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【藥品名稱】
通用名稱：氯化鈉注射液
英文名稱：Sodium Chloride Injection
【成份】 本品主(zhu)要成份及(ji)其(qi)化學名稱：氯化鈉

【 適應(ying)(ying)癥 】 各種原因所致的(de)失水，包括低滲性、等(deng)滲性和高滲性失水；高滲性非酮癥糖尿病昏迷(mi)，應(ying)(ying)用(yong)(yong)等(deng)滲或低滲氯(lv)化鈉可糾(jiu)正失水和高滲狀態；低氯(lv)性代謝性堿中毒；外用(yong)(yong)生理鹽水沖(chong)洗眼部、洗滌傷(shang)口等(deng)；還用(yong)(yong)于(yu)產科(ke)的(de)水囊引產。

 【用(yong)(yong)法用(yong)(yong)量(liang)(liang)(liang)】 1．高(gao)滲(shen)(shen)(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 高(gao)滲(shen)(shen)(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui)時(shi)(shi)(shi)(shi)(shi)患者腦(nao)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)和(he)腦(nao)脊液(ye)(ye)(ye)(ye)(ye)滲(shen)(shen)(shen)(shen)透(tou)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)升(sheng)高(gao)，若(ruo)治(zhi)療使(shi)血(xue)(xue)(xue)(xue)漿(jiang)(jiang)和(he)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)外(wai)液(ye)(ye)(ye)(ye)(ye)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)和(he)滲(shen)(shen)(shen)(shen)透(tou)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)過(guo)快下降(jiang)，可(ke)致(zhi)腦(nao)水(shui)(shui)腫(zhong)。故一般認為，在(zai)(zai)治(zhi)療開始的(de)48小(xiao)時(shi)(shi)(shi)(shi)(shi)內，血(xue)(xue)(xue)(xue)漿(jiang)(jiang)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)每小(xiao)時(shi)(shi)(shi)(shi)(shi)下降(jiang)不超(chao)過(guo)0.5mmol/L。 若(ruo)患者存在(zai)(zai)休克，應先予(yu)氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)，并(bing)酌情補(bu)充膠體(ti)，待(dai)休克糾(jiu)正，血(xue)(xue)(xue)(xue)鈉>155mmol/L，血(xue)(xue)(xue)(xue)漿(jiang)(jiang)滲(shen)(shen)(shen)(shen)透(tou)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)>350mOsm/L，可(ke)予(yu)0.6%低(di)(di)滲(shen)(shen)(shen)(shen)氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)。待(dai)血(xue)(xue)(xue)(xue)漿(jiang)(jiang)滲(shen)(shen)(shen)(shen)透(tou)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)<330mOsm/L，改(gai)用(yong)(yong)0.9%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)。補(bu)液(ye)(ye)(ye)(ye)(ye)總量(liang)(liang)(liang)根據下列公(gong)式計算，作為參(can)考： [血(xue)(xue)(xue)(xue)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) -142] 所(suo)需補(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)（L)=----------------------------- ×0.6×體(ti)重(zhong)(zhong)(Kg) 血(xue)(xue)(xue)(xue)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) 一般第一日補(bu)給(gei)(gei)半(ban)量(liang)(liang)(liang)，余量(liang)(liang)(liang)在(zai)(zai)以(yi)(yi)(yi)后(hou)2～3日內補(bu)給(gei)(gei)，并(bing)根據心肺腎功能酌情調節。 2．等滲(shen)(shen)(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 原則給(gei)(gei)予(yu)等滲(shen)(shen)(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)，如0.9%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)復(fu)方(fang)(fang)氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)，但(dan)上(shang)述溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)氯(lv)(lv)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)明顯高(gao)于(yu)血(xue)(xue)(xue)(xue)漿(jiang)(jiang)，單(dan)獨大量(liang)(liang)(liang)使(shi)用(yong)(yong)可(ke)致(zhi)高(gao)氯(lv)(lv)血(xue)(xue)(xue)(xue)癥，故可(ke)將(jiang)(jiang)0.9%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)和(he)1.25%碳酸(suan)氫鈉或(huo)1.86%(1/6M)乳(ru)酸(suan)鈉以(yi)(yi)(yi)7:3的(de)比例配制后(hou)補(bu)給(gei)(gei)。