思路: ① 一般配比药物+溶剂为50ml,若药物为粉剂,则溶剂为50ml,若药物为水剂,则水剂药物和溶剂共加至50ml。特殊情况根据临床用药习惯配比,如为方便计算,“善宁”泵入常加至48ml,“呋塞米”泵入常加至40ml; ② 浓度C=质量M/体积V; ③药物的安全泵量范围是规定好的,根据泵量去计算泵速从而调整微量泵。 1.多巴胺/多巴酚丁胺(20mg/2ml/支) (体重kg×3) mg + 5% GS 至50ml, 1ml/h 相当于1μg/( kg˙ min ), 用药范围:1-20μg/( kg˙min )。 例如:体重60kg患者,用量为:5μg /( kg˙min ):180mg+ 5% GS 32ml,5ml/h 思路: ① 多巴胺使用量需根据患者公斤体重配比,例如60kg的患者需多巴胺用量为60×3=180mg; ② 该患者需用多巴胺为180mg,共180mg/20mg=9支,即18ml; ③ 配比时需要多巴胺18ml,糖50ml-18ml=32ml; ④ 该溶液的浓度=180mg/50ml=3.6mg/ml; ⑤ 多巴胺的安全泵量是1-20μg/( kg˙min ),若我们需要5μg /( kg˙min )的泵量,那微量泵的泵速该如何调整? ⑥ 已知1mg=1000μg,1h=60min,那么泵量5μg /( kg˙min ) =0.005mg/(kg˙1/60h) =0.3mg/(kg˙h),该患者为60kg,则需泵量为0.3mg/(kg˙h)×60kg=18mg/h; ⑦ 根据④我们可知该溶液的浓度为3.6mg/ml,那么泵量18mg/h=[18mg/(3.6mg/ml)]/h=5ml/h,即泵速为5ml/h; ⑧ 即泵量5μg /( kg˙min )时泵速为5ml/h,即1ml/h 相当于1μg/( kg˙ min )。 2.去甲肾上腺素(2mg/1ml/支) (体重kg×0.3) mg +0.9% NS至50ml, 1ml/ h 相当于0.1μg/( kg˙ min ) 用药范围:0.1-2μg/( kg˙min ) 例如:体重60kg患者用量为:0.5μg/( kg˙min ):18mg+0.9% NS 41ml,5ml/h 3.肾上腺素(1mg/1ml/支) (体重kg×0.3) mg 加0.9% NS 至50ml, 1ml/h 相当于0.1μg/( kg˙min) 用药范围:0.1-2μg/( kg˙min) 例如:体重60kg患者,用量为0.5μg /( kg˙min):18mg+0.9% NS 32ml,5ml/h 4.异丙肾上腺素(1mg/2ml/支) 3mg+0.9% NS 44ml, 1ml/h (1μg/min) 5.利多卡因(200mg/10ml/支) 原液(无需稀释), 3-9ml/h (1-3mg/min) 6.艾司洛尔(200mg/2ml/支) 原液,bolus 0.5mg/kg, 维持50-300μg /(kg˙min), 100μg/(kg˙min)=3.6/h( BWt =60kg) 7.胺碘酮(150mg/3ml) 首剂150-300mg iv 10min内推完; 450mg+5% GS 36ml 泵入, 6ml/h (1mg/min ) x 6h; 减至3ml/h (0.5mg/min)持续泵入; 24h总量<2.2g(禁用NS) 8.硝酸甘油(5mg/1ml/支) 50mg+0.9% NS 40ml,10μg/min 开始,可用到200μg/min,(10μg/min =0.6mI/h)(避光) 9.硝普钠(50mg/支粉剂) 50mg+5% GS 50ml,10μg/ min 开始,可用到200-300μg / min ,(10μg/min =0.6ml/h)(避光) 思路: ① 硝普钠为粉剂,1支硝普钠50mg需50ml糖配,该溶液浓度为=50mg/50ml=1mg/ml; ② 硝普钠的安全泵量范围为200-300μg/min,若我们需要10μg / min 的泵量,那微量泵的泵速该如何调整? ③ 泵量10μg/min=0.01mg/(1/60h) =0.6mg/h=0.6ml/h,即泵速为0.6ml/h; ④ 即泵量10μg/min时泵速为0.6ml/h。 10.亚宁定(乌拉地尔)(25mg/5ml/支) 原液(无需稀释), 从1.2ml/ h (100μg/min)开始, 可逐渐加量到400μg/min (4.8ml/h) 11.尼莫地平(10mg/50ml/支) 原液(无需稀释), 起泵2.5ml/ h ,2h后加至 5ml/h , 根据血压调整,最高10ml/h ,持续5-14d 12.吗啡(10mg/1ml/支) 50mg+0.9% NS 45ml, 1-6ml/h (1-6mg/h) 13.地西泮(安定)(10mg/2ml/支) 原液(无需稀释), 0.2-3ml/h(1-6mg/h) 14.咪达唑仑(咪唑安定)(5mg/5ml/支) 原液(无需稀释), 1-6mg/h,0.04-0.2mg/( kg˙h) 15.德巴金(400mg/粉针) 1200mg+0.9% NS 50ml (浓度24mg/ml) 首次应用: Bolus 15mg/kg 静推>3min( BW =60kg为3g),维持1-2mg/( kg˙h)(2.5-5ml/h ); 原曾口服: 以原剂量泵入[如BW =60kg 0.5g tid po →25mg/( kg˙d )→1mg/( kg˙h )] 16.