針頭指南介紹注射技術(shù)

1、《中國(guó)糖尿病藥物注射技術(shù)指南2011版》注射技術(shù)篇,注射技術(shù)是糖尿病注射治療的三大關(guān)鍵因素之一,,注射技術(shù)：注射部位的選擇注射部位的輪換注射部位的檢查和消毒選擇是否捏皮選擇進(jìn)針角度拔針時(shí)間注射器材的廢棄關(guān)于針頭重復(fù)使用的建議,,,腹部以肚臍為中心，半徑2.5cm外的距離。越靠近腰部?jī)蓚?cè)（即使是肥胖患者），皮下組織的厚度也會(huì)變薄，因此容易導(dǎo)致肌肉注射。,根據(jù)可操作性/神經(jīng)血管距離/皮下組織狀況：適合注射的部位,,上臂上

2、臂側(cè)面或者后側(cè)部位；皮下組織較厚，導(dǎo)致肌肉注射的概率較低。,,臀部臀部上端外側(cè)部位；即使是少兒患者還是身材偏瘦的患者，該部位的皮下組織仍然豐富，最大限度降低肌肉注射的危險(xiǎn)性。,大腿大腿外側(cè)；皮下組織較厚，離大腿血管和坐骨神經(jīng)較遠(yuǎn)，針頭導(dǎo)致外傷的概率較低。,推薦的注射部位,,,,,注射部位還應(yīng)考慮胰島素在不同部位的吸收差異,不同注射部位胰島素吸收不同（分鐘）： —研究顯示，50%胰島素吸收所需要的時(shí)間腹部最快，手臂中等，大

3、腿和臀部較慢1,1.The American Journal of Nursing, Vol. 98, No.7, pp. 55+57,關(guān)于注射部位選擇的推薦：,,注射餐時(shí)胰島素等短效胰島素，最好選擇腹部[1-7]；A1希望胰島素的吸收速度較緩時(shí)，可以選擇臀部。臀部注射可以最大限度地降低注射至肌肉層的風(fēng)險(xiǎn)[8,9]；A1給少兒患者注射中效或者長(zhǎng)效胰島素時(shí)，最好選擇臀部或者大腿[10]。A1,Frid A, Gunnarsson R,

4、 Güntner P, Linde B. Effects of accidental intramuskulær injection on insulin absorption in IDDM. Diabetes Care 1988; 11: 41-45. Frid A & B Linde (1993) Clinically important differences in insulin absorpti

5、on from the abdomen in IDDM. Diabetes Research and Clinical Practice: Vol 21. No 2-3. 137-141. Frid A, Lindén B. Intraregional differences in the absorption of unmodified insulin from the abdominal wall. Diabet Med

6、 1992;9:236-9.Annersten M, Willman A. Performing subcutaneous injections: a literature review. Worldviews Evid Based Nurs 2005; 2: 122-30.Zehrer C, Hansen R, Bantle J. Reducing blood glucose variability by use of abdom

7、inal insulin injection sites. Diabetes Educ 1985;16:474-7.Henriksen JE, Djurhuus MS, Vaag A, Thye-Ronn P, Knudsen D. Hother-Nielsen O, et al. Impact of injection sites for soluble insulin on glycaemic control in type 1

8、(insulin-dependent) diabetic patients treated with a multiple insulin injection regimen. Diabetologia 1993;36:752-8.Sindelka G, Heinemann L, Berger M. Frenck W, Chantelau E. Effect of insulin concentration, subcutaneous

9、 fat thickness and skin temperature on subcutaneous insulin absorption in healthy subjects. Diabetologia 1994;37:377-40.Ahern J & ML Mazur (2001) Site rotation. Diabetes Forecast: Vol 54. No 4. 66-68. Wood L, Wilbo

10、urne J, Kyne-Grzebalski D, et al. administration of insulin by injection. Practice Diabetes International 2002; 19(Suppl 2-1): S1-S2.Smith CP, Sargent MA, Wilson BP, Price DA. Subcutaneous or intramuscular insulin injec

