Micro-injection pump, referred to as micro-pump, as a new type of pumping equipment, can pump a small amount of liquid medicine into patients in a small amount, accurately, continuously and evenly according to the requirements of doctor's advice, so as to maintain effective blood concentration of drugs in the body and save critically ill patients.
Micropump drugs commonly used in cardiovascular diseases are divided into the following seven categories according to their pharmacological effects:
Antihypertensive drugs
During the use of antihypertensive drugs, it is necessary to monitor the blood pressure level of patients and be alert to the occurrence of hypotension.
1. sodium nitroprusside
Preparation method: sodium nitroprusside injection 50 mg +5% GS 50 ml.
Dosage: the initial pump speed is 0.2-0.5 μg/kg/min, which is increased by 0.5- 1 mg/ time according to blood pressure control, and the maximum amount is 10 μg/kg/min. The total amount is 3.5 mg/kg (by weight).
Note: Sodium nitroprusside is sensitive to light and its solution stability is poor. The infusion solution should be freshly prepared, the infusion pump should be quickly protected from light, and the infusion set should be used in the meantime.
The toxicity of sodium nitroprusside comes from its metabolite cyanide, so we should be alert to cyanide poisoning during use.
In cyanide poisoning, sodium thiosulfate can be used to detoxify, and it can be dissolved into 5% solution with sterile water for injection, and 0.5- 1 g intramuscular or intravenous injection once.
2. Urapidil hydrochloride
Preparation method: urapidil injection 100 mg+ NS 30 ml or 200 mg+ NS 10 ml, the former is more commonly used.
Dosage: the initial pump speed is 6- 10 mg/h, and the micropump flow is adjusted according to the target blood pressure, 2-4 mg each time, once every 15-30 min.
3. nicardipine hydrochloride
Preparation method: directly pump 20 mg(20 ml) stock solution;
Dilute with NS or 5% GS into a solution with a concentration of 0.0 1%-0.02%, that is, the infusion contains 0. 1-0.2 mg of nicardipine hydrochloride.
Dosage: In case of hypertension emergency, the initial dosage is 2 mg/h and the maximum dosage is 20 mg/h, or 0.5-6 μg/kg/min, and the infusion speed is adjusted according to the blood pressure control.
Precautions: This product is a calcium antagonist, which can cause reflex tachycardia by inhibiting the influx of calcium ions to dilate blood vessels;
At the same time, because of its strong vasodilating effect, it is forbidden for patients with intracranial hypertension and suspected active intracranial hemorrhage.
Drugs for lowering blood pressure and heart rate.
These drugs have the effects of lowering blood pressure and slowing down heart rate.
1. esmolol
Preparation method: Esmolol injection is water injection, which can be pumped with 2000 mg/20 ml stock solution.
Dosage: The loading dose of 1 min is 0.25 ml(0.5 mg/kg), and the maintenance dose is 0.05-0.3 mg/kg/min, depending on the patient's blood pressure and heart rate control.
Caution: It may lead to bradycardia and hypotension. For patients with hypotension, it should be closely monitored when used. Once the blood pressure is too low, you need to reduce the final maintenance.
2. Diltiazem Hydrochloride
Preparation method: diltiazem hydrochloride 100 mg+50 ml NS (commonly used to reduce blood pressure); Diltiazem hydrochloride 50 mg+50 ml NS (commonly used to reduce heart rate);
Dosage: the pumping speed is 7.5-23 ml/h, which is equivalent to 5- 15 μg/kg/min (depressurization); The pumping speed is 3- 15 ml/h, which is equivalent to 1-5 μg/kg/min (heart rate decreased).
Precautions: Pay attention to the occurrence of hypotension or bradycardia.
Antiarrhythmic drugs
Amine iodine Darron
Amiodarone is called an antiarrhythmic drug because it has all the pharmacological effects of antiarrhythmic drugs.
Preparation method: amiodarone injection 300 mg+5% GS 44 ml, only glucose injection can be used.
Dosage: The loading dose is 150 mg+5% GS 10 ml, then it is pumped in at 10 ml/h( 1 mg/min), and the dosage is reduced to 5 ml/h(0.5 mg/min) after 6 hours.
Note: Because amiodarone injection contains Tween 80, it is necessary to monitor blood pressure to prevent hypotension.
Amiodarone has been reported as torsade de pointes, so attention should be paid when using it.
Anti-angina drugs (crown enlargement)
The vasodilating effect of these drugs will lead to the increase of reflex heart rate and the decrease of blood pressure, so attention should be paid when using them.
