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维生素K1注射液用法

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维生素K1注射液用法维生素K1注射液用法 维生素K1注射液用法:提倡皮下注射,谨慎配伍用药 维生素K1注射液为常用药,临床实践中发现给药方法静脉输液居多,部分为配伍用药,个别存在配伍禁忌。这样的给药方法常规并不不提倡。本文对维生素K1注射液用法相关资料予以整理,并列出部分常见的忌配文献,供临床使用参考。 1 维生素K1注射液的给药方法 1.1 药品说明书 其用法用量项下记载,(1)低凝血酶原血症:肌内或深部皮下注射,每次10mg,每日1,2次,24小时内总量不超过40mg。(2)预防新生儿出血:可于分娩前12,24小时给母亲肌注或缓慢静注...
维生素K1注射液用法
维生素K1注射液用法 维生素K1注射液用法:提倡皮下注射,谨慎配伍用药 维生素K1注射液为常用药,临床实践中发现给药方法静脉输液居多,部分为配伍用药,个别存在配伍禁忌。这样的给药方法常规并不不提倡。本文对维生素K1注射液用法相关资料予以整理,并列出部分常见的忌配文献,供临床使用参考。 1 维生素K1注射液的给药方法 1.1 药品 其用法用量项下记载,(1)低凝血酶原血症:肌内或深部皮下注射,每次10mg,每日1,2次,24小时内总量不超过40mg。(2)预防新生儿出血:可于分娩前12,24小时给母亲肌注或缓慢静注2,5mg。也可在新生儿出生后肌内或皮下注射0.5,1mg,8小时后可重复。(3)本品用于重症患者静注时,给药速度不应超过1mg/分。 1.2 2010年版药典《临床用药须知(化学药和生物制品卷)》 肌内、皮下注射或静脉注射。仅病情严重时采用静脉注射,注药速度每分钟不超过1mg。 1.3 卫生部合理用药专家委员会《中国医师药师临床用药指南》 本药肌内注射、静脉注射时可导致包括死亡在内的严重不良反应。对本药进行稀释和缓慢注射也可能引起严重不良反应,典型的类似于超敏反应或过敏反应,包括休克、心跳和(或)呼吸停止。有些患者在接受本药后第一时间就出现反应。因此肌内及静脉给药途径仅在皮下给药途径不可行且必须时才可使用。肠道吸收不良患者,采用皮下、肌内注射给药为宜;如仍采用口服,宜同时给予胆盐,以利吸收。静脉给药由于可引起呼吸循环意外,只适用于不能采用其他途径给药的患者,并应控制给药速度(开始10分钟只输入1mg,无明显反应时速率不超过1mg/min)。本药可稀释于5%葡萄糖注射液、5%葡萄糖氯化钠注射液或生理盐水中,不要使用其他稀释液。 1.4 《中国国家处方集》 (1)低凝血酶原血症,肌内或深部皮下注射,一次10mg ,一日1- 2 次, 24 小时内总量不超过40mg。(2)预防新生儿出血,可于分娩前12 - 24 小时给母亲肌内注射或缓慢静脉注射2- 5mg。也可在新生儿出生后肌内或皮下注射0.5 - 1mg, 8 小时后可重复。 1.5 《新编药物学》第17版 肌内注射或静脉注射。 1.6 《马丁代尔药物大典》第35版 静脉给维生素K1能引起严重的反应,类似超敏反应和过敏性反应。症状包括面色潮红、出汗、胸部压缩感和胸痛、呼吸困难、发绀、心血管性虚脱;也有报道可引起死亡。过敏反应通常与输注速度过快相关。但甚至也被报道出现在溶液被稀释和输入缓慢时。通常认为这是因为含有在一些肠外成分中作为面活性剂的多乙氧基化蓖麻油;而当配方中不含有多乙氧基化蓖麻油成分时,很少有关于该反应的报道。有报道在皮下、肌内、静脉内和口服使用维生素K后,发生超敏反应,尽管发生率很低。皮下给药被认为相比静脉途径,发生过敏反应的风险更低,静脉内使用后曾报道发生死亡。甚至在低剂量、缓慢给予以及稀释后输注时发生。 1.7 国家药品不良反应监测中心药品不良反应信息通报(第43期)《警惕维生素K1注射液的严重过敏反应》 维生素K1注射液说明书提示,维生素K1注射液一般应采用肌内和皮下注射的给药途径,特殊情况下患者可使用静脉注射。