Seifi A, Mowla A, Vaziri Moien M T, Talei A R, Namazy M R
Nemazee Hospital, Shiraz, Iran.
Middle East J Anaesthesiol. 2004 Jun;17(5):975-81.
In total parenteral nutrition (TPN) solution, adsorbance of insulin to polyvinylchloride (PVC) surfaces of fluid containers and infusion-sets, decrease the amount of insulin that reaches the patients.
To clarify the biding sites of insulin and to propose a solution to overcome this problem.
To each of four 1000ml. PVC bottles of 5 percent dextrose solution, 300 microunit of insulin per each milliliter of dextrose solution were added. Each bottle was then connected to an infusion-set and the system made to run at an infusion rate of 100ml. per hour. One milliliter samples were then collected from both the PVC bottles and infusion-sets-terminal, separately, immediately at the starting point (time zero) and 15, 30, 45 and 60 minutes thereafter. The concentrations of insulin were checked using insulin kits.
At the starting point (time zero) the mean of insulin concentrations among four PVC bottles was 213.79 microunit per each milliliter of 5 percent dextrose solution. No significant fluctuation was noted in the concentration of insulin in the PVC bottles through 60th minute period. However the concentration of insulin at infusion-set- terminal decreased significantly at the end of the same hour (p. value = 0.004).
Our results demonstrate that the adsorbance of insulin takes place at the surfaces of infusion sets. It follows therefore that increase in the primary dosage of insulin added to PVC infusion solutions and the selection of a suitable infusion set (polyethylene) seem to be beneficial for overcoming this problem.
在全胃肠外营养(TPN)溶液中,胰岛素会吸附在液体容器和输液器的聚氯乙烯(PVC)表面,从而减少进入患者体内的胰岛素量。
明确胰岛素的结合位点,并提出解决该问题的方案。
向四个1000毫升装有5%葡萄糖溶液的PVC瓶中,每毫升葡萄糖溶液添加300微单位胰岛素。然后将每个瓶子连接到一个输液器,并使系统以每小时100毫升的输注速度运行。随后分别在起始点(时间零点)以及此后的15、30、45和60分钟,从PVC瓶和输液器末端分别采集1毫升样本。使用胰岛素试剂盒检测胰岛素浓度。
在起始点(时间零点),四个PVC瓶中胰岛素浓度的平均值为每毫升5%葡萄糖溶液213.79微单位。在60分钟内,PVC瓶中胰岛素浓度未出现显著波动。然而,在同一小时结束时,输液器末端的胰岛素浓度显著下降(p值 = 0.004)。
我们的结果表明,胰岛素的吸附发生在输液器表面。因此,增加添加到PVC输液溶液中的胰岛素初始剂量以及选择合适的输液器(聚乙烯材质)似乎有利于解决该问题。