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Umbuzo: I-Norepinephrine sisiyobisi esiphezulu esisebenzayo esilawulwayo (iv) njengokuncitshiswa okuqhubekayo. Ngumfanekiso oqhelekileyo oqhele ukugcina uxinzelelo lwegazi olwaneleyo kunye ne-genersusion egudileyo kubantu abadala abagulayo nabantwana abanoxinzelelo oluqatha okanye olothusayo oluqhubekayo. Neempazamo ezincinci kwisicamango okanye idosi, kunye nokulibaziseka kunyango, kunokukhokelela kwiziphumo ebezingalindelekanga. Inkqubo yezempilo ye-Multicterster isandula ukuthumela iziphumo ze-Ismp Study Aptures (CCA) kwiimpazamo ezili-106 ze-norepinephrine zenzekile ngo-2020 norepinephrine zenzekile ngo-2020 no-2021. Ukuhlola imicimbi emininzi ye-CCA ivumela imibutho eqhelekileyo kunye nenkqubo yobungozi benkqubo. Idatha evela kwinkqubo yombutho kunye neempompo ze-smart isetyenziselwa ukuchonga iimpazamo ezinokubakho.
I-ISMP ifumene iiNgxelo ezinxulumene ne-noradrenali ezine ngo-2020 ne-2021 ngeNkqubo yeNgxelo yeMpumelelo ye-Ismp ye-Ismp (i-ISPMPE). Malunga nesinye kwisithathu kwezi ngxelo sijongane neengozi ezinxulumene namagama afanayo, iilebheli, okanye ukupakisha, kodwa akukho zimpazamo zixeliwe. Sipapashe iingxelo zempazamo ezisixhenxe zeNorepinephrine: Iimpazamo ezine ze-Doss impazamo enye yokugxila engachanekanga; Impazamo enye yezishumi ezingachanekanga kwechiza; Ukuphazamiseka ngengozi kwe-norepinephrine. Zonke iingxelo ezili-16 ze-Ismp zongezwa kwiNkqubo yeMpilo ye-CCA (N = 106) kunye neziphumo ezithenjisiweyo (n = 122) kwinyathelo ngalinye lokusebenzisa iziyobisi kuboniswe ngezantsi. Impazamo exeliweyo ifakiwe ukubonelela ngomzekelo wezizathu eziqhelekileyo.
Nikezela. Sichonge izinto ezininzi zengozi ezinxulumene nomthetho omiselweyo, kubandakanya ukusetyenziswa okungafunekiyo kwimiyalelo yomlomo, echaza i-norepinephrine ngaphandle kokusetyenziswa kweeseti zomyalelo, kunye neethagethi ezingacacanga okanye ezingacacanga ukuba zisetyenziswa). Ngamanye amaxesha iiparamitha ezimiselweyo zokulinganisa zingqongqo kakhulu okanye ezingenakwenzeka (umz. Ngamanye amaxesha, oogqirha banokumisela iidosi ezisekwe bubunzima okanye ezingesosisindo, kodwa ngamanye amaxesha zididekile. Olu nyango luphuma-lwebhokisi-yebhokisi ephuma-the-ye-intanethi lunyusa amathuba okwenza iimpazamo, kubandakanya iimpazamo zenkqubo yempompo, kuba iimpazamo ezimbini ze-dosing ziyafumaneka kwilayibrari ye-pump. Ukongeza, ukulibaziseka kwathiwa kufundiswa inkcazo-bhile yoku-odola xa kumiselwe imiyalelo esekwe kwi-Doing.
