【藥品名稱】
通用名稱：氯化鈉注射液
英文名稱：Sodium Chloride Injection
【成(cheng)份】 本品主(zhu)要成(cheng)份及其化學名稱：氯(lv)化鈉

【 適應癥 】 各種(zhong)原(yuan)因所致的失(shi)水(shui)(shui)，包括(kuo)低(di)(di)滲(shen)性、等(deng)(deng)滲(shen)性和(he)高(gao)滲(shen)性失(shi)水(shui)(shui)；高(gao)滲(shen)性非酮癥糖尿病昏迷，應用等(deng)(deng)滲(shen)或低(di)(di)滲(shen)氯化(hua)鈉可糾(jiu)正失(shi)水(shui)(shui)和(he)高(gao)滲(shen)狀(zhuang)態(tai)；低(di)(di)氯性代謝性堿(jian)中毒；外用生(sheng)理(li)鹽水(shui)(shui)沖洗眼部、洗滌(di)傷(shang)口等(deng)(deng)；還(huan)用于產科(ke)的水(shui)(shui)囊引產。

 【用(yong)(yong)(yong)法用(yong)(yong)(yong)量(liang)(liang)(liang)(liang)】 1．高(gao)滲(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 高(gao)滲(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui)時(shi)(shi)患(huan)者(zhe)(zhe)腦細(xi)胞(bao)(bao)(bao)(bao)(bao)和(he)(he)腦脊液(ye)(ye)(ye)(ye)(ye)滲(shen)(shen)透(tou)(tou)濃(nong)(nong)(nong)(nong)度(du)(du)(du)升高(gao)，若治(zhi)(zhi)療(liao)使血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)和(he)(he)細(xi)胞(bao)(bao)(bao)(bao)(bao)外(wai)液(ye)(ye)(ye)(ye)(ye)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)和(he)(he)滲(shen)(shen)透(tou)(tou)濃(nong)(nong)(nong)(nong)度(du)(du)(du)過快下降(jiang)，可(ke)(ke)(ke)致(zhi)(zhi)腦水(shui)(shui)腫。故(gu)一(yi)般(ban)(ban)認為(wei)(wei)，在(zai)(zai)治(zhi)(zhi)療(liao)開始的(de)48小(xiao)時(shi)(shi)內(nei)，血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)每小(xiao)時(shi)(shi)下降(jiang)不(bu)超過0.5mmol/L。 若患(huan)者(zhe)(zhe)存在(zai)(zai)休克，應先予(yu)(yu)(yu)氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)，并酌情補(bu)(bu)(bu)充膠體，待休克糾正(zheng)，血(xue)(xue)鈉(na)(na)(na)(na)(na)>155mmol/L，血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)滲(shen)(shen)透(tou)(tou)濃(nong)(nong)(nong)(nong)度(du)(du)(du)>350mOsm/L，可(ke)(ke)(ke)予(yu)(yu)(yu)0.6%低(di)(di)滲(shen)(shen)氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)。待血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)滲(shen)(shen)透(tou)(tou)濃(nong)(nong)(nong)(nong)度(du)(du)(du)<330mOsm/L，改(gai)用(yong)(yong)(yong)0.9%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)。補(bu)(bu)(bu)液(ye)(ye)(ye)(ye)(ye)總量(liang)(liang)(liang)(liang)根據下列公式計(ji)算(suan)，作為(wei)(wei)參考： [血(xue)(xue)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) -142] 所需補(bu)(bu)(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)(liang)（L)=----------------------------- ×0.6×體重(zhong)(zhong)(Kg) 血(xue)(xue)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) 一(yi)般(ban)(ban)第一(yi)日(ri)(ri)補(bu)(bu)(bu)給(gei)(gei)半量(liang)(liang)(liang)(liang)，余量(liang)(liang)(liang)(liang)在(zai)(zai)以(yi)后2～3日(ri)(ri)內(nei)補(bu)(bu)(bu)給(gei)(gei)，并根據心肺腎功能酌情調節。 2．等(deng)(deng)滲(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 原則(ze)給(gei)(gei)予(yu)(yu)(yu)等(deng)(deng)滲(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)，如(ru)0.9%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)(huo)復方氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)，但上(shang)(shang)(shang)述溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)氯(lv)(lv)(lv)濃(nong)(nong)(nong)(nong)度(du)(du)(du)明顯(xian)高(gao)于(yu)血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)，單獨大量(liang)(liang)(liang)(liang)使用(yong)(yong)(yong)可(ke)(ke)(ke)致(zhi)(zhi)高(gao)氯(lv)(lv)(lv)血(xue)(xue)癥，故(gu)可(ke)(ke)(ke)將(jiang)(jiang)0.9%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)和(he)(he)1.25%碳酸氫(qing)鈉(na)(na)(na)(na)(na)或(huo)(huo)1.86%(1/6M)乳酸鈉(na)(na)(na)(na)(na)以(yi)7:3的(de)比例配制后補(bu)(bu)(bu)給(gei)(gei)。后者(zhe)(zhe)氯(lv)(lv)(lv)濃(nong)(nong)(nong)(nong)度(du)(du)(du)為(wei)(wei)107 mmol/L，并可(ke)(ke)(ke)糾正(zheng)代謝性(xing)酸中(zhong)(zhong)毒。