novocaine. Yog li ntawd, cov kua yuav tsum tsis txhob muaj impurities, cov sediment feem ntau yog pob tshab.
Cov kuab tshuaj rau kev npaj cov khoom siv tshuaj
Kev siv cov kua yog tsim nyog los yaj cov hmoov daim ntawv ntawm cov tshuaj. Cov tshuaj hu ua "Dej rau kev txhaj tshuaj", nws tus nqi kuj qis, koj tuaj yeem yuav nws ntawm txhua lub khw muag tshuaj. Thaum siv, lawv sau cov dej los ntawm lub ampoule thiab ncuav nws mus rau hauv lub vial nrog cov tshuaj, dilute nws kom tsis txhob muaj me me lumps.
Thaum sau ntawv sau tshuaj rau cov ntawv txhaj tshuaj, tus kws kho mob feem ntau qhia tias yuav tsum tau yuav cov tshuaj twg ntxiv. Cov roj uas tsis muaj dej muaj xws li roj xws li castor, txiv ntseej, paj rwb, txiv maj phaub, lossis txiv duaj. Nws yuav tsum tau deodorized, refined. Vim lub fact tias cov roj yog viscous nyob rau hauv cov qauv, txhaj tshuaj nrog lawv yog mob, muaj kev pheej hmoo ntawm kev tsim.granulomas. Ethyl ether tuaj yeem siv los txo qis viscosity me ntsis.
Yog tus kws kho mob tau sau cov vitamins ntawm pab pawg B hauv ampoules rau kev txhaj tshuaj, ces ethyl oleate tuaj yeem siv los ua cov kuab tshuaj. Nws muaj peev xwm zoo dua rau dilute cov tshuaj, nws yooj yim absorbed dua oily sawv daws yuav. Haum rau cov ntaub ntawv tshuaj hormonal. Thaum sau cov vitamins A thiab D, tshuaj tua kab mob, barbiturates, sulfonamides, alkaloid bases, propylene glycol yog siv.
Ethanol raug xaiv los ua tshuaj tua kab mob thiab hnyav rau kev txhaj tshuaj ntawm lub plawv glycosides (strophanthin K, convallatoxin). Hauv qhov kawg, glycerin tseem yuav ua haujlwm zoo ntawm lub luag haujlwm no. Nrog nws, kev txhaj tshuaj ntawm fetanol, mezaton, dibazol thiab lwm yam yog tsim.
Uss
Nyob ntawm seb qhov twg ntawm lub cev tau txhaj tshuaj, nws yog ib txwm ua kom paub qhov txawv ntawm cov hauv qab no ntawm daim ntawv thov:
- Intramuscular.
- Subcutaneous thiab intradermal.
- - intravascular, intracavitured thiab intraossous.
- Nyob hauv kab ntawm lub hlwb.
Feem ntau ntawm cov saum toj no tsuas yog ua los ntawm cov kws kho mob uas tsim nyog hauv lub tsev kho mob. Intramuscular, raws li txoj cai, ntau tus tuaj yeem ua hauv tsev. Kev txawj ntse, tsis muaj menyuam thiab kev ntseeg siab ntawm tus kheej ua yog qhov tseem ceeb ntawm no.
Intramuscular
Kev tshuaj tiv thaiv kab mob los ntawm tus kws kho mob feem ntau txwv rau cov vitamins B.tsev muag tshuaj. Cov kua ntshiab muaj xim daj-ntsuab ntsuab, nrog cov yam ntxwv tsw ntawm thiamine. Cov tshuaj yog txhaj intramuscularly rau hauv femoral, deltoid lossis gluteal leeg, ntawm kaum ntawm 90 degrees. Qee pab pawg vitamin kuj tuaj yeem muab tso rau hauv cov hlab ntsha.
Rau ib daim ntawv thov, los ntawm 1 mus rau 20 ml ntawm kev daws yog txhaj, qee zaum, yog tias muaj cov lus qhia, 50-70 ml. Daim ntawv ntawm cov tshuaj tuaj yeem yog ib qho, ncua kev txhaj tshuaj, oily, aqueous daws, emulsions. Nws yuav tsum to taub tias cov txheej txheem nqus tau qeeb, yog li nws raug pom zoo kom nyob twj ywm rau qee lub sijhawm tom qab cov txheej txheem.