Ugqirha ubuza umongikazi ukuba abhale ngonyango lwe-norepinephrine yesigulana ngoxinzelelo lwegazi olungazinzanga. Umongikazi wangena kwi-odolo kanye njengoko ugqirha wayalela ngomlomo: 0.05 MCG / kg / i-IV / i-IV / i-IV ityalwe kwithagethi yoxinzelelo (imephu) ngaphezulu kwe-65 mmhg. Kodwa imiyalelo kagqirha yoGqirha ixubusha idosi engasekwe bubunzima obungaphezulu kwedosi esekwe kwi-DESE Impompo yombutho ye-smart ye-smart ye-smart ye-smart ayikwazanga ukuthoba i-MCG / idosi ye-MS kwidosi esekwe kwi-DES, i-MCG / KG / imiz. Usokhemesti kwakufuneka ahlole imiyalelo ngoogqirha, ekhokelela kulibaziseko ekuboneleleni ngononophelo.
Lungiselela kwaye usasaze. Iimpazamo ezininzi zokulungiselela kunye ne-dosing zibangelwa ngumsebenzi wekhemisi ogqithisileyo, oxhonywe ngabasebenzi abasekhefini (i-32 MG / 250 ML) khokelela kwi-moltiting kunye nokudinwa. Ezinye izinto eziqhelekileyo zokusasaza iimpazamo zibandakanya iileyibhile ze-noradrenaline ezifihlwe kwiingxowa eziqinileyo kunye nokungaqondakali kwabasebenzi bexesha lokuhluka.
I-co-insulion ye-norepinephrine kunye ne-nirkersipine kwibhegi emnyama ye-amber ihambe kakuhle. Ukutyikitya okumnyama, inkqubo yedosi iprintwe iilebheli ezimbini, enye kwibhegi ye-influsion uqobo kwaye enye ngaphandle kwengxowa ye-amber. I-Norepinephrine ifakwe ngaphakathi kwiipakethi ze-Amber iipakethi ezingenalo "uNirdrkerpine" ngaphambi kokusasazwa kwemveliso yokusetyenziswa kwezigulana ezahlukeneyo kunye ne-vice verda. Iimpazamo zazingaphawulwa ngaphambi kokusasaza okanye idosi. Isigulana esinyangwa nge-nirkerlipine sanikwa i-norepinephrine kodwa ayizange ibangele ingozi yexesha elide.
yolawulo. Iimpazamo eziqhelekileyo zibandakanya idosi engachanekanga okanye impazamo yoxinzelelo, imposiso engachanekanga, kunye nempazamo engalunganga yeziyobisi. Uninzi lwezi mpazamo kungenxa yenkqubo engachanekanga yempompo ye-smart ye-smart, kwinxalenye yokuba ubukho bokhetho lwe-Dose kwithala lencwadi leziyobisi, ngaphandle kwawo; iimpazamo zokugcina; Unxibelelwano kwaye uqhagamshele ukubuyiswa kokuphazamiseka okanye ukunqunyanyiswa kwesigulana kuqalile ukutshitshiswa okungalunganga okanye akuzange kubekiwe imigca kwaye akubalandeli xa uqala okanye ukuphinda uqalise okanye ukuphinda uqalise ukuthandwa. Into engahambanga kakuhle kumagumbi kaxakeka kunye namagumbi okusebenza, kunye ne-pump ye-smart pump yokushicilela nge-elektroniki (i-EHR) ayifumaneki. Ukukhokelela ekukhokeleni komonakalo we-tissice kukwaxeliwe.
Umongikazi olawulwa nge-norepinephrine njengoko kuyalelwe ngenqanaba le-0.1 μg / kg / min. Endaweni yokuqhubela phambili impompo ukuba ihambise i-0.1 MCG / kg / imiz, umongikazi ubeke impompo ukuba i-0.1 MCG / imiz. Ngenxa yoko, isiguli sifumene izihlandlo ezingama-80 ubuncinci kancinane kunokuba zimiselwe. Xa ukutshitshiswa ngokuthe ngcembe kwateyitiswa kwaye kufikelelwa kwi-1.5 μg / min, umongikazi wagweba ukuba wayefikelele kumda ophezulu we-1.5 μg / kg / min / imiz / imiz / imiz / imiz / imiz / imiz / imiz / imizuzu. Kuba isigulana soxinzelelo soxinzelelo sasingaqhelekanga, kongezwa i-vaskor yesibini.