静脉注射时宜缓慢,给药速度不应超过1mg/分;静注过快,超过5mg/分,可引起面部潮红、出汗、支气管痉挛、心动过速、低血压等。病例报告分析显示,95.3,的严重不良反应/事件报告为静脉途径给药。文献报道中有一例患者半分钟内静脉注射维生素K1注射液10mg,导致严重不良反应。建议医务人员严格按照药品说明书规定的用法用量给药;选择合理的给药途径,并严格控制给药速度。 2 维生素K1注射液忌配的部分文献 见表1。 表1 维生素K1注射液忌配的部分文献 序药品名称 配伍摘要 参考文献 号 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 维生素K1与苯妥英钠混合2小时后可出1 苯妥英钠 现颗粒沉淀。 维生素K1与维生素C、维生素B12、右旋2 维生素B12 糖酐混合易出现混浊。 维生素K1说明书(上海第一 生化药业有限公司) 维生素K1与维生素C、维生素B12、右旋3 维生素C 糖酐混合易出现混浊。 维生素K1与维生素C、维生素B12、右旋4 右旋糖酐 糖酐混合易出现混浊。 硫酸阿米卡星注射液说明5 阿米卡星 阿米卡星不宜与其它药物同瓶滴注。 书(齐鲁制药有限公司) 硫酸奈替米星注射液说明硫酸奈替米6 硫酸奈替米星不宜与其他药物同瓶滴注。 书(江西钟山药业有限责任星 公司) 注射用头孢噻肟钠说明书7 头孢噻肟 头孢噻肟不能与其它注射溶液混用。 (德国赫司特公司) 头孢替唑钠与下列药物有配伍禁忌:盐酸 金霉素、氨茶碱、氯化钙、葡萄糖酸钙、注射用头孢替唑钠说明书 8 头孢替唑钠 盐酸苯海拉明等抗组胺药、去甲肾上腺(山东罗欣药业股份有限公素、间羟胺、苯妥英钠、维生素B族、维司) 生素。 垂体后叶素与维生素K1混合后出现理化、9 垂体后叶素 药动学及药效学等方面的配伍禁忌。 维生素K1与放线菌素D混合后出现理化、10 放线菌素D 药动学及药效学等方面的配伍禁忌。 复方氨基酸(-17)与维生素K1混合后出现复方氨基酸11 理化、药动学及药效学等方面的配伍禁(-17) 忌。 汤光编著.400种中西药注维生素K1与肝素钠混合后出现理化、药射剂临床配伍应用检索手12 肝素钠 动学及药效学等方面的配伍禁忌。 册.第1版.北京:中国医药 科技出版社.2008 维生素K1与谷胱甘肽混合后出现理化、13 谷胱甘肽 药动学及药效学等方面的配伍禁忌。 维生素K1与华法林钠混合后出现理化、14 华法林钠 药动学及药效学等方面的配伍禁忌。 磺胺嘧啶钠与维生素K1混合后出现理化、15 磺胺嘧啶钠 药动学及药效学等方面的配伍禁忌。 16 甲磺酸培氟甲磺酸培氟沙星与维生素K1混合后出现 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 沙星 理化、药动学及药效学等方面的配伍禁 忌。 两性霉素B与维生素K1混合后出现理化、17 两性霉素B 药动学及药效学等方面的配伍禁忌。 硫喷妥钠与维生素K1混合后出现理化、18 硫喷妥钠 药动学及药效学等方面的配伍禁忌。 硫酸长春新维生素K1与硫酸长春新碱混合后出现理19 碱 化、药动学及药效学等方面的配伍禁忌。 硫酸卡那霉硫酸卡那霉素与维生素K1混合后出现理20 素 化、药动学及药效学等方面的配伍禁忌。 硫酸美芬丁硫酸美芬丁胺与维生素K1混合后出现理21 胺 化、药动学及药效学等方面的配伍禁忌。 硫酸镁与维生素K1混合后出现理化、药22 硫酸镁 动学及药效学等方面的配伍禁忌。 硫酸庆大霉硫酸庆大霉素与维生素K1混合后出现理23 素 化、药动学及药效学等方面的配伍禁忌。 青霉素钠与维生素K1混合后出现理化、24 青霉素钠 药动学及药效学等方面的配伍禁忌。 三磷腺苷与维生素K1混合后出现理化、25 三磷腺苷 药动学及药效学等方面的配伍禁忌。 头孢匹胺钠与维生素K1混合后出现理化、26 头孢匹胺钠 药动学及药效学等方面的配伍禁忌。 维生素K1与戊巴比妥钠混合后出现理化、27 戊巴比妥钠 药动学及药效学等方面的配伍禁忌。 