11、tions. Arch Dis Child 1991;66:879-82.,關(guān)于注射部位輪換的推薦：,,一種已經(jīng)證實(shí)有效的注射部位輪換方案：將注射部位分為四個(gè)象限（大腿或臀部可等分為兩個(gè)等分區(qū)域），每周使用一個(gè)象限并始終按順時(shí)針?lè)较蜻M(jìn)行輪換[1,2]；A3在任何一個(gè)象限或等分區(qū)域內(nèi)注射時(shí)，每次的注射點(diǎn)都應(yīng)間隔至少1cm，以避免重復(fù)的組織損傷；A3從注射治療一開(kāi)始，就應(yīng)教會(huì)患者掌握一套簡(jiǎn)單易行的注射部位輪換方案[3]；A2每次

12、患者就診時(shí)，醫(yī)護(hù)人員都應(yīng)檢查患者輪換方案的執(zhí)行情況。A3,Diagrams courtesy of Lourdes Saez-de Ibarra and Ruth Gaspar, Diabetes Nurses and Specialist Educators from La Paz Hospital, Madrid, Spain.Lumber T. Tips for site rotation. When it comes to i

13、nsulin. where you inject is just as important as how much and when. Diabetes Forecast 2004;57:68-70.Thatcher G. Insulin injections. The case against random rotation. Am J Nurs 1985; 85: 690-2.,注射部位的輪換：不同注射部位之間的輪換,午餐前,晚餐

14、前,不同注射部位之間的輪換：“每天同一時(shí)間注射同一部位，每天不同時(shí)間注射不同部位”,早餐前,午餐前,晚餐前,早餐前,睡前,一天注射三次：,一天注射四次：,注射部位的輪換：左右輪換,注射部位左右輪換：左邊一周，右邊一周，部位對(duì)稱(chēng)輪換左邊一次，右邊一次，部位對(duì)稱(chēng)輪換,注射部位的輪換：同一注射部位內(nèi)的輪換,同一注射部位內(nèi)的輪換：每次注射時(shí)離上次注射點(diǎn)之間距離至少1cm的距離,關(guān)于注射部位檢查和消毒的推薦：,,患者應(yīng)于注射前檢查注射部位

15、[1,2]；A3一旦發(fā)現(xiàn)注射部位若出現(xiàn)脂肪增生、炎癥或感染，應(yīng)更換注射部位[3-10]；A2注射時(shí)，應(yīng)保持注射部位的清潔[11]；A2當(dāng)注射部位不潔凈，或者患者處于感染已于傳播的環(huán)境（如：醫(yī)院或療養(yǎng)院），注射前應(yīng)消毒注射部位[2,12,16-18]。A3,Danish Nurses Organization. Evidence-based Clinical Guidelines for Injection of Insulin f

16、or Adults with Diabetes Mellitus, 2nd edition, December 2006.Association for Diabetescare Professionals (EADV). Guideline: The Administration of Insulin with the Insulin Pen. September 2008.Johansson U. Amsberg S, Hann

17、erz L, Wredling R, Adamson U, Arnqvist HJ & P Lins (2005) Impaired Absorption of insulin Aspart from Lipohypertrophic Injection Sites. Diabetes Care: Vol 28, No 8, 2025-2027. Ariza-Andraca CR, Altamirano-Bustamante

18、E, Frati-Munari AC, Altamirano-Bustamante P, Graef-Sanchez A. Delayed insulin absorption due to subcutaneous edema. Arch Invest Med 1991;22:229-33.Saez-de Ibarra L, Gallego F. Factors related to lipohypertrophy in insul

19、in-treated diabetic patients; role of educational intervention. Pract Diabetes Int 1998;15:9-11.Young RJ, Hannan WJ, Frier BM, Steel JM, Duncan LJ. Young RJ, Hannan WJ, Frier BM, Steel JM Diabetic lipohypertrophy delays

20、 insulin absorption. Diabetes Care 1984;7:479-80.Chowdhury TA, Escudier V. Poor glycaemic control caused by insulin induced lipohypertrophy. BMJ 2003;327:383-4.Johansson UB. Impaired absorption of insulin aspart from l