Uluhlu lwe-inventri kunye nokugcinwa. Uninzi lweempazamo zenzeka xa kuzalisa iikhavathi ezizenzekelayo (ii-ADCs) okanye ukutshintsha i-vialpinephrine vials kwiinqwelo ezinamakhowudi. Esona sizathu sezi mpazamo ze-Inventri kukwenza ilebheli efanayo kunye nokupakisha. Nangona kunjalo, ezinye izinto ezixhaphakileyo ziye zachongwa, ezinjengamanqanaba aphantsi emigangatho ye-norepinephrine kwi-ADC yeYunithi yoNyango, ekhokelela kulibaziseko lonyango ukuba kunqongophele ngenxa yokunqongophala. Ukusilela ukuskena ibhakhowudi yemveliso nganye ye-norepinephrine ngelixa ugcina i-adc yenye imithombo yempazamo.
Ikhemesti ilahle i-idc ngempazamo ngekhemisi-ilungiselelwe i-scowpinehrine yesisombululo kwi-4 MG / 250 ML Drawer Codreware. Umongikazi waqulunqa imposiso ngelixa uzama ukufumana i-4 mg / 250 ml norepinephrine kwi-ADC. I-Barcode kwi-insulion nganye ayizange iskenwe ngaphambi kokuba ibekwe kwi-ADC. Xa umongikazi waqonda ukuba kukho kuphela i-32 MG / 250 ye-ML kwi-ADC (kufuneka ibe kwinxalenye ye-ADC), yacela uxinzelelo oluchanekileyo. I-Norepinephrine 4MG / 250Ml SOLSOITION ZISISEKELWE KUKHONA KUKHONA KAKHULU UKUQHUTYELWA KWE-STEMGER ye-4MG / 250ML Iipakethi zokuHlanganisa kuncedo lokuxubana.
jonga. Ukubek'esweni okungalunganga kwezigulana, isithuba seNorepinephrine Ukuncitshiswa ngaphandle kweeparamitha zoku-odola, kwaye ukungalindeli xa ingxowa ye-infoion elandelayo iyafuneka ezona zinto zibangela ukubeka iliso kwiimpazamo eziqhelekileyo.
Isigulana esifayo yimiyalelo "yokungavumi ukuba" ifakwe i-norepinephrine ukuya kuhlala ixesha elide ngokwaneleyo kwintsapho yakhe ukuba ithethe kakuhle. I-norepinephrine iphela, kwaye kwakungekho ngqwirha lokuphumla kwi-ADC. Umongikazi ngoko nangoko wabiza ikhemesti kwaye wacela ibhegi entsha. Ikhemisi yayingenalo ixesha lokulungiselela iyeza ngaphambi kokuba isigulana sidlule saza saya kusapho.
Ingozi. Zonke iingozi ezingakhokelela kwimpazamo zixelwe kwi-ISMP kwaye zibandakanya iilebheli ezifanayo okanye amagama amachiza. Uninzi lweeNgxelo zibonisa ukuba ukupakisha kunye neelebheli zoxinaniso olwahlukileyo lwe-norepinephrine olwenziwe ngabangaphandle abangama-503b ngaphandle kwe-phantse.
Iingcebiso zokuziqhelanisa ngokukhuselekileyo. Qwalasela ezi ngcebiso zilandelayo xa uphuhlisa okanye uhlaziye isicwangciso sendawo yakho yokunciphisa iimpazamo ekusebenziseni ngokukhuselekileyo kwe-norepinephrine (kunye nolunye uVesinerestesterestesterestessor):
umda uxinzelelo. Imigangatho emiselweyo yenani eliqingqiweyo loxinzelelo lonyango lwabagqirha kunye / okanye abaguli abadala. Chaza umda wobunzima we-insulion egxininisiweyo ukuba igcinwe kwizigulana ezinesithintelo okanye ifuna ukonakala eziphezulu ze-norepinephrine (ukunciphisa utshintsho lwebhegi).