后(hou)者氯(lv)(lv)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)為107 mmol/L，并(bing)可(ke)糾(jiu)正代謝(xie)性(xing)酸(suan)中(zhong)(zhong)毒。補(bu)給(gei)(gei)量(liang)(liang)(liang)可(ke)按體(ti)重(zhong)(zhong)或(huo)紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積計算，作為參(can)考。①按體(ti)重(zhong)(zhong)計算：補(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)(L)=(體(ti)重(zhong)(zhong)下降(jiang)(kg) ×142)/154；②按紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積計算：補(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)(L)=(實(shi)際紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積－正常(chang)紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積×體(ti)重(zhong)(zhong)(kg)×0.2)/ 正常(chang)紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積。正常(chang)紅(hong)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)壓積男性(xing)為48%，女性(xing)為42%。 3．低(di)(di)滲(shen)(shen)(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 嚴(yan)重(zhong)(zhong)低(di)(di)滲(shen)(shen)(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui)時(shi)(shi)(shi)(shi)(shi)，腦(nao)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)內溶(rong)(rong)(rong)質(zhi)減(jian)少以(yi)(yi)(yi)維持(chi)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)容積。若(ruo)治(zhi)療使(shi)血(xue)(xue)(xue)(xue)漿(jiang)(jiang)和(he)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)外(wai)液(ye)(ye)(ye)(ye)(ye)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)和(he)滲(shen)(shen)(shen)(shen)透(tou)濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)迅速回升(sheng)，可(ke)致(zhi)腦(nao)細(xi)(xi)(xi)(xi)(xi)(xi)胞(bao)損傷。一般認為，當血(xue)(xue)(xue)(xue)鈉低(di)(di)于(yu)120 mmol/L時(shi)(shi)(shi)(shi)(shi)，治(zhi)療使(shi)血(xue)(xue)(xue)(xue)鈉上(shang)升(sheng)速度(du)(du)(du)在(zai)(zai)每小(xiao)時(shi)(shi)(shi)(shi)(shi)0.5 mmol/L，補(bu)超(chao)過(guo)每小(xiao)時(shi)(shi)(shi)(shi)(shi)1.5 mmol/L。 當血(xue)(xue)(xue)(xue)鈉低(di)(di)于(yu)120 mmol/L時(shi)(shi)(shi)(shi)(shi)或(huo)出(chu)現中(zhong)(zhong)樞神(shen)經系統癥狀時(shi)(shi)(shi)(shi)(shi)，可(ke)給(gei)(gei)予(yu)3%～5%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)緩解滴注(zhu)(zhu)(zhu)。一般要求在(zai)(zai)6小(xiao)時(shi)(shi)(shi)(shi)(shi)內將(jiang)(jiang)血(xue)(xue)(xue)(xue)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)提(ti)高(gao)至(zhi)(zhi)120 mmol/L以(yi)(yi)(yi)上(shang)。補(bu)鈉量(liang)(liang)(liang)(mmol/L)＝[142－實(shi)際血(xue)(xue)(xue)(xue)鈉濃(nong)(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) ]×體(ti)重(zhong)(zhong)(kg)×0.2。待(dai)血(xue)(xue)(xue)(xue)鈉回升(sheng)至(zhi)(zhi)120～125mmol/L以(yi)(yi)(yi)上(shang)，可(ke)改(gai)用(yong)(yong)等滲(shen)(shen)(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)或(huo)等滲(shen)(shen)(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)中(zhong)(zhong)酌情加入高(gao)滲(shen)(shen)(shen)(shen)葡萄糖注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)10%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)。 4．低(di)(di)氯(lv)(lv)性(xing)堿(jian)中(zhong)(zhong)毒 給(gei)(gei)予(yu)0.9%氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)復(fu)方(fang)(fang)氯(lv)(lv)化(hua)(hua)鈉注(zhu)(zhu)(zhu)射(she)(she)(she)(she)(she)(she)液(ye)(ye)(ye)(ye)(ye)（林格(ge)氏液(ye)(ye)(ye)(ye)(ye)）500～1000ml，以(yi)(yi)(yi)后(hou)根據堿(jian)中(zhong)(zhong)毒情況(kuang)決定用(yong)(yong)量(liang)(liang)(liang)。 5．外(wai)用(yong)(yong)，用(yong)(yong)生理氯(lv)(lv)化(hua)(hua)鈉溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)洗滌傷口、沖洗眼(yan)部。

