输注甘露醇后瞳孔竟然开始散大!这究竟是怎么回事?

2019-02-22 赵遥岑 护士网

2月份的天气已渐渐回暖,我拖着疲惫的身躯穿梭于整个病区内。原本热闹的走廊也渐渐安静下来。心电监护与输液泵的报警声预示着这又是一个不眠之夜。

2月份的天气已渐渐回暖,我拖着疲惫的身躯穿梭于整个病区内。原本热闹的走廊也渐渐安静下来。心电监护与输液泵的报警声预示着这又是一个不眠之夜。

20点左右,匆匆输注完q12h的抗生素,我开始巡视病房。当我巡视到12床的时候,常规观察患者瞳孔,却发现患者瞳孔与白班交班时相比已经开始散大,我急忙查看患者病例,发现白天时患者瞳孔直径约2.5mm左右,而现在患者瞳孔直径却到了4mm。我急忙叫来大夫,大夫看过后怀疑患者脑疝,遂医嘱甘露醇150ml静滴。一切治疗都安然有序。可是就在患者滴完甘露醇后,我为患者测量血压,发现患者血压为80/45mmhg,刚开始我以为患者因为体位导致血压低,遂用水银血压计为患者测量。发现患者血压仍然为85/42mmhg。这时我急忙翻看患者病例。发现患者有心力衰竭病史。

这时我才恍然大悟,甘露醇为脱水药。患者心功能不好,用了甘露醇后因脱水太快导致患者血容量不足,从而引发心脏供血不足,这才引起了血压低,找到原因后,我通知大夫,急忙为患者补液,并1小时一次为患者鼻饲管注水。大约3小时后,患者血压恢复到135/83mmhg。

甘露醇为高渗透降压药,临床上一般用来治疗脑水肿,降低颅内压,虽然甘露醇对于降低颅内压效果非常好,却不是每个人都适用。那么,在临床上应用甘露醇时,我们应该如何在用药期间及时观察并做好护理工作。

1、谨防静脉炎的产生

输注甘露醇时要求速度快,常用20号以上的头皮针穿刺。血管壁容易受损。快速滴注时可致局部静脉血管内渗透压迅速升高,血管内内皮细胞脱水,静脉壁的通透性增强,白细胞浸润并产生炎症。

护理:要严格选择静脉,最好是粗直的静脉血管,护士应加强巡视,防止外渗。对长期输注甘露醇的患者经常更换穿刺部位,提高穿刺成功率,也可使用静脉留置针,以保护血管。若发生静脉炎,尽早使用硫酸镁湿敷或使用溃疡贴。

2、防止电解质紊乱

长期输注甘露醇 的患者,会出现尿量增多,血容量不足,伴随血钾的丢失会而出现低血钾。会出现肌无力,腹胀,食欲减退等症状,严重者会出现膈肌麻痹,呼吸衰竭,危及生命。

护理:注意观察输注甘露醇的时生命体征,若患者出现腹胀,全身无力,食欲减退的症状,应提醒大夫,尽早做血清钾检测。结合化验结果,做出相应的处理。若病情较轻者,一般口服补钾。当出现神经肌肉表现时,应给予静脉补钾。

3、注意生命体征的监测

心功能不全患者若快速滴注甘露醇时会造成脱水严重,尿量增多,血容量不足。从而导致心脏负荷过重,心脏供血不足。从而出现低血压及心率减慢的情况

护理:对于脑血管意外伴心功能不全的患者,对于甘露醇的应用应该慎重。若是静脉滴注甘露醇,应密切观察生命体征的变化,加强巡视,避免因输入速度过快或血容量增加诱发心率衰竭

4、对各类危重患者应用甘露醇时应注意检查尿液分析,血尿渗透压。以防患者的肾功能改变,血尿渗透压的检测具有重要的临床价值,特别是对有肾功能不全者。

护理:应加强巡视,严密观察患者病情。避免因巡视不当,观察不到位而引发的一系列问题。

5、防止甘露醇肾病

大量快速注射甘露醇时会使肾小管液渗透压上升过快,导致肾小管上皮细胞损伤。在临床上会出现尿少,甚至急性肾衰。

6、防止诱发脑血管病

长期输注甘露醇的患者可出现血液浓缩,使血液处于高粘状态,诱发脑血管病,还可加重老年人肾脏负担。对有脑血管病,糖尿病老年人应慎用。

此类事件虽然普通,却是护理前辈们用鲜血和泪水换来的,请大家引此为戒,避免此类事件的发生。

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    2019-02-25 红色围巾

    经验学习,共同进步

    0

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    2019-02-24 smartxiuxiu

    有用

    0

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    2019-02-23 小几洁
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    2019-02-22 1581f80970m

    谢谢分享

    0

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    2019-02-22 12543c13m83暂无昵称

    谢谢分享

    0

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    2019-02-22 飛歌

    学习了很有用不错啊

    0

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目前,甘露醇在保留肾单位手术(NSS)中被作为减轻肾缺血影响的保护剂使用,但该临床惯例尚缺乏严格的方法学研究。

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20%甘露醇注射液作为中国药典收录国家基本药物,作为治疗脑水肿、降低颅内压、预防和治疗急性肾功能衰竭及青光眼、大面积烧烫伤等引起的水肿、腹水等常用药、首选用药,在临床广泛应用,特别是在神经学科疾病治疗中尤其重要。回顾性总结甘露醇在神经学科疾病中的使用情况,谈谈甘露醇的临床应用误区及经验。