21、ipohypertrophic injection sites. Diabetes Care 2005;28:2025-7.Overland J, Molyneaux L, Tewari S., Fatouros R, Melville P, Foote D, et al. Lipohypertrophy: Does it matter in daily life? A study using a continuous glucose

22、 monitoring system. Diabetes Obes Metab2009;11:460-3.Frid A, Linden B. Computed tomography of injection sites in patients with diabetes mellitus. Injection and Absorption of Insulin. Stockholm: Thesis, 1992.Gorman KC.

23、Good hygiene versus alcohol swabs before insulin injections (Letter). Diabetes Care 1993;16:960-1.Schuler G, Pelz K, Kerp L. Is the reuse of needles for insulin injection systems associated with a higher risk of cutaneo

24、us complications? Diabetes Res Clin Pract 1992;16:209-12.Workman B. Safe injection techniques. Nurs Stand 1999;13:47-53.Bain A, Graham A. How do patients dispose of syringes? Pract Diabetes Int 1998; 15: 19-21.Chantel

25、au E, Schiffers T, Schutze J, Hansen B. Effect of patient-selected intensive insulin therapy on quality of life. Patient Educ Couns 1997 Feb; 30(2): 167-73.Le Floch JP, Herbreteau C, Lange F, Perlemuter L. Biologic mate

26、rial in needles and cartridges after insulin injection with a pen in diabetic patients. Diabetes Care 1998;21:1502-4.McCarthy JA, Covarrubias B, Sink P. Is the traditional alcohol wipe necessary before an insulin inject

27、ion? Dogma disputed (Letter). Diabetes Care 1993;16:402.Swahn A. Erfarenheter av 94000 osterilt givna insulininjektioner (Experiences from 94000 insulin injections given without skin swab). Sv Lakaresallskapets Handling

28、ar Hygiea 1982;92:160(3O).,關(guān)于捏皮的推薦：,,所有患者在起始胰島素治療時(shí)就應(yīng)掌握捏皮的正確方法；A3捏皮時(shí)力度不得過(guò)大導(dǎo)致皮膚發(fā)白或疼痛；A3不能用整只手來(lái)提捏皮膚，以避免將肌肉及皮下組織一同捏起；最佳的注射步驟為：捏起皮膚形成皮褶；和皮褶表面呈90°角進(jìn)針后，緩慢推注胰島素；當(dāng)活塞完全推壓到底后，針頭在皮膚內(nèi)停留10秒鐘（采用胰島素筆注射）；拔出針頭；松開(kāi)皮褶。A3,正確的捏皮手法

29、,錯(cuò)誤的捏皮手法,Clauson PG, Linde B. Absorption of rapid-acting insulin in obese and nonobese NIDDM patients. Diabetes Care 1995;18:986-91.Jamal R, Ross SA, Parkes JL, Pardo S, Ginsberg BH. Role of injection technique in use o

30、f insulin pens: prospective evaluation of a 31-gauge, 8mm insulin pen needle. Endocr Pract 1999;5:245-50.Birkebaek N, Solvig J, Hansen B, Jorgensen C, Smedegaard J, Christiansen J. A 4mm needle reduces the risk of intra

31、muscular injections without increasing backflow to skin surface in lean diabetic children and adults. Diabetes Care. 2008 Sep;22(9): e65. Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Skin and subcutaneous adipose layer thic

32、kness in adults with diabetes at sites used for insulin injections: Implications for needle length recommendations. Curr MedRes Opin 2010;26:1519-30.Hirsch L, Klaff L, Bailey T, Gibney M, Albanese J, Qu S, et al. Compar

33、ative glycemic control, safety and patient ratings for a new 4 mm\32G insulin pen needle in adults with diabetes. Curr Med Res Opin 2010;26:1531-41.Kreugel G, Keers JC, Jongbloed A, Verweij-Gjaltema AH, Wolffenbuttel BH