【不良反(fan)應】 （1）輸液過(guo)多(duo)(duo)、過(guo)快，可致水鈉潴留，引起(qi)水腫、血(xue)壓升高、心率(lv)加快、胸悶、呼吸(xi)困難(nan)，甚(shen)至急性左心衰竭。 （2）過(guo)多(duo)(duo)、過(guo)快給(gei)予低滲氯(lv)化鈉可致溶血(xue)、腦水腫等。

【禁忌】 無特(te)殊注(zhu)意。

【注(zhu)意事項】（1）下列(lie)情況(kuang)慎用：①水(shui)腫(zhong)性(xing)疾病，如腎病綜合征、肝硬化、腹(fu)水(shui)、充血(xue)(xue)(xue)性(xing)心(xin)力衰(shuai)(shuai)竭(jie)(jie)、急性(xing)左心(xin)衰(shuai)(shuai)竭(jie)(jie)、腦水(shui)腫(zhong)及特發(fa)性(xing)水(shui)腫(zhong)等；②急性(xing)腎功能(neng)(neng)衰(shuai)(shuai)竭(jie)(jie)少尿期，慢性(xing)腎功能(neng)(neng)衰(shuai)(shuai)竭(jie)(jie)尿量減少而對(dui)利尿藥反應不(bu)佳者(zhe)；③高(gao)血(xue)(xue)(xue)壓；④低(di)鉀(jia)血(xue)(xue)(xue)癥。 （2）根據臨床需要，檢查血(xue)(xue)(xue)清中鈉、鉀(jia)、氯離(li)子濃(nong)度；血(xue)(xue)(xue)液中酸堿(jian)濃(nong)度平衡指標、腎功能(neng)(neng)及血(xue)(xue)(xue)壓和心(xin)肺功能(neng)(neng)。

【特殊人群用藥】兒童注意事項：
補液量和速度應嚴格控制。

妊娠與哺乳期注意事項：
妊娠高血壓綜合征禁(jin)用。

老人注意事項：
補(bu)液(ye)量和(he)速(su)度應嚴格控制。

【藥(yao)物相(xiang)互作(zuo)用】 作(zuo)為藥(yao)物溶(rong)劑或(huo)稀釋劑時，應注意藥(yao)物之間的配(pei)伍(wu)禁忌(ji)。

 【藥(yao)理(li)作用(yong)】氯化(hua)鈉是(shi)一種電解(jie)質補充藥(yao)物。鈉和(he)氯是(shi)機(ji)體重要的電解(jie)質，主(zhu)要存在于細(xi)胞(bao)外液，對維持正(zheng)常(chang)的血(xue)液和(he)細(xi)胞(bao)外液的容(rong)量和(he)滲(shen)(shen)透(tou)壓(ya)(ya)起(qi)著非(fei)常(chang)重要的作用(yong)。正(zheng)常(chang)血(xue)清鈉濃度為135～145mmol/L，占血(xue)漿(jiang)陽離(li)子的92%，總滲(shen)(shen)透(tou)壓(ya)(ya)的90%，故血(xue)漿(jiang)鈉量對滲(shen)(shen)透(tou)壓(ya)(ya)起(qi)著決定性作用(yong)。正(zheng)常(chang)血(xue)清氯濃度為98～106mmol/L，人(ren)體中鈉、氯離(li)子主(zhu)要通過下丘腦(nao)、垂體后葉和(he)腎(shen)臟進行(xing)調節，維持體液容(rong)量和(he)滲(shen)(shen)透(tou)壓(ya)(ya)的穩定。

【貯藏】 密閉保存。

【批準文(wen)號】 國藥(yao)準字H20123400

【生產企業(ye)】 企業(ye)名稱：湖南(nan)科倫制(zhi)藥有(you)限公司(si)