各科输液反应的抢救顺序,每一步你都清楚了吗?

2019-10-22 佚名 纳洛酮的护理天地

为大家介绍几个常见的输液反应临床抢救顺序,供大家学习参考。

今日为大家介绍几个常见的输液反应临床抢救顺序,供大家学习参考。

一、过敏性休克的抢救顺序

过敏性休克0.1%盐酸,肾上腺素0.5-1.0毫升静注、继以1毫升肌注或皮下注射、必要时重复抗组胺药:如非那根25~50毫克肌注,保证呼吸道通畅,必要时气管切开、吸氧、氢化可的松200~400毫克,加入100毫升葡萄糖液中静滴,酌情选用血管活性药。

二、过敏性休克诊断要点及抢救措施


1、有过敏接触史;

2、表现胸闷、喉头堵塞感、继而呼吸困难、发绀、濒死感,严重者可咳出粉红色泡沫样痰;

3、常有剧烈的肠绞痛,恶心、呕吐、或腹泻;

4、意识障碍,四肢麻木、抽搐、失语、大小便失禁、脉细弱、血压下降

抢救:

1、立即应用肾上腺素;

2、静脉快速注入肾上腺皮质激素;

3、扩容;

4、吸氧或高压给氧;

5、给予钙剂及抗组胺药物;

6、及时处理喉头水肿、肺水肿、脑水肿等;

措施:

1、0.1%肾上腺素0.5~1.0毫升肌注或静注;

2、去甲肾上腺素1~4毫克溶于500毫升溶液中静滴;

3、地塞米松10~20毫克加5%葡萄糖100毫升(静滴);

4、10%葡萄糖酸钙20毫升,静脉缓注;

5、氨茶碱0.25克加50%糖40毫升静脉缓注;

6、平衡晶水:500~1000毫升静滴。

三、循环负荷过重(急性肺水肿)诊断要点及抢救措施

诊断:

1、严重的呼吸困难,端坐呼吸,口唇发绀,大汗淋漓;

2、阵发性咳嗽,伴有白色或粉红色泡沫样痰;

3、肺部可扪及湿性罗音与鼾鸣声或大量痰鸣音;

抢救:

1、吸氧或高压给氧;

2、选用血管扩张剂;

3、选用强心、利尿剂;

4、给激素药物;

5、四肢轮流结扎、半坐位。

急救:

1、吗啡10毫克,皮下注射;

2、西地兰0.4~0.6毫克加50%糖20毫升静脉缓注;

3、速尿40毫克加50%糖20毫升(静脉缓注);

4、硝酸甘油0.5毫克或硝酸异山梨醇10毫克舌下含服;

5、硝普钠5~10毫克与5%糖100毫升(静缓滴)直至症状体征消失(注意血压)

6、酚妥拉明1.5~3.0毫克,50%糖40毫升(10分钟静注完)

四、输液反应和防治

输液反应:

(一)反热反应,症状:发冷、寒战和发热,严重者初起即寒战、继之高热达40-41℃并有恶心、 呕吐、头痛、脉速等症状;防治:减慢滴注速度或停止输液,并通知医生;

(二)(肺水肿)循环负荷过量:症状:突然出现呼吸困难气促、咳嗽、泡沫痰或泡沫血性痰、肺部出现湿罗音。

(三)静脉炎症状:出现条索状红线、局部组织发红、肿胀、灼热、疼痛。

(四)空气栓塞症状:病员胸部感到异常不适,发生呼吸困难和严重紫绀,听诊心前区可扪及响亮的,持续的“水泡音”

防治:

(1)输液过程中注意滴注速度不宜过快,液量不可过多;

(2)如发现症状须立即使病员端坐,两腿下垂,减少静脉回流;

(3)加压给氧,使氧气经20~30%酒精湿化后吸入;

(4)按医嘱给镇静剂和扩血管药物及毛地黄等强心剂;

(5)必要时四肢轮流结扎;

防治:

(1)严格执行无菌技术操作,对血管刺激的药物,要有计划更换注射部位。

(2)患肢抬高并制动,局部用95%酒精或50%硫酸镁行热湿敷;