34、R. The influence of needle length on glycemic control and patient preference in obese diabetic patients. Diabetes 2009;58:A117.Kreugel G, Beijer HJM, Kerstens MN, ter Maaten JC, Sluiter WJ, Boot BS. Influence of needle

35、size for SC insulin administration on metabolic control and patient acceptance. Europ Diab Nursing 2007;4:1-5.Van Doorn LG, Alberda A, Lytzen L. Insulin leakage and pain perception with NovoFine 6 mm and NovoFine 12 mm

36、needle lengths in patients with type 1 or type 2 diabetes. Diabet Med 1998;1:S50.Solvig J, Christiansen JS, Hansen B, Lytzen L. Localisation of potential insulin deposition in normal weight and obese patients with diabe

37、tes using Novofine 6 mm and Novofine 12 mm needles. Meeting Federation European Nurses in Diabetes, Jerusalem, Israel, 2000 (Abstract).Schwartz S, Hassman D, Shelmet J, Sievers R, Weinstein R, Liang J, Lyness W. A mult

38、icenter, open-label, randomized, two-period crossover trial comparing glycemic control, satisfaction, and preference achieved with a 31 gauge x 6mm needle versus a 29 gauge x 12.7mm needle in obese patients with diabetes

39、 mellitus. Clin Ther 2004;26:1663-78.Frid A, Lindén B. Where do lean diabetics inject their insulin? A study using computed tomography. BMJ 1986; 292:1638.,關(guān)于進(jìn)針角度的推薦：,,使用較短（4mm或5mm）的針頭時(shí)，大部分患者無(wú)需捏起皮膚，并可90°進(jìn)針[1-9

40、]；A1使用較長(zhǎng)（≥ 8mm）的針頭時(shí)，需要捏皮或45°角以降低肌肉注射風(fēng)險(xiǎn)[10,11]。A1,進(jìn)針角度,90°注射,45°注射,為保證將胰島素注射至皮下組織，在不捏皮的情況下可以45°角進(jìn)行注射，以增加皮下組織的厚度，降低胰島素注射至肌肉層的危險(xiǎn)。,針頭留置時(shí)間,藥液的流速還與注射筆針頭的內(nèi)徑有關(guān)，注射筆針頭的內(nèi)徑越大，其藥液流速更快。目前，臨床上有采用 “薄壁”設(shè)計(jì)的針頭，在同等外徑的情況

41、下內(nèi)徑更大，在降低注射引起不適感的同時(shí)保證胰島素的流速，更利于機(jī)體對(duì)胰島素的吸收,* Frid A. New injection recommendations for patients with diabetes.Diabetes & Metabolism 36 (2010) S3-S18,*,A3,,,關(guān)于注射器材廢棄的推薦,,醫(yī)護(hù)人員和患者必須熟知國(guó)家有關(guān)醫(yī)療廢棄物處理的相關(guān)規(guī)定[1]；A3所有醫(yī)護(hù)人員從注射治療的開(kāi)

42、始，就應(yīng)教會(huì)患者如何正確廢棄注射器材[2]；A3醫(yī)護(hù)人員應(yīng)向患者說(shuō)明可能發(fā)生于患者家人（如刺傷兒童）和服務(wù)人員（如垃圾收運(yùn)工和清潔工）的不良事件；A3任何情況下都不能將注射器材丟入公共垃圾桶或者垃圾場(chǎng)。A3,Workman B. Safe injection techniques. Nurs Stand 1999;13:47-53.Bain A, Graham A. How do patients dispose of syrin

43、ges? Pract Diabetes Int 1998; 15: 19-21.,注射器材的規(guī)范廢棄,胰島素注射筆針頭的廢棄,胰島素專(zhuān)用注射器的廢棄,廢棄針頭或者注射器的最佳方法是，將注射器或注射筆針頭（套上外針帽）放入專(zhuān)用廢棄容器內(nèi)再丟棄。如果沒(méi)有專(zhuān)用廢棄容器，也可使用加蓋的硬殼容器。,關(guān)于針頭重復(fù)使用的建議,,注射筆針頭應(yīng)一次性使用[1-7]。A2,Chantelau E, Lee DM, Hemmann DM, Zipfel U,