冬眠合剂: 异丙嗪(50mg/2ml/支), 氯丙嗪(50mg/ 2ml/ 支), 哌替啶(50mg/1ml)。 各1ml+0.9% NS 17ml,泵速1-2ml/ h 17.异丙酚(200mg/20ml/支) 原液(无需稀释), 5-80μg/( kg˙min ), 10μg/( kg˙min )=3.6ml/h ( BW =60kg) 18.维库溴铵(万可松)(4mg/支粉剂,1ml/支溶剂) 10支+0.9% NS 10ml, 0.8-1.2μg /(kg˙min), 1μg /( kg˙min ) =1.8ml/h (BW =60kg) 19.垂体后叶素(6IU/1ml/支) 首剂12-18U入壶; 原液(无需稀释), 消化道出血2-4ml/h(0.2-0.4U/min ), 咯血1-2ml/h(0.1-0.2U/min ) 20.生长抑素(思他宁)(3mg/2ml/支) 3mg+0.9% NS 48ml; 维持4ml/h (250μg/h) 21.奥曲肽(善宁)(0.1mg/1ml/支) 0.1mg 入壶; 0.5mg+0.9% NS 45ml 维持2.5ml/h (25μg/h ) 22.普通肝素(12500U/2ml/支) 1支+0.9% NS 48ml, 2ml/h (500U/h), 根据 APTT 调整 23.氨茶碱(250mg/10ml/支) 500mg+5% GS 30ml, 2ml/h (24h<1g) 24. NS 500ml+生长抑素3mg|ivgtt,维持12h NS 48ml+生长抑素3mg|泵入,维持:4mL/h即250μg/h 25. NS 50ml+耐信80mg|泵入,5ml/h即8mg/h 26. NS 45ml+善宁0.3mg(共48ml)|泵入,4ml/h即25μg/h,12h泵完; 6ml/h→37.5μg/h→8h; 8ml/h→50μg/h→6h; 27.垂体后叶素3000(50mL)|原液泵入,1ml/h即0.1U/min 28. GS 20ml+胺碘酮150mg|10min内静推 GS 38ml+胺碘酮600mg|5ml/h即1mg/min,持续6h 29. GS 250ml+异丙肾上腺素0.5~1mg|缓慢静滴 30. GS/NS 500ml+阿托品3-5mg|缓慢静滴 31. GS 50-100ml+硫酸镁1~2g|ivgtt 32. NS 30ml+乌拉地尔100mg|3ml/h起泵,即100μg /min 33. NS 45ml+酚妥拉明50mg|泵入,2mL/h即2mg/h 34. GS 50ml+普罗帕酮70mg|ivgtt,>10min 35. NS 50ml+丙戊酸钠0.8g |泵入,5ml/h即80mg/h 36. GS 30ml+氨茶碱0.5g|泵入,2ml/h即20mg/h 37. GS 46ml+喘定0.5g|泵入,2ml/h即20mg/h 38. NS 38ml+呋塞米20mg(共40ml) |10ml/h起泵,即5mg/h NS 36ml+呋塞米40mg(共40ml) |5ml/h起泵,即5mg/h 39. NS 30ml+Kcl3.0g|泵入,2ml/h 40. 0.9% NS 100ml+10% NS 30ml(即3%NS)|输液泵泵入,维持5h 41. NS/GS 250-500ml+纳洛酮1.2-2mg|ivgtt 42. NS/GS 250ml+去甲肾上腺素10mg|ivgtt,30ml/h 冷NS 500ml+去甲肾上腺素20mg|每次口服20ml 43. NS/GS 250ml+多巴胺100mg|ivgtt 44. NS/GS 500ml+间羟胺20-100mg|ivgtt 45. NS/GS 250ml+硝酸甘油10mg|ivgtt 46. NS/GS 100ml+硝酸异山梨酯10mg|ivgtt 47. NS/GS 100ml+单硝酸异山梨酯20mg|ivgtt NS/GS 50ml+单硝酸异山梨酯50mg|泵入,5ml/h即5mg/h 48. NS/GS 20ml+西地兰0.2-0.4mg|iv,>5min 49. NS/GS 250ml+利多卡因800mg|ivgtt,30ml/h 50. GS 20ml+胺碘酮150mg|iv GS 20ml+胺碘酮300mg|ivgtt,40-50ml/h 51. NS/GS 250ml+普罗帕酮70-210mg|ivgtt 52. NS/GS 250ml+乌拉地尔100mg|ivgtt,40-50ml/h 53. NS/GS 100ml+尼卡地平10mg|ivgtt 54. NS/GS 20ml+地尔硫卓10mg|iv,3min NS/GS 250ml+地尔硫卓30mg|ivgtt 55. 6-12U垂体后叶素+NS至20ml|iv NS 250ml+垂体后叶素24U|ivgtt,12-24ml/h 56. NS/GS 50ml+重组人脑利钠肽(新活素)0.5mg|泵入4ml/h,3d |
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