防治:

(1)置病人有左侧卧位和头低足高位;

(2)氧气吸入;

(3)加压输液时严密观察;护士不得离开病人。

五、输液反应谨慎处理

输液反应有危险,谨慎处理莫慌乱。输液反应是医疗活动中极为常见的现象,其本身并无致死性。

但它可诱导病人基楚疾病恶化而带来生命危险。临床中应重在防范;一旦发生,判断要准确,处置要果断。

至于输液反应时皮下注射肾上腺素则应慎重。原因是输液反应不是速发型过敏反应,用肾上腺素违背了输液反应的病理机制,肾上腺素是儿茶酚胺类药物,有快速升压效应,用于速发型过敏反应是正确的;

另外,肾上腺素的升压效应会使原有高血压的病人病情恶化。当然,在一时不能判断出是输液反应还是速发型过敏反应时,小心使用也未尝不可;

在输液反应又合并血压急速下降时使用也是对的。

至于烦躁不安时镇静剂的使用也应慎重。实践证明,输液反应经上述处理大多能很快安静下来,不再需要用镇静剂;

对这种病人用镇静剂也会掩盖病情变化。再需要用镇静剂;对这种病人用镇静剂也会掩盖病情变化。

各科输液反应的临床抢救顺序,每一步你都清楚了吗?

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    2022-09-23 ms8000001294115901

    学习了!谢谢老师!

    0

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    2019-10-24 一天没事干

    很好的学习机会

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2089899, encodeId=e63c20898992a, content=学习了!谢谢老师!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26828342170, createdName=ms8000001294115901, createdTime=Fri Sep 23 09:31:23 CST 2022, time=2022-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940655, encodeId=629f1940655cc, content=<a href='/topic/show?id=e99e93e914a' target=_blank style='color:#2F92EE;'>#输液反应#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93791, encryptionId=e99e93e914a, topicName=输液反应)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Fri Sep 25 22:07:00 CST 2020, time=2020-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374327, encodeId=37bb3e4327b2, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Thu Oct 24 11:14:11 CST 2019, time=2019-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1471380, encodeId=acd114e13802b, content=<a href='/topic/show?id=ac13558e9cb' target=_blank style='color:#2F92EE;'>#抢救#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55879, encryptionId=ac13558e9cb, topicName=抢救)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=be1a7117101, createdName=lfyang, createdTime=Wed Oct 23 18:07:00 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374273, encodeId=99533e427355, content=好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 23 05:59:08 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374219, encodeId=a63a3e4219fe, content=受教了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4dc5091922, createdName=145d5865m01暂无昵称, createdTime=Tue Oct 22 08:42:31 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374218, encodeId=415c3e4218e7, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/21/e031c1d6c6115cbe1737b2149e602c1d.jpg, createdBy=3c105212218, createdName=147612bem32暂无昵称, createdTime=Tue Oct 22 08:40:33 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374212, encodeId=3def3e4212ed, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Oct 22 07:42:36 CST 2019, time=2019-10-22, status=1, ipAttribution=)]
    2019-10-23 lfyang
  5. [GetPortalCommentsPageByObjectIdResponse(id=2089899, encodeId=e63c20898992a, content=学习了!谢谢老师!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26828342170, createdName=ms8000001294115901, createdTime=Fri Sep 23 09:31:23 CST 2022, time=2022-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940655, encodeId=629f1940655cc, content=<a href='/topic/show?id=e99e93e914a' target=_blank style='color:#2F92EE;'>#输液反应#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93791, encryptionId=e99e93e914a, topicName=输液反应)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Fri Sep 25 22:07:00 CST 2020, time=2020-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374327, encodeId=37bb3e4327b2, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Thu Oct 24 11:14:11 CST 2019, time=2019-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1471380, encodeId=acd114e13802b, content=<a href='/topic/show?id=ac13558e9cb' target=_blank style='color:#2F92EE;'>#抢救#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55879, encryptionId=ac13558e9cb, topicName=抢救)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=be1a7117101, createdName=lfyang, createdTime=Wed Oct 23 18:07:00 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374273, encodeId=99533e427355, content=好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 23 05:59:08 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374219, encodeId=a63a3e4219fe, content=受教了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4dc5091922, createdName=145d5865m01暂无昵称, createdTime=Tue Oct 22 08:42:31 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374218, encodeId=415c3e4218e7, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/21/e031c1d6c6115cbe1737b2149e602c1d.jpg, createdBy=3c105212218, createdName=147612bem32暂无昵称, createdTime=Tue Oct 22 08:40:33 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374212, encodeId=3def3e4212ed, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Oct 22 07:42:36 CST 2019, time=2019-10-22, status=1, ipAttribution=)]
    2019-10-23 yjs木玉