1. nitroglycerin
Preparation method: nitroglycerin injection 5 mg+50 ml NS or 10 mg+50 ml NS.
Dosage: The initial dropping speed is 3 ml/hour (5 μ g/min), and then it will be increased by 3 ml/hour (5 μ g/min) every 3-5 minutes.
Note: Plastic has a strong adsorption effect on nitroglycerin, so it is recommended to use a glass infusion container.
2. Isosorbide nitrate
Preparation method: Use 50mg/50ml stock solution.
Dose: the initial pump speed is 1-2 mg/h, and the dose is gradually increased according to the patient's response, and the maximum dose is 8 8- 10 mg/h 0 mg/h.
3. Isosorbide mononitrate
According to experts' understanding of standardized application of nitrate in cardiovascular diseases:
The onset, peak and steady-state time of intravenous infusion of isosorbide 5- mononitrate were significantly delayed compared with the same dose of oral preparation.
Although intravenous injection can obviously accelerate the onset time, it can cause drastic changes in hemodynamics and unpredictable drug accumulation effect in the later period.
Therefore, the intravenous dosage form of isosorbide 5- mononitrate lacks rationality and should be abandoned. There is no such dosage form for clinical use in Europe and America.
cardiac stimulant
1. Milinon
Preparation method: Use 50mg/50ml stock solution.
Dosage: intravenous injection of 25-75 μg/kg in the initial 5- 10 min, maintenance dose of 0.75-3 ml/h (equivalent to 50 kg body weight, 0.25- 1 μg/kg/min), and daily dose not exceeding1./kloc-0.
Precautions: prevent hypotension.
2. Left West Donald J. Munro
The recommended level of levofloxacin Donald J. Munro in the treatment of acute heart failure is higher than other positive inotropic drugs, and it belongs to calcium sensitizer, which can enhance myocardial contractility and improve prognosis without increasing myocardial oxygen consumption.
Preparation method: levofloxacin Donald J. Munro injection 12.5 mg+45 ml of normal saline.
Dose: the loading dose is 6- 12 μg/kg, and the time is not less than10 min; ; Maintain the dose of 0.05-0.2 μg/kg/min and pump continuously for 24 hours.
Precautions: patients with systolic blood pressure > > 90 mmHg can use loading dose and adjust the dose according to blood pressure; Patients with systolic blood pressure < < 90 mmHg need no load, so maintenance dose should be used directly to prevent hypotension.
Antihypertensive and cardiotonic drugs
1. norepinephrine
Preparation method: norepinephrine injection 8 mg+36 ml NS (commonly used) or 16 mg+32 ml NS (central vein must be used).
Dosage: 1 ml/hour, equivalent to 50 kg body weight, 0.067 μ g/kg/min, maintenance dose of 2-4 μ g/min, and maximum dose of 25 μ g/min.
Note: the heart rate is accelerated; When using peripheral vein infusion, it is necessary to observe whether there is leakage to prevent skin necrosis.
2. Dopamine/dobutamine
Preparation method: Dopamine/Dobutamine Injection 150 mg+35 ml NS (commonly used) or 300 mg+20 ml NS (for central vein) or 50 mg+45 ml NS (for peripheral vein).
There is also a simple method, the dosage of dopamine = the individual's body weight (kg) × 3, add the solvent to 50ml, and then pump it in at the speed of ml/h as much as ug/kg/min.
Dosage: the pumping speed is 2-20 ml/h, which is equivalent to 2-20 μg/kg/min. It should be noted that < 2 ug/kg/min is the diuretic effect of dilating renal blood vessels.
Precautions: The incidence of adverse cardiac events of dopamine/dobutamine is higher than that of norepinephrine, and attention should be paid to the occurrence of arrhythmia such as tachycardia during use.
emictory
furosemide ,frusemide,lasix,diural,furanlral, seguril,urex
Acute left heart failure, especially patients with water and sodium retention, is a strong indication of diuretic use.
When the effect of intravenous infusion is not good, especially when it is used alternately with torasemide (such as the diuretic effect is not good after a single intravenous infusion 100 mg), continuous intravenous medication should be considered.
Preparation method: 200 mg furosemide injection +30 ml normal saline.
Dosage: the loading dose is 20 mg, and the pump is maintained at 2-20 ml/h, which is adjusted according to the patient's diuretic response.