盐酸多巴酚丁胺与维生素K1混合后出现盐酸多巴酚28 理化、药动学及药效学等方面的配伍禁丁胺 忌。 盐酸多柔比维生素K1与盐酸多柔比星混合后出现理29 星 化、药动学及药效学等方面的配伍禁忌。 盐酸克林霉盐酸克林霉素与维生素K1混合后出现理30 素 化、药动学及药效学等方面的配伍禁忌。 盐酸雷尼替盐酸雷尼替丁与维生素K1混合后出现理31 丁 化、药动学及药效学等方面的配伍禁忌。 盐酸四环素与维生素K1混合后出现理化、32 盐酸四环素 药动学及药效学等方面的配伍禁忌。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 氧氟沙星与维生素K1混合后出现理化、33 氧氟沙星 药动学及药效学等方面的配伍禁忌。 异戊巴比妥异戊巴比妥钠与维生素K1混合后出现理34 钠 化、药动学及药效学等方面的配伍禁忌。 重酒石酸去甲肾上腺素与维生素K1混合重酒石酸去35 后出现理化、药动学及药效学等方面的配甲肾上腺素 伍禁忌。 氨苄西林钠(2% pH值8.2)与维生素36 氨苄西林钠 K1(10mg/ml pH值5.0-6.5)配伍不妥。 氨苄西林-舒巴坦钠(1.5% pH值氨苄西林-37 8.0-10.0)与维生素K1(10mg/ml pH值舒巴坦钠 5.0-6.5)配伍不妥,或忌配。 唐镜波编著.新编268种注维生素K1(10mg/ml pH值5.0-6.5)与苯巴射液理化与治疗学配伍检比妥钠(2% pH值9.6)忌配,混合后可能索表.第4版.郑州:河南科38 苯巴比妥钠 出现浑浊、沉淀、产气、变色、失效、增学技术出版社.2004 毒或拮抗。 维生素K1(10mg/ml pH值5.0-6.5)与谷氨 酸钠(28.75% pH值7.5)忌配,混合后可39 谷氨酸钠 能出现浑浊、沉淀、产气、变色、失效、 增毒或拮抗。 实验结果显示,维生素K1与10%氯化钾的 配伍液的PH值在开始时骤急上升,然后10%氯化钾40 随着时间的变化趋于平稳,说明配伍变化注射液 发生在起始阶,两个药品之间存在配伍禁张瑛,习丹,赖小平.维生忌。 素K1与维生素C等药物配 伍的稳定性研究.药品评实验结果显示,维生素K1与维生素B6的 价.2005,2(5):369 配伍液的PH值在开始时骤急上升,然后维生素B6注41 随着时间的变化趋于平稳,说明配伍变化射液 发生在起始阶,两个药品之间存在配伍禁 忌。 国家基本药物(西药).国家 药品监督管理局安全监管 司,国家药品监督管理局药42 鱼精蛋白 鱼精蛋白宜单独给药。 品评价中心编.第二版.北 京:人民卫生出版 社,2002:561 《中成药临床应用指导原则》强调: 临中成药临床应用指导原则 43 中药注射剂 床中西注射剂联用时应谨慎考虑两种注(国中医药医政发〔2010〕射剂的使用间隔时间以及药物相互作用。30号).国家中医药管理 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 给药时尽可能选择不同的给药途径(如穴局.2010-6-11 位注射、静脉注射),如必须同一途径用 药时,应将中西药分开使用。 3 讨论 尽管不同文献对维生素K1的用药方法与配伍描述略有差异,从安全用药角度,提倡常规皮下注射给药,重症患者需要静注时控制给药速度,鉴于配伍禁忌药物甚多,不使用5%葡萄糖注射液、5%葡萄糖氯化钠注射液或生理盐水之外的含有其他药物的稀释液,应当是比较理想的。在给药方法的常规选择上,还应注意的一点是,不同疾病及严重程度的区别,对选择合适的用法也是有所区别,过多的静脉输液途径用药与病情严重程度的正常分布并不相符,说明临床在给药途径选择上存在相应偏颇,宜引起重视并建议改进。既往的用药习惯随着医药学科的进展,应当予以必要的修正与完善。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions
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