各种皮试液配制方法课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,青霉素皮试,名称,皮试液浓度,配,制,方,法,反应判断,青霉素,200u/mlI,原,液,加生理盐水,每毫升含量,阴性（一）：皮丘无改变,.,周围不红肿,.,无自觉症状,注入,0.1ml=20u,80,万,u,4ml,20,万,u,阳性（,+,）：局部皮肤隆起、并出现红晕,.,硬结直径大于,1,厘米，有伪足，严重可出现休克,（,抽三推二,）,0.1ml,0.9ml,2000u,0.1ml,0.9ml,200u,0.1mi,0.9ml,200u,2.,试验方法,.,确定患者无青霉素过敏史，于患者前臂掌侧下段皮内注射青霉素皮试液,0.1ml,（含青霉素,20,或,50U,），,20,分钟后观察、判断并记录实验结果。,3.,实验结果判断：,结果 局部皮丘反应 全身情况,阴性 大小无改变，无红肿，无红晕 无自觉症状,阳性 皮丘隆起增大，出现红晕，直径 可有头晕、心慌、恶心，,大于,1cm,周围有伪足伴局部痒感 甚至发生过敏性休克,注意事项,1.,青霉素过敏试验前详细询问患者的用药物史、药物过敏史及家族过敏史。,2.,凡第一次用药、停药,3,天后再用，以及在应用中更换青霉素批号时，均须按常规做过敏试验。,3.,皮肤试验液必须现用现配，浓度与剂量必须准确。,4.,严密观察患者，首次注射后须观察,30,分钟，注意局部和全身反应，倾听患者主诉，并,做好急救准备工作。,5.,皮试结果阳性者不可使用青霉素，并在体温单、医嘱单、床头卡醒目注明，注射本上注销，同时将结果告知患者及家属。,6.,如对皮试结果有怀疑，应在对侧前臂皮内注射生理盐水,0.1ml,，以作对照，确认青霉素皮试结果为阴性方可用药。使用青霉素过程中要严密观察反应。,过敏性休克的表现,临床表现,呼吸道阻塞症状 ：胸闷，气促，呼吸困难，伴濒死感,循环衰竭症状 ： 面色苍白，发绀，脉搏细弱，血压下降,中枢神经系统症状,： 面部及四肢麻木 ，意识丧失，抽搐，大小便失禁,其他过敏反应表现,： 荨麻疹 恶心 呕吐 腹痛,过敏性休克的急救措施,1,、立即停药，使病人平卧。,2,、立即皮下注射,0.1%,肾上腺素,1ml,，小儿酌减。症状如不缓解，可每隔半小时皮下或静脉注射该药,0.5ml,。直至脱离危险期。,3,、给予氧气吸入，改善缺氧症状。呼吸受抑制时，应立即进行人工呼吸，并使用呼吸兴奋剂。喉头水肿引致窒息时，应尽快实行气管切开。,4,、根据医嘱静脉注射地塞米松,5-10mg,，应用抗组胺类药，如盐酸异丙嗪等。,5,、静脉滴注,10%,葡萄糖溶液或平衡液扩充血容量。血压仍不回升，按医嘱加入多巴胺等。,6,、若心跳骤停，则立即进行复苏抢救。,7,、密切观察病情，记录病人呼吸、脉搏、血压、神志和尿量等变化,破伤风抗毒素,破伤风抗毒素：,TAT,皮试浓度：,150u/ml,（,0.1=15u,）,配制方法：取含,1500,国际单位的破伤风抗毒素药液,0.1ml,加等量生理盐水,0.9ml(150,国际单位,/ml),反应判断,阴性：局部无红肿，全身无不适,;,阳性：局部反应皮丘红肿，硬结大于,1.5cm,红晕超过,4cm,有伪足瘙痒感,破伤风抗毒素脱敏法,次数,1500u,抗毒素血清,生理盐水,(,毫升,),含量,注：肌肉注射，每次间隔,20,分钟,1,0.1ml,0.9ml,150u,2,0.2ml,0.8ml,300u,3,0.3ml,0.7ml,450u,4,余量,0.6ml,600u,碘,30%,泛影葡胺,1ml=0.3,1.,静注：取碘造影剂,1ml,于,静脉缓慢注射,2.,皮内注射,:,取碘造影剂,0.1ml,于皮内注射,3.,口服法：,510%,碘化钾（钠,）,5ml,每日,3,次共,3,天,碘,结果观察：,5-15,分种后观察结果，如有血压、脉搏、呼吸和面色等改变为阳性。,20,分钟后观察结果，局部有红、肿、硬块、直径超过,1cm,为阳性。口服后有口麻，大量流涕、头晕、心慌、恶心、呕吐或呼吸困难。,盐酸普鲁卡因,盐酸普鲁卡因,皮试液浓度：,0.25%/0.1ml,配制方法：,取,0.25%,普鲁卡因液,0.1ml,做皮内注射,取浓度为,2%,普鲁卡因,2ml,加生理盐水至,4ml,再取,1ml,加生理盐水至,4ml,则浓度为,0.25%.,取,1%,普鲁卡因取,0.1ml,加生理盐水,0.4ml=0.25%,0.5%,普鲁卡因取,0.1,加生理盐水至,0.2=0.25%,反应判断同青霉素，阳性者不能用用此药,结核菌素,结核菌素：,50U/,支,/ml,取上液,0.1ml,作皮试,(5U/ ml),皮试时于左手注入试敏液，右手注入生理盐水作对照。