Precautions: This product is an alkaline liquid, so it is not suitable for dilution with glucose injection; Diuretics can lead to low potassium and high sodium, so it is necessary to monitor electrolytes during use. 20 16-06-28 horse cardiovascular time
Micro-injection pump, referred to as micro-pump, as a new type of pumping equipment, can pump a small amount of liquid medicine into patients in a small amount, accurately, continuously and evenly according to the requirements of doctor's advice, so as to maintain effective blood concentration of drugs in the body and save critically ill patients.
Micropump drugs commonly used in cardiovascular diseases are divided into the following seven categories according to their pharmacological effects:
Antihypertensive drugs
During the use of antihypertensive drugs, it is necessary to monitor the blood pressure level of patients and be alert to the occurrence of hypotension.
1. sodium nitroprusside
Preparation method: sodium nitroprusside injection 50 mg +5% GS 50 ml.
Dosage: the initial pump speed is 0.2-0.5 μg/kg/min, which is increased by 0.5- 1 mg/ time according to blood pressure control, and the maximum amount is 10 μg/kg/min. The total amount is 3.5 mg/kg (by weight).
Note: Sodium nitroprusside is sensitive to light and its solution stability is poor. The infusion solution should be freshly prepared, the infusion pump should be quickly protected from light, and the infusion set should be used in the meantime.
The toxicity of sodium nitroprusside comes from its metabolite cyanide, so we should be alert to cyanide poisoning during use.
In cyanide poisoning, sodium thiosulfate can be used to detoxify, and it can be dissolved into 5% solution with sterile water for injection, and 0.5- 1 g intramuscular or intravenous injection once.
2. Urapidil hydrochloride
Preparation method: urapidil injection 100 mg+ NS 30 ml or 200 mg+ NS 10 ml, the former is more commonly used.
Dosage: the initial pump speed is 6- 10 mg/h, and the micropump flow is adjusted according to the target blood pressure, 2-4 mg each time, once every 15-30 min.
3. nicardipine hydrochloride
Preparation method: directly pump 20 mg(20 ml) stock solution;
Dilute with NS or 5% GS into a solution with a concentration of 0.0 1%-0.02%, that is, the infusion contains 0. 1-0.2 mg of nicardipine hydrochloride.
Dosage: In case of hypertension emergency, the initial dosage is 2 mg/h and the maximum dosage is 20 mg/h, or 0.5-6 μg/kg/min, and the infusion speed is adjusted according to the blood pressure control.
Precautions: This product is a calcium antagonist, which can cause reflex tachycardia by inhibiting the influx of calcium ions to dilate blood vessels;
At the same time, because of its strong vasodilating effect, it is forbidden for patients with intracranial hypertension and suspected active intracranial hemorrhage.
Drugs for lowering blood pressure and heart rate.
These drugs have the effects of lowering blood pressure and slowing down heart rate.
1. esmolol
Preparation method: Esmolol injection is water injection, which can be pumped with 2000 mg/20 ml stock solution.
Dosage: The loading dose of 1 min is 0.25 ml(0.5 mg/kg), and the maintenance dose is 0.05-0.3 mg/kg/min, depending on the patient's blood pressure and heart rate control.
Caution: It may lead to bradycardia and hypotension. For patients with hypotension, it should be closely monitored when used. Once the blood pressure is too low, you need to reduce the final maintenance.
2. Diltiazem Hydrochloride
Preparation method: diltiazem hydrochloride 100 mg+50 ml NS (commonly used to reduce blood pressure); Diltiazem hydrochloride 50 mg+50 ml NS (commonly used to reduce heart rate);
Dosage: the pumping speed is 7.5-23 ml/h, which is equivalent to 5- 15 μg/kg/min (depressurization); The pumping speed is 3- 15 ml/h, which is equivalent to 1-5 μg/kg/min (heart rate decreased).
Precautions: Pay attention to the occurrence of hypotension or bradycardia.
Antiarrhythmic drugs
Amine iodine Darron
Amiodarone is called an antiarrhythmic drug because it has all the pharmacological effects of antiarrhythmic drugs.
Preparation method: amiodarone injection 300 mg+5% GS 44 ml, only glucose injection can be used.
Dosage: The loading dose is 150 mg+5% GS 10 ml, then it is pumped in at 10 ml/h( 1 mg/min), and the dosage is reduced to 5 ml/h(0.5 mg/min) after 6 hours.
Note: Because amiodarone injection contains Tween 80, it is necessary to monitor blood pressure to prevent hypotension.
Amiodarone has been reported as torsade de pointes, so attention should be paid when using it.
Anti-angina drugs (crown enlargement)
The vasodilating effect of these drugs will lead to the increase of reflex heart rate and the decrease of blood pressure, so attention should be paid when using them.