Khetha indlela yedosi enye. Yenza imigangatho yokuphelisa i-Norepinephrine kunye ne-MCG / MCG / Kg / I-Kg / Min) okanye ngaphandle kwayo (MCG / MS) ukunciphisa umngcipheko wempazamo. Umbutho waseMelika weNkqubo yoKhuseleko lwezeMpilo (i-Ashp) inyathelo lemigangatho ye-NORPINDPHRHREPREPREPROPHREPHREPHREPROPHRPPHREPHREPROPHRPPHREDHREPROPHREPROPHREPHREPHREDPRINDDPHREDHREDPREDHRE POST kwi-microgram / kg / umzuzu. Ezinye izibhedlele zinokwenza umgangatho osemgangathweni ukuya kwimicrogram ngomzuzu kuxhomekeke kukhetho lweGqirha-zombini zamkelekile, kodwa iindlela ezimbini zokwenza ukutya azivumelekanga.
Ifuna ukumisela ngokwethemplethi yomyalelo oqhelekileyo. Ifuna ukuba i-norepinephrine yokungcola isebenzisa itemplate yoku-odola enamasimi afunekayo e-systeral, i-DOSE, i-Sysing Prequed), idosi ye-Sysult, i-Systoc, i-Systocal, i-Systocal, i-Systocal All) i-Syssician kufuneka ibizwe. Ixesha lokujikajika elingagqibekanga kufuneka libe "ngu-st" kule miyalelo ukuba ithathe indawo yokuqala kumgca wekhemesti.
Nciphisa ii-odolo zomlomo. Beka imiyalelo yomlomo kwiimeko zokwenyani zokwenyani okanye xa ugqirha engakwazi ukungena okanye ubhale iodolo ye-elektroniki. Oogqirha kufuneka benze ezabo amalungiselelo ngaphandle kokuba kukho iimeko zokukhulisa.
Thenga izisombululo ezilungiselelwe ukuthunyelwa xa zikhona. Sebenzisa ugxininiso lwe-Nreminephrine ye-NORPINPPHRPPHRIne abavela kubavelisi kunye / okanye izisombululo ezilungiselelwe ngabathengisi bomntu wesithathu (njenge-503b) ukunciphisa iimpazamo zekhemesti, kwaye uphephe iimpazamo zokuqulunqwa kwekhemesti.
Umahluko umahluko. Ukwahlula ugxininiso olwahlukileyo ngokubenza bahluke ngokupheleleyo ngaphambi kodongwe.
Nikeza inqanaba le-ADC elaneleyo le-ADC. Isitokhwe kwi-ADC kwaye sinike ubunzima obungaphezulu kwe-norepinephrine yokuhlangabezana neemfuno zesigulana. Ukubeka iliso ekusetyenzisweni kunye nokulungelelanisa amanqanaba aqhelekileyo njengoko kufuneka.
Yenza iinkqubo zokulungisa kwe-batch kunye / okanye ukudibanisa kwimfuno. Kuba linokuthatha ixesha lokuxubana koxinzelelo olungafundekiyo, i-pharmeries inokusebenzisa iindlela ezahlukeneyo zokulungiselela ukulungiselela ixesha elifanelekileyo kunye nokuhanjiswa xa izikhongozeli zingenazithuba okanye i-imeyile ye-imeyile kufuneka ilungiswe.
Iphakheji nganye / i-vial iskenwa. Ukuthintela iimpazamo ngexesha lokulungiselela, ukuhanjiswa, okanye ukugcinwa, ukuskena i-barcode ibhegi yengxowa ye-norepinephrine okanye i-vial yokuqinisekisa ngaphambi kokulungiswa, ukuhambisa kwi-ADC. I-Barcode inokusetyenziswa kuphela kwiilebheli ezinamathele ngqo kwiphakheji.