,48-72,小时观察结果,阴性：皮肤硬结小于,5mm,阳性：皮肤硬结,5-10m,（,+,）皮肤硬结,10-15mm(+),皮肤硬结,15-20mm(+),皮肤硬结大于,20mm,或局部出现水疱或坏死者为（,+,）,应向病人解释结核菌素试验阳性仅表明曾有结核,青霉素类药物皮试液配制方法,氨苄西林,1g/,瓶、氯唑西林,1g/,瓶、氨苄西林钠氯唑西林钠,1g/,瓶、阿洛西林舒巴坦钠,1g/,瓶：,以上所需药物加生理盐水溶解至,4ml,；（,250mg/ml,） 取上液,0.1ml+,生理盐水至,1ml,；（,25mg/ml,） 取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,） 取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,） 取上液,0.1ml,作皮试（即,0.05mg,）,(,皮试结果判断同青霉素,),氨苄西林钠氯唑西林钠,2g/,瓶,以上所需药物加生理盐水溶解至,8ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）取上液,0.1ml,作皮试（即,0.05mg,）,(,皮试结果判断同青霉素,),美洛西林舒巴坦钠,1.25g/,瓶,以上所需药物加生理盐水溶解至,5ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）取上液,0.1ml,作皮试（即,0.05mg,）,(,皮试结果判断同青霉素,),阿莫西林舒巴坦钠,1. 5g/,瓶、派拉西林舒巴坦钠,1.5g/,瓶,以上所需药物加生理盐水溶解至,6ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）取上液,0.1ml,作皮试（即,0.05mg,）皮试结果判断同青霉素。,美洛西林,0.5g/,瓶、派拉西林,0.5g/,瓶、氨苄西林,0.5g/,瓶,以上所需药物加生理盐水溶解至,2ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）取上液,0.1ml,作皮试（即,0.05mg,）皮试结果判断同青霉素。,长效西林（苄星青霉素）,120,万,U/,瓶：,长效西林,+,生理盐水,5.8ml,溶解；（,20,万,U/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2,万,U/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2,千,U/ml,）取上液,0.25ml+,生理盐水至,1ml,；（,500U/ml,）取上液,0.1ml,作皮试（即,50U/0.1ml,）,(,皮试结果判断同青霉素,),先锋铋,1g/,瓶、头孢替唑,1g/,瓶：,以上所需药物加生理盐水溶解至,4ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）,(500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）,(,皮试结果判断同青霉素,),头孢菌素类药物过敏试验法,头孢唑林钠,0.5,、头孢拉定,0.5,、头孢呋辛,1.0,、头孢曲松,1.0,、头孢哌酮舒巴坦,0.75,等皮试液配制成,500ug/1ml,生理盐水溶液为标准，皮试注入剂量为,0.1ml(,含,50ug),头孢拉定 加,0.9%,盐水（,ml,）每,ml,药液头孢拉定含量,0 .5g 2 250mg,取上液,0.2ml 0.8 50mg,取上液,0.1ml 0.9 5mg,取上液,0.1ml 0.9 500ug,头胞哌酮舒巴坦,0.75,皮试配制,头胞哌酮舒巴坦 加,0.9%,氯化钠溶液 每,ml,药液,头胞哌酮舒巴坦含量,0.75g 3ml 250mg,取上液,0.2ml 0.8 50mg,取上液,0.1ml 0.9 5mg,取上液,0.1ml 0.9 500ug,头孢替唑,1.0,头孢哌酮钠,1.0,头孢硫脒,1.0,头孢西丁,1.0,头孢噻肟钠,1.0,头孢甲肟,1.0,头孢曲松钠,1.0,头孢美唑,1.0,以上所需药物加生理盐水溶解至,8ml,；（,125mg/ml,即,0.5g/4ml,）取上液,0.1ml+,生理盐水至,1ml,；（,12.5 