44、 Echterhoff S. What makes insulin injections painful? British Medical Journal 1991; 303: 26-27.Strauss K, De Gols H, Letondeur C, Matyjaszczyk M, Frid A. The second injection technique event (SITE), May 2000, Barcelona,

45、 Spain. Pract Diabetes Int 2002; 19: 17-21.Danish Nurses Organization. Evidence-based Clinical Guidelines for Injection of Insulin for Adults with Diabetes Mellitus, 2nd edition, December 2006.Association for Diabetesc

46、are Professionals (EADV). Guideline: The Administration of Insulin with the Insulin Pen. September 2008.Schuler G, Pelz K, Kerp L. Is the reuse of needles for insulin injection systems associated with a higher risk of c

47、utaneous complications? Diabetes Res Clin Pract 1992;16:209-12.Maljaars C. Scherpe studie naalden voor eenmalig gebruik [Sharp study needles for single use]; Diabetes and Levery 2002;4:36-7.Torrance T. An unexpected ha

48、zard of insulin injection. Pract Diabetes Int 2002;19:63.,重復(fù)使用注射筆針頭的常見(jiàn)原因,知識(shí)缺乏不了解重復(fù)使用針頭的危害,經(jīng)濟(jì)條件太貴了，不能承受,個(gè)人經(jīng)驗(yàn)多次重復(fù)使用未感到風(fēng)險(xiǎn),風(fēng)險(xiǎn)教育教育者沒(méi)有提過(guò),其他,中華現(xiàn)代護(hù)理雜志 2010,16(14): 1631-1632.,358例使用胰島素注射筆的糖尿病患者，年齡19~82歲，以問(wèn)卷形式進(jìn)行調(diào)查其胰島素筆用針頭安全使用

49、情況。,重復(fù)使用注射筆針頭具有多重風(fēng)險(xiǎn)之一：影響注射劑量的準(zhǔn)確性,,,,,注射漏液,藥液流失,溫度降低時(shí)胰島素體積收縮導(dǎo)致空氣進(jìn)入筆芯，產(chǎn)生氣泡導(dǎo)致注射時(shí)間的延長(zhǎng)產(chǎn)生漏液現(xiàn)象,溫度升高時(shí)胰島素體積膨脹而從筆芯泄漏浪費(fèi)胰島素改變混合胰島素的濃度,重復(fù)使用注射筆針頭具有多重風(fēng)險(xiǎn)之二：針頭斷裂或針管堵塞,重復(fù)使用注射筆針頭具有多重風(fēng)險(xiǎn)之三：疼痛增加,新針頭,多次使用后的針頭,（高倍電子顯微鏡下的針頭形狀）,1.Bangstad

50、 H-J. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium.Pediatric Diabetes 2009:10(Suppl.12):82-99.2.Chantelau E, et al. What makes insulin injections painful? British Medical Journal 1991;303: 26-27.

51、,重復(fù)使用注射筆針頭具有多重風(fēng)險(xiǎn)之四：導(dǎo)致皮下脂肪增生和硬結(jié),下腹部皮下脂肪增生,上腹部皮下脂肪增生,腹部?jī)蓚?cè)皮下脂肪增生,Diabetes & Metabolism 36 (2010) S3-S18,與注射相關(guān)的相關(guān)問(wèn)題,,皮下脂肪營(yíng)養(yǎng)障礙與其他并發(fā)癥皮下脂肪營(yíng)養(yǎng)障礙疼痛出血和淤血胰島素的貯存胰島素的混勻特殊人群的胰島素混勻兒童妊娠,皮下脂肪營(yíng)養(yǎng)障礙,左側(cè)：正常的部位捏起皮膚較薄,右側(cè)：發(fā)生皮下脂肪營(yíng)養(yǎng)障