Jonga ileyibhile ebhegini. Ukuba ibhegi ekhanyayo eqinileyo isetyenziswa ngexesha lokujonga i-dosine sokupela, ukungcola kweNorepinephrine kufuneka kususwe okwethutyana kwingxowa yovavanyo. Ngenye indlela, faka ibhegi yokukhusela ukukhanya ngaphezulu kwe-insulion ngaphambi kovavanyo kwaye ubeke ebhegini kwangoko emva kovavanyo.
Yenza izikhokelo. Seka izikhokelo (okanye iprotocol) yokuthathwa kwe-norepinephrine (okanye elinye iyeza elinesidima), i-ranges ekhuselekileyo, i-Dose ekhuselekileyo, i-Dose ye-Desection (imizuzu), i-DOSE, isiseko, kunye nokubekwa kweliso. Ukuba kunokwenzeka, qhagamshela izindululo kwi-odolo yoku-odola kwiRekhodi yokuLawula amayeza (Mar).
Sebenzisa impompo ye-smart. Yonke i-norepinephrine ihlukunyezwa kwaye inesibi-mali usebenzisa impompo ye-smart ye-smart ngenkqubo yokunciphisa i-Dose
Yenza ukubakho. Apho kunokwenzeka, yenza impompo ye-bi-facture smart smart ehambelana neerekhodi zempilo ye-elektroniki. Iqela elisebenzayo livumela iipumps ukuba zizaliswe ziseto eziqinisekisiweyo ezingqiqweniweyo ngugqirha (ubuncinci ekuqaleni kokuqalisa) kwaye ikwandisa ulwazi oluphawulekayo.
Phawula imigca kwaye ulandele imibhobho. Faka ilebhile umgca ngamnye we-insuluon ngaphezulu kwempompo kwaye kufutshane nendawo yokufikelela kwisigulana. Ukongeza, ngaphambi kokuqala okanye ukutshintsha ibhegi ye-Norepinephrine okanye i-influoIshini, indlela ye-tubsing ukusuka kwisisombululo kwimpompo / isigulana kunye nendlela yolawulo ichanekile.
Yamkela uvavanyo. Xa i-insulion entsha inqunyanyisiwe, uhlolo lobuchwephesha (umz.
Yiyeke ukuthoka. Ukuba isigulana sizinzile ngaphakathi kweeyure ezi-2 zokuyeka ukungcola kwe-Norepinephrine, cinga ukufumana i-odolo ye-odolo ukusuka kugqirha ophathwayo. Nje ukuba i-insulion imisiwe, yanqamla kwangoko i-insulion, yisuse kwimpompo, kwaye ulahle ukuphepha ulawulo lwengozi. Ukufakwa kwentembeko kufuneka kukhutshelwe kwisigulana ukuba ukungcola kuphazamiseka ngaphezulu kweeyure ezi-2.
Misela iprotokholi yobuqhetseba. Misela iproteyini yobuqhetseba ye-froy throinephrine. Abongikazi kufuneka baxelelwe malunga nerejimeni, kubandakanya unyango nge-phentolaminemine kunye nokunqanda iicomputer ezibandayo kwindawo echaphazelekayo, enokuphelisa ukonakala kwe-tism.
Vavanya izicelo. Ukubeka iliso kuthotyelwa kwabasebenzi kunye neengcebiso ze-norepinephrine, imigaqo-nkqubo kunye nemigqaliselo ethile yogqirha, kunye nezigulana. Imizekelo yamanyathelo ibandakanya ukuthotyelwa kweeparamitha zesidima ezifunekayo ukuze i-oda; ukulibaziseka kunyango; Ukusetyenziswa kweempompo ze-smart ezine-ders zenziwe (kunye nokusebenzisana); qala ukutshitshiswa kwinqanaba elimiselweyo; Isibonelelo ngokwemithombo emiselweyo kunye neeparamitha zedosi; Impompo ye-Smart Pump iyakwazisa rhoqo kunye nohlobo lwedosi, amaxwebhu emilinganiselo yokulinganisa (kufuneka atshintshe utshintsho lwe-Dose) kunye nokwenzakala konyango ngexesha lonyango.