Cov roj daws, tshem tawm, emulsions muab cov tshuaj maj mam nkag mus rau hauv lub cev, tsim ib hom "depot". Cov no suav nrog cov tshuaj tiv thaiv hormonal, anabolic steroids. Daim ntawv no ua rau lub sijhawm ntev ntawm cov tshuaj, qee zaum ob peb lub hlis. Tom qab cov txheej txheem, nws yog ib qho tsim nyog los xyuas kom meej tias tom qab txhaj tshuaj abscess tsis tsim.
Ntxiv rau cov tshuaj saum toj no, cov tshuaj tiv thaiv kab mob khaub thuas, kab mob siab A, rabies, morphine, penicillin, prednisolone, codeine thiab lwm yam tuaj yeem txhaj tshuaj intramuscularly. Tag nrho cov no tau sau los ntawm tus kws kho mob thiab tsis tuaj yeem pom zoo rau kev kho tus kheej.
YIntradermal thiab subcutaneous
Txhua daim ntawv txhaj tshuaj yuav tsum tau ntim rau hauv cov thawv tsis muaj menyuam. Kev txhaj tshuaj intradermal yog nkag mus rau hauv txheej txheej sab saud ntawm cov epidermis, qhov ntim ntawm cov kua yog 0.2-0.5 ml, piv txwv li, Tuberculin. Nwspaub rau ntau tus thaum kuaj Mantoux tiav. Nyob rau hauv cov ntaub ntawv no, lub koob yog siv nrog ib tug beveled taub, raws li ib tug tshwm sim ntawm kev txhaj tshuaj ntawm cov tshuaj, ib tug npuas daim ntawv nyob rau hauv daim tawv nqaij, ib tug me me foob.
Thaum txhaj tshuaj subcutaneous, koob nce mus txog cov rog subcutaneous. Qhov ntim ntawm ib qho tshuaj noj yog 1-2 ml. Yog tias siv cov tshuaj drips, tom qab ntawd txog li 500 ml ntawm cov tshuaj tuaj yeem siv rau ib zaug. Subcutaneous, nyob rau hauv uas ib tug emulsion nyob rau hauv ib tug ntau npaum daim ntawv yog siv rau kev txhaj tshuaj, sai sai nkag mus rau hauv cov hlab ntsha thiab kis thoob plaws lub cev. Raws li txoj cai, cov txheej txheem yog nqa tawm hauv thaj tsam ntawm sab hauv ntawm caj npab, hauv plab plab, ncej puab.
Hom tshuaj tseem ceeb tshaj plaws: insulins thiab heparins. Yog tias tsim nyog kom ncua lawv qhov kev txiav txim, ces cov roj tov, emulsions lossis ncua kev kawm ntawv yog siv los ua ib qho diluent. Rau qhov nws yuav tsim nyog rau nruab ib lub cuab yeej tshwj xeeb uas muaj microcapsule ntawm cov tshuaj nyob rau hauv daim phiaj siv tshuaj.
Cov muaj pes tsawg leeg ntawm cov kuab tshuaj rau kev npaj cov ntawv ntau npaum rau kev txhaj tshuaj yog nyob ntawm tus nqi ntawm nws qhov nqus. Qhov qeeb tshaj plaws nws tshwm sim hauv cov roj, thiab dej, ntawm qhov tsis sib xws, nkag mus rau hauv lub cev sai dua. Lub ntsiab yuav tsum tau ua thaum ua raws li cov txheej txheem no yog kom muaj tus naj npawb txaus. Txij li thaum muaj qhov tshwm sim ntau ntawm kev puas tsuaj rau cov ntaub so ntswg, tsim ntawm hematomas. Raws li txoj cai, thaum siv cov cua sov thiab noo noo, cov infiltrates sai sai daws.
Intravascular, intracavitary thiab intraosseous cov txheej txheem
rau intravascularsuav nrog intra-arterial (nws tuaj yeem yog brachial, carotid lossis femoral artery) thiab cov hlab ntsha (qhia rau hauv subclavian lossis ulnar). Phosphate los yog erythromycin ascorbate yog siv los ua cov kuab tshuaj. Cov tshuaj yuav tsum tau ua aseptically, kom tsis muaj menyuam. Cov nyhuv ntawm qhov kev taw qhia ntawm daim ntawv ntau npaum yog ua tiav nyob rau hauv ib lub vib nas this.