    好好好好好好

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2089899, encodeId=e63c20898992a, content=学习了!谢谢老师!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26828342170, createdName=ms8000001294115901, createdTime=Fri Sep 23 09:31:23 CST 2022, time=2022-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940655, encodeId=629f1940655cc, content=<a href='/topic/show?id=e99e93e914a' target=_blank style='color:#2F92EE;'>#输液反应#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93791, encryptionId=e99e93e914a, topicName=输液反应)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Fri Sep 25 22:07:00 CST 2020, time=2020-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374327, encodeId=37bb3e4327b2, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Thu Oct 24 11:14:11 CST 2019, time=2019-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1471380, encodeId=acd114e13802b, content=<a href='/topic/show?id=ac13558e9cb' target=_blank style='color:#2F92EE;'>#抢救#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55879, encryptionId=ac13558e9cb, topicName=抢救)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=be1a7117101, createdName=lfyang, createdTime=Wed Oct 23 18:07:00 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374273, encodeId=99533e427355, content=好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Wed Oct 23 05:59:08 CST 2019, time=2019-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374219, encodeId=a63a3e4219fe, content=受教了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4dc5091922, createdName=145d5865m01暂无昵称, createdTime=Tue Oct 22 08:42:31 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374218, encodeId=415c3e4218e7, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/21/e031c1d6c6115cbe1737b2149e602c1d.jpg, createdBy=3c105212218, createdName=147612bem32暂无昵称, createdTime=Tue Oct 22 08:40:33 CST 2019, time=2019-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374212, encodeId=3def3e4212ed, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Oct 22 07:42:36 CST 2019, time=2019-10-22, status=1, ipAttribution=)]
    2019-10-22 145d5865m01暂无昵称

    受教了。

    0

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    2019-10-22 147612bem32暂无昵称

    好东西

    0

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    2019-10-22 飛歌

    学习了很有用不错

    0

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腹痛+面色苍白,这个真不是输液反应!

疼痛不太剧烈,隐痛,基本上呈持续性,程度稍有波动,前天呕吐一次,为胃内容物,无胸闷,无心悸,无发热,胃纳同前,二便无殊。

药物滴注速度知多少

如果静脉输注速度不当,不仅导致输液反应,且能引起药物不良反应,轻则导致停药,影响患者治疗,重则导致患者病情加重,延长住院时间,增加患者经济负担。

ANN RHEUM DIS:英夫利昔单抗治疗中的输液反应与IgE抗英夫利昔抗体无关

在英夫利昔单抗治疗的患者中很少发现IgE-ADA。此外,大多数IR +患者中不存在IgE-ADA,表明IgE-ADA与输液反应无关。

怎么鉴别:输液反应 or 过敏反应 ?

临床常见的输液反应以热原反应和药物过敏反应最为常见,且二者有相似的临床症状,都可以出现寒战、发热、头痛、恶心、呕吐、心悸、胸闷、低血压休克等,因此本文重点讨论热原反应和药物过敏反应,其鉴别要点下表。一、输液反应的范围输液反应实际应该包括药物过敏反应、热原反应、菌污染反应。1 、药物过敏反应也称药物变态反应,是指机体再次接触某一药物相同抗原或半抗原时,发生的一种以机体生理功能紊乱或组织损伤为主的特异