52、礙的部位，捏起皮膚較厚,每次注射前都應(yīng)檢查注射部位，尤其是對(duì)已經(jīng)出現(xiàn)皮下脂肪增生的患者推薦方法：不僅需要視診而且需要觸診。正常皮膚能被緊緊的捏在一起，而發(fā)生皮膚硬結(jié)的皮膚卻不能判斷并避開(kāi)出現(xiàn)疼痛、皮膚凹陷、皮膚硬結(jié)、出血、瘀斑、感染的部位如發(fā)現(xiàn)皮膚硬結(jié)，請(qǐng)確認(rèn)出現(xiàn)硬結(jié)的部位及大小，避開(kāi)硬結(jié)進(jìn)行注射,關(guān)于皮下脂肪營(yíng)養(yǎng)障礙的推薦：（一）,,患者（尤其是已經(jīng)出現(xiàn)皮下脂肪營(yíng)養(yǎng)障礙的患者）每次就診時(shí)，醫(yī)護(hù)人員應(yīng)對(duì)其注射部位進(jìn)行檢查。每個(gè)注

53、射部位至少每年檢查一次（兒童患者最好每次就診時(shí)都檢查）。醫(yī)護(hù)人員應(yīng)教會(huì)患者自己檢查注射部位，并培訓(xùn)他們?nèi)绾伟l(fā)現(xiàn)皮下脂肪增生[1,2]；A2用墨水筆在皮下脂肪營(yíng)養(yǎng)障礙部位的兩端，即正常皮膚與“橡皮樣”病變的交界處做標(biāo)記，測(cè)量并記錄病變的大小以便長(zhǎng)期隨訪(fǎng)。若病變部位肉眼可見(jiàn)，應(yīng)同時(shí)拍照以便長(zhǎng)期隨訪(fǎng)；A3,Seyoum B, Abdulkadir J. Systematic inspection of insulin injection s

54、ites for local complications related to incorrect injection technique. Trop Doct 1996;26:159-61.Teft G. Lipohypertrophy: patient awareness and implications for practice. J Diab Nursing 2002;6:20-3.,關(guān)于皮下脂肪營(yíng)養(yǎng)障礙的推薦：（二）,,病變

55、組織恢復(fù)正常通常需要數(shù)月至數(shù)年，在此之前，不得在此部位進(jìn)行注射[1,2]；A2注射部位由病變組織轉(zhuǎn)換至正常組織時(shí)，通常需要減少胰島素的注射劑量。注射劑量的實(shí)際變化因人而異，并在頻繁血糖監(jiān)測(cè)的指導(dǎo)下進(jìn)行[2,3]；A2目前，預(yù)防和治療皮下脂肪營(yíng)養(yǎng)障礙的策略包括：使用純化的人胰島素，每次注射時(shí)規(guī)范檢查注射部位，選擇注射部位時(shí)范圍更廣，不重復(fù)使用注射筆針頭[4-9]。A2,Hambridge K. The management of li

56、pohypertrophy in diabetes care. Br J Nurs 2007;16:520-4.Jansà M, Colungo C, Vidal M. Actualización sobre técnicas y sistemas de administración de la insulina (II). [Update on insulin administration t

57、echniques and devices (II)]. Av Diabetol 2008;24:255-69.Saez-de Ibarra L, Gallego F. Factors related to lipohypertrophy in insulin-treated diabetic patients; role of educational intervention. Pract Diabetes Int 1998;15:

58、9-11.Teft G. Lipohypertrophy: patient awareness and implications for practice. J Diab Nursing 2002;6:20-3.Nielsen BB, Musaeus L, Gæde P. Attention to injection technique is associated with a lower frequency of lip

59、ohypertrophy in insulin treated type 2 diabetic patients. Diabetologia 1998;41(suppl1): A251 (Abstract 970).Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diab

60、etes Res Clin Pract 2007;77: 231-6.Ampudia-Blasco J, Girbes J, Carmena R. A case of lipoatrophy with insulin glargine. Diabetes Care 2005;28: 2983.[De Villiers FP. Lipohypertrophy -a complication of insulin injections.