Yog tias peb tham txog kev txhaj tshuaj intravascular, tom qab ntawd cov txheej txheem tshwj xeeb rau kev txhaj tshuaj ntawm cov kua dej yog siv rau qhov no. Qhov tshwm sim ntawm tus txheej txheem tsis raug:
- hematoma, uas yog tsim los ntawm kev puas tsuaj rau cov leeg;
- air embolism (kev thaiv ntawm cov hlab ntsha nrog cua npuas);
- paj puas;
- thov ntawm txoj hlab ntshav.
Nws yog ib qho tseem ceeb heev rau kev ntseeg siab rau kev tswj hwm ntawm kev txhaj tshuaj intramuscular rau cov neeg ua haujlwm kho mob tsim nyog.
Ib yam tshwj xeeb ntawm cov txheej txheem intravascular yog kev siv cov dej-raws li kev daws teeb meem nkaus xwb. Lawv yuav tsum tsis txhob ua rau cov ntshav txhaws, hemolysis ntawm cov qe ntshav liab, thiab tsis muaj kev cuam tshuam rau cov phab ntsa ntawm cov hlab ntsha. Nws tsim nyog yuav cov dej tsis huv rau kev txhaj tshuaj, tus nqi qis dua, ntxiv rau, nws raug muag hauv khw muag tshuaj ze ntawm tsev.
Yog tias thaj chaw ntawm kev siv tshuaj yog nyob rau hauv qee cov hlab ntsha, tom qab ntawd kev tswj hwm hauv cov hlab ntsha yuav tso cai rau hauv zos ua haujlwm rau nws. Ua cov txheej txheem intracavitary thiab intraosseous yuav tsum tau ua nyob rau hauv ib lub tsev kho mob tshwj xeeb, los ntawm tus kws tshaj lij.
Nyob hauv lub plhaub ntawm lub hlwb
Qhov kev pom nosiv rau kev txhaj tshuaj intracranial thiab txha caj qaum. Thawj txoj kev yog siv nrog kev qhia txog kev daws teeb meem ntawm streptomycin thaum muaj kab mob meningitis. Daim ntawv npaum li cas ntawm cov tshuaj tsuas yog ib qho aqueous, nruab nrab cov tshuaj tiv thaiv, qhov ntim ntawm cov tshuaj tau muab rau ib lub sij hawm yog ib mus rau ob milliliters. Cov nyhuv ntawm daim ntawv thov yog tiav tam sim ntawd. Cov txheej txheem tsuas yog ua tau los ntawm tus kws kho mob lossis tus kws saib xyuas neeg mob uas paub txog hauv lub chaw kho mob.
Txoj kev thib ob feem ntau pom nrog kev qhia txog tshuaj loog lossis tshuaj tua kab mob. Cov tshuaj tsuas tuaj yeem yog dej-raws li, muaj qhov nruab nrab pH ntawm 5 mus rau 8. Qhov chaw rau cov txheej txheem yog nyob rau hauv lub epidural thiab subarachnoid qhov chaw ntawm lub 3rd thiab 4th lumbar vertebrae. Qhov phom sij ntawm kev txhaj tshuaj tsis muaj kev phom sij yog qhov kev pheej hmoo ntawm kev puas tsuaj rau lub davhlau ya nyob twg ntawm tus txha caj qaum, vim li ntawd, kev tuag ntawm ob txhais ceg yuav tshwm sim. Tau ua hauv tsev kho mob.
Basic application rules
Nws yog ib qho tseem ceeb uas yuav tsum tau ua raws li qhov yuav tsum tau ua rau cov ntaub ntawv ntau npaum li cas rau kev txhaj tshuaj, tswj hnub thiab hnub tas sij hawm ntawm kev siv, kub thaum khaws cia. Rau cov txheej txheem, nws yog ib qhov tsim nyog los npaj cov cuab yeej: ib lub koob txhaj tshuaj nrog ib rab koob, dej cawv so, dilution tov, ampoule nrog tshuaj. Nws yog ib qho tseem ceeb uas yuav tsum tau saib xyuas cov xwm txheej khaws cia rau cov ntaub ntawv ntau npaum li cas thiab txhaj tshuaj txhawm rau tiv thaiv kev siv tshuaj lwj.