1. nitroglycerin
Preparation method: nitroglycerin injection 5 mg+50 ml NS or 10 mg+50 ml NS.
Dosage: The initial dropping speed is 3 ml/hour (5 μ g/min), and then it will be increased by 3 ml/hour (5 μ g/min) every 3-5 minutes.
Note: Plastic has a strong adsorption effect on nitroglycerin, so it is recommended to use a glass infusion container.
2. Isosorbide nitrate
Preparation method: Use 50mg/50ml stock solution.
Dose: the initial pump speed is 1-2 mg/h, and the dose is gradually increased according to the patient's response, and the maximum dose is 8 8- 10 mg/h 0 mg/h.
3. Isosorbide mononitrate
According to experts' understanding of standardized application of nitrate in cardiovascular diseases:
The onset, peak and steady-state time of intravenous infusion of isosorbide 5- mononitrate were significantly delayed compared with the same dose of oral preparation.
Although intravenous injection can obviously accelerate the onset time, it can cause drastic changes in hemodynamics and unpredictable drug accumulation effect in the later period.
Therefore, the intravenous dosage form of isosorbide 5- mononitrate lacks rationality and should be abandoned. There is no such dosage form for clinical use in Europe and America.
cardiac stimulant
1. Milinon
Preparation method: Use 50mg/50ml stock solution.
Dosage: intravenous injection of 25-75 μg/kg in the initial 5- 10 min, maintenance dose of 0.75-3 ml/h (equivalent to 50 kg body weight, 0.25- 1 μg/kg/min), and daily dose not exceeding1./kloc-0.
Precautions: prevent hypotension.
2. Left West Donald J. Munro
The recommended level of levofloxacin Donald J. Munro in the treatment of acute heart failure is higher than other positive inotropic drugs, and it belongs to calcium sensitizer, which can enhance myocardial contractility and improve prognosis without increasing myocardial oxygen consumption.
Preparation method: levofloxacin Donald J. Munro injection 12.5 mg+45 ml of normal saline.
Dose: the loading dose is 6- 12 μg/kg, and the time is not less than10 min; ; Maintain the dose of 0.05-0.2 μg/kg/min and pump continuously for 24 hours.
Precautions: patients with systolic blood pressure > > 90 mmHg can use loading dose and adjust the dose according to blood pressure; Patients with systolic blood pressure < < 90 mmHg need no load, so maintenance dose should be used directly to prevent hypotension.
Antihypertensive and cardiotonic drugs
1. norepinephrine
Preparation method: norepinephrine injection 8 mg+36 ml NS (commonly used) or 16 mg+32 ml NS (central vein must be used).
Dosage: 1 ml/hour, equivalent to 50 kg body weight, 0.067 μ g/kg/min, maintenance dose of 2-4 μ g/min, and maximum dose of 25 μ g/min.
Note: the heart rate is accelerated; When using peripheral vein infusion, it is necessary to observe whether there is leakage to prevent skin necrosis.
2. Dopamine/dobutamine
Preparation method: Dopamine/Dobutamine Injection 150 mg+35 ml NS (commonly used) or 300 mg+20 ml NS (for central vein) or 50 mg+45 ml NS (for peripheral vein).
There is also a simple method, the dosage of dopamine = the individual's body weight (kg) × 3, add the solvent to 50ml, and then pump it in at the speed of ml/h as much as ug/kg/min.
Dosage: the pumping speed is 2-20 ml/h, which is equivalent to 2-20 μg/kg/min. It should be noted that < 2 ug/kg/min is the diuretic effect of dilating renal blood vessels.
Precautions: The incidence of adverse cardiac events of dopamine/dobutamine is higher than that of norepinephrine, and attention should be paid to the occurrence of arrhythmia such as tachycardia during use.
emictory
furosemide ,frusemide,lasix,diural,furanlral, seguril,urex
Acute left heart failure, especially patients with water and sodium retention, is a strong indication of diuretic use.
When the effect of intravenous infusion is not good, especially when it is used alternately with torasemide (such as the diuretic effect is not good after a single intravenous infusion 100 mg), continuous intravenous medication should be considered.
Preparation method: 200 mg furosemide injection +30 ml normal saline.
Dosage: the loading dose is 20 mg, and the pump is maintained at 2-20 ml/h, which is adjusted according to the patient's diuretic response.
Precautions: This product is an alkaline liquid, so it is not suitable for dilution with glucose injection; Diuretics can lead to low potassium and high sodium, so it is necessary to monitor electrolytes during use.