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,1.25mg/ml,）取上液,0.4ml+,生理盐水至,1ml,；（,0.5mg/ml,即,500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）,(,皮试结果判断同青霉素,),头孢他啶,1.5,头孢呋辛,1.5,头孢哌酮舒巴坦,1.5,以上所需药物加生理盐水溶解至,6ml,；（,250mg/ml,即,0.5g/2ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,即,500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）,(,皮试结果判断同青霉素,),头孢哌酮,2.0,以上所需药物加生理盐水溶解至,8ml,；（,250mg/ml,即,0.5g/2ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,即,500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）,(,皮试结果判断同青霉素,),头孢唑林钠,0.5,头孢唑肟,0.5,头孢米诺,0.5,五水头孢唑林,0.5,头孢替胺,0.5,头孢匹罗,0.5,以上所需药物加生理盐水溶解至,4ml,；（,125mg/ml,即,0.5g/4ml,） 第一次：取上液,0.1ml+,生理盐水至,1ml,；（,12.5 mg/ml,） 第二次：取上液,0.1ml+,生理盐水至,1ml,；（,1.25mg/ml,） 第三次：取上液,0.4ml+,生理盐水至,1ml,；（,0.5mg/ml,即,500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）,(,皮试结果判断同青霉素,),头孢拉定,0.5g/,瓶、头孢呋新钠,0.5g/,瓶、头孢地嗪钠,0.5g/,瓶、头孢派酮钠舒巴坦钠,0.5g/,瓶、头孢唑林钠,0.5g/,瓶：,以上所需药物加生理盐水溶解至,2ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）,(500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）皮试结果判断同青霉素。,头孢曲松,1.5g/,瓶、头孢曲松舒巴坦钠,1.5g/,瓶,以上所需药物加生理盐水溶解至,6ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）,(500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）皮试结果判断同青霉素。,头孢他定舒巴坦钠,0.75g/,瓶,以上所需药物加生理盐水溶解至,3ml,；（,250mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,25 mg/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5mg/ml,）取上液,0.2ml+,生理盐水至,1ml,；（,0.5mg/ml,）,(500ug/ml),皮试时取,0.1ml,（即,50ug/0.1ml,）皮试结果判断同青霉素。,总结,通过以上两例皮试液配制方法可以看出，头孢类药物配制皮试液时药物含量乘以四得出的数字是：第一次溶解药液的毫升数，每毫升药液的含量是,250mg,，按以上配制方法进行配制。,细胞色素,C,15mg/,支,/2ml,：取细胞色素,C 0.1ml+,生理盐水至,1ml,；（,0.75mg/ml,）取上液,0.1ml,作皮试（即,0.07mg,），局部红肿，直径大于,1cm,，有丘疹者为阳性,链霉素,1g,（,100,万,U/,瓶）：链霉素,100,万,U+,生理盐水至,3.5ml,（共,4ml,）（,25,万,U/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2.5,万,U/ml,）取上液,0.1ml+,生理盐水至,1ml,；（,2500,万,U/ml,）取上液,0.1ml,作皮试（即,2500U,）（皮试结果判断同青霉素。链霉素过敏性休克抢救措施同青霉素过敏性休克抢救措施，因链霉素可与钙离子铬合，从而使链霉素的毒性症状减轻或消失。故需备,10%,葡萄糖酸钙注射液静脉注射）,糜蛋白酶,4000U/,瓶糜蛋白酶,4000U/,瓶,+,生理盐水,5ml,溶解；（,800U/ml,）取上液,0.5ml+,生理盐水至,1ml,；（,40U/ml,）取上液,0.1ml,作皮试（即,4U,）（肌注者需皮试；皮试结果判断同青霉素。）,B1,注射液,10mg/,瓶,/2ml,取上液,0.1ml+,生理盐水至,1ml,；（,0.5mg/ml,）取上液,0.1ml,作皮试 （,0.05mg/ml,）（皮试结果判断同青霉素）,18,、,结核菌素,50U/,支,/ml,鲑鱼降钙素注射液,50,单位（,10g/,支）,1,、,1ml,注射器取,0.2ml,原液用生理盐水稀释至,1ml,；,2,、取上液,0.1ml,（即,1,单位）皮下注射。观察,15,分钟看结果。结果判断同青霉素。,