61、 S Afr Med J 2005;95:858-9.Hauner H, Stockamp B, Haastert B. Prevalence of lipohypertrophy in insulin-treated diabetic patients and predisposing factors. Exp Clin Endocrinol Diabetes 1996;104:106-10.,關(guān)于疼痛的推薦：,,減輕注射疼痛的方法

62、包括：室溫保存正在使用的胰島素；如果使用酒精對(duì)注射部位進(jìn)行消毒，應(yīng)于酒精徹底揮發(fā)后進(jìn)行注射；避免在體毛根部注射；選用直徑較小、長(zhǎng)度較短的注射筆針頭；每次注射使用新的注射筆針頭[1-5]。A2,Bohannon NJ. Insulin delivery using pen devices. Simple-to-use tools may help young and old alike. Postgrad Med 1999;10

63、6:57-8.Dejgaard A, Murmann C. Air bubbles in insulin pens. Lancet 1989;334:871.Danish Nurses Organization. Evidence-based Clinical Guidelines for Injection of Insulin for Adults with Diabetes Mellitus, 2nd edition, Dec

64、ember 2006.Association for Diabetescare Professionals (EADV). Guideline: The Administration of Insulin with the Insulin Pen. September 2008.Chantelau E, Lee DM, Hemmann DM, Zipfel U, Echterhoff S. What makes insulin in

65、jections painful? BMJ 1991;303: 26-7.,注射過(guò)程多種情況引發(fā)疼痛增加,,,,,,,,,,,因注射疼痛導(dǎo)致的不愿進(jìn)行胰島素治療的比例達(dá)50.8%,溫度較低的胰島素誘發(fā)疼痛和不適感,消毒皮膚的酒精未干會(huì)從針眼帶到皮下引起疼痛,體毛根部附近神經(jīng)末梢豐富,直徑較小、長(zhǎng)度較短的注射筆針頭具有較好的安全性和耐受性,注射筆針頭重復(fù)使用后卷邊反刺，針頭表面潤(rùn)滑層發(fā)生脫落，增加患者疼痛,低溫胰島素,消毒酒精未干,注

66、射在體毛根部,針頭的直徑和長(zhǎng)度,針頭重復(fù)使用,關(guān)于出血和淤血的推薦：,,應(yīng)使患者放心，注射部位局部出血或淤血并不會(huì)給胰島素的吸收或者糖尿病的整體管理帶來(lái)不良的臨床后果。A2,注射時(shí)針頭有時(shí)會(huì)觸到血管，導(dǎo)致局部出血或淤血。更換注射筆針頭的長(zhǎng)度或者改變其他注射參數(shù)，似乎并不能改變出血或淤血的發(fā)生頻率，盡管一項(xiàng)研究提出5mm針頭注射可減少出血或淤血的發(fā)生。,Kahara T Kawara S. Shimizu A, Hisada A, No

67、to Y, Kida H. Subcutaneous hematoma due to frequent insulin injections in a single site. Intern Med 2004;43:148-9.Kreugel G, Beter HJM, Kerstens MN, Maaten ter JC, Sluiter WJ, Boot BS. Influence of needle size on metabo

68、lic control and patient acceptance. Europ Diab Nursing 2007;4:51-5.,關(guān)于胰島素貯存的推薦：,,已開(kāi)封的瓶裝胰島素或胰島素筆芯可在室溫下保存（保存期為開(kāi)啟后一個(gè)月內(nèi)，且不能超過(guò)保質(zhì)期）；A2未開(kāi)封的瓶裝胰島素或胰島素筆芯應(yīng)儲(chǔ)藏在2℃~8℃的環(huán)境中，切勿冷凍；A2避免受熱或陽(yáng)光照射，防止震蕩；有必要培訓(xùn)患者，在抽取胰島素之前，先確認(rèn)是否存在結(jié)晶體、浮游物或者顏色變化等

69、異常現(xiàn)象。,Perriello G, Torlone E, Di Santo S. Fanelli C. De Feo P. Santusanio F. Brunetti P, Bolli GB. Effect of storage temperature on pharmacokinetics and pharmadynamics of insulin mixtures injected subcutaneously in subje