Kev nyab xeeb yog ua raws li cov txheej txheem ntawm tes huv si, nyiam dua kho nrog cawv. Ua ntej npaj rau kev txhaj tshuaj, nws yog ib qho tsim nyog yuav tau xaiv lub koob txhaj tshuaj zoo. Nws txawvntim, ob- thiab peb-khoom, imported los yog Russian-made.
Lub koob txuas nrog lub koob txhaj tshuaj, cov kua yog shaken tawm ntawm lub taub ntawm ampoule, piv txwv li, maj mam tapping nrog tus ntiv tes. Yog hais tias lub ampoule yog iav, ces nyob rau hauv txoj kab uas hla nws yuav tsum tau ua ntaub ntawv nrog ib tug tshwj xeeb ntaus ntawv (raws li txoj cai, nws los nrog kev npaj). Txhawm rau tiv thaiv koj cov ntiv tes, koj tuaj yeem qhwv nws nrog ib daim ntaub so ntswg thiab tawg nws ntawm lub saw txiav. Tom ntej no, koj yuav tsum tau sau cov tshuaj los ntawm lub ampoule thiab nyem tawm cov cua tshaj nrog ib tug piston los ntawm lub syringe.
Yog tias txhaj tshuaj tau ua tiav, ces koj yuav tsum rub caj npab saum lub luj tshib nrog lub tourniquet, thiab tam sim ntawd tom qab qhov kawg ntawm txoj kev, nws yuav tsis muaj zog. Qhov chaw txhaj tshuaj yog kho nrog tshuaj tua kab mob. Ua ntej txhaj tshuaj, xyuas seb lub koob tau nkag mus rau hauv cov hlab ntsha los yog tsis. Txhawm rau ua qhov no, rub lub piston ntawm nws tus kheej kom txog thaum cov ntshav tshwm hauv cov koob txhaj tshuaj. Yog tias nws cov xim tsaus, ces koj tuaj yeem nkag mus rau cov tshuaj. Nws tshwm sim tias qhov chaw ntawm cov hlab ntsha hauv lub luj tshib khoov tsis tso cai rau cov txheej txheem, thiab tom qab ntawd nws yuav tsum tau muab cov tshuaj rau sab nraub qaum ntawm lub dab teg. Txhawm rau zam qhov tsim ntawm hematoma, caj npab khoov ntawm lub luj tshib yuav tsum tuav 5 feeb.
Intramuscular txhaj tsis tas yuav npaj tshwj xeeb rau ntawm tus neeg mob. Tus uas ua tus txheej txheem yuav tsum paub nyob rau hauv qhov chaw txhaj tshuaj. Los ntawm visually faib lub pob tw rau hauv plaub qhov chaw, koj tuaj yeem txiav txim siab qhov chaw zoo rau kev tswj xyuas. Qhov chaw zoo tshaj plaws yog suav tias yog lub sab sauv sab nrauv. Yog li, nws muaj peev xwm zam tau cov tshuaj mus rau hauv cov hlab ntsha sciatic. Yog koj txhaj koj tus kheejntawm koj tus kheej, koj tuaj yeem xaiv thaj tsam ntawm qhov chaw sab nrauv ntawm tus ncej puab, txawm li cas los xij, qhov no tsis yooj yim heev.
Thaum lub sijhawm txhaj tshuaj intramuscular, qhov mob tseem ceeb yog qhov kev taw qhia maj mam thiab du qhovntsej thiaj tsis mob ntawm lub piston. Qhov ntev ntev ntawm rab koob yog tsis ntau tshaj 5 cm, qhov no yuav txo tau qhov mob thaum lub sij hawm tus txheej txheem thiab ua tsis tau tom qab txhaj tshuaj seals. Yog tias cov tshuaj txhaj tshuaj sai dhau lawm, tus neeg mob yuav hnov mob hnyav, kev tsim cov tshuaj stagnation tuaj yeem ua tau thiab ua pob ntxiv ntawm qhov chaw txhaj tshuaj tsis tuaj yeem zam tau.
Tom qab ua tiav cov kev tswj hwm, qhov chaw ua haujlwm yuav tsum tau ntxuav. Siv vials, syringe, paj rwb swabs - pov tseg.