補(bu)(bu)(bu)給(gei)(gei)量(liang)(liang)(liang)(liang)可(ke)(ke)(ke)按體重(zhong)(zhong)或(huo)(huo)紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)計(ji)算(suan)，作為(wei)(wei)參考。①按體重(zhong)(zhong)計(ji)算(suan)：補(bu)(bu)(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)(liang)(L)=(體重(zhong)(zhong)下降(jiang)(kg) ×142)/154；②按紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)計(ji)算(suan)：補(bu)(bu)(bu)液(ye)(ye)(ye)(ye)(ye)量(liang)(liang)(liang)(liang)(L)=(實(shi)際(ji)紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)－正(zheng)常紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)×體重(zhong)(zhong)(kg)×0.2)/ 正(zheng)常紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)。正(zheng)常紅(hong)(hong)(hong)細(xi)胞(bao)(bao)(bao)(bao)(bao)壓積(ji)(ji)(ji)男性(xing)為(wei)(wei)48%，女性(xing)為(wei)(wei)42%。 3．低(di)(di)滲(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui) 嚴(yan)重(zhong)(zhong)低(di)(di)滲(shen)(shen)性(xing)失(shi)(shi)水(shui)(shui)時(shi)(shi)，腦細(xi)胞(bao)(bao)(bao)(bao)(bao)內(nei)溶(rong)(rong)(rong)質減少以(yi)維(wei)持細(xi)胞(bao)(bao)(bao)(bao)(bao)容(rong)積(ji)(ji)(ji)。若治(zhi)(zhi)療(liao)使血(xue)(xue)漿(jiang)(jiang)(jiang)(jiang)和(he)(he)細(xi)胞(bao)(bao)(bao)(bao)(bao)外(wai)液(ye)(ye)(ye)(ye)(ye)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)和(he)(he)滲(shen)(shen)透(tou)(tou)濃(nong)(nong)(nong)(nong)度(du)(du)(du)迅速(su)回升，可(ke)(ke)(ke)致(zhi)(zhi)腦細(xi)胞(bao)(bao)(bao)(bao)(bao)損傷(shang)。一(yi)般(ban)(ban)認為(wei)(wei)，當血(xue)(xue)鈉(na)(na)(na)(na)(na)低(di)(di)于(yu)120 mmol/L時(shi)(shi)，治(zhi)(zhi)療(liao)使血(xue)(xue)鈉(na)(na)(na)(na)(na)上(shang)(shang)(shang)升速(su)度(du)(du)(du)在(zai)(zai)每小(xiao)時(shi)(shi)0.5 mmol/L，補(bu)(bu)(bu)超過每小(xiao)時(shi)(shi)1.5 mmol/L。 當血(xue)(xue)鈉(na)(na)(na)(na)(na)低(di)(di)于(yu)120 mmol/L時(shi)(shi)或(huo)(huo)出現中(zhong)(zhong)樞(shu)神經系統癥狀時(shi)(shi)，可(ke)(ke)(ke)給(gei)(gei)予(yu)(yu)(yu)3%～5%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)緩解滴注(zhu)(zhu)。一(yi)般(ban)(ban)要(yao)求(qiu)在(zai)(zai)6小(xiao)時(shi)(shi)內(nei)將(jiang)(jiang)血(xue)(xue)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)提(ti)高(gao)至(zhi)120 mmol/L以(yi)上(shang)(shang)(shang)。補(bu)(bu)(bu)鈉(na)(na)(na)(na)(na)量(liang)(liang)(liang)(liang)(mmol/L)＝[142－實(shi)際(ji)血(xue)(xue)鈉(na)(na)(na)(na)(na)濃(nong)(nong)(nong)(nong)度(du)(du)(du)(mmol/L) ]×體重(zhong)(zhong)(kg)×0.2。待血(xue)(xue)鈉(na)(na)(na)(na)(na)回升至(zhi)120～125mmol/L以(yi)上(shang)(shang)(shang)，可(ke)(ke)(ke)改(gai)用(yong)(yong)(yong)等(deng)(deng)滲(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)或(huo)(huo)等(deng)(deng)滲(shen)(shen)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)中(zhong)(zhong)酌情加(jia)入(ru)高(gao)滲(shen)(shen)葡(pu)萄糖(tang)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)(huo)10%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)。 4．低(di)(di)氯(lv)(lv)(lv)性(xing)堿(jian)中(zhong)(zhong)毒 給(gei)(gei)予(yu)(yu)(yu)0.9%氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)或(huo)(huo)復方氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)注(zhu)(zhu)射(she)(she)液(ye)(ye)(ye)(ye)(ye)（林格氏液(ye)(ye)(ye)(ye)(ye)）500～1000ml，以(yi)后根據堿(jian)中(zhong)(zhong)毒情況(kuang)決定用(yong)(yong)(yong)量(liang)(liang)(liang)(liang)。 5．外(wai)用(yong)(yong)(yong)，用(yong)(yong)(yong)生(sheng)理氯(lv)(lv)(lv)化(hua)(hua)鈉(na)(na)(na)(na)(na)溶(rong)(rong)(rong)液(ye)(ye)(ye)(ye)(ye)洗(xi)滌傷(shang)口、沖洗(xi)眼部。

【不良反應】 （1）輸液過(guo)多、過(guo)快，可致水鈉(na)潴留(liu)，引起水腫(zhong)、血壓(ya)升高、心(xin)(xin)率加快、胸悶、呼吸(xi)困難，甚至急性(xing)左心(xin)(xin)衰竭。 （2）過(guo)多、過(guo)快給予低滲(shen)氯化鈉(na)可致溶血、腦水腫(zhong)等。

【禁(jin)忌】 無特殊注意。

【注意事項】（1）下列情(qing)況慎用：①水(shui)腫(zhong)(zhong)性(xing)疾病，如腎(shen)(shen)病綜合征、肝硬化、腹水(shui)、充血(xue)性(xing)心力衰(shuai)竭、急性(xing)左心衰(shuai)竭、腦(nao)水(shui)腫(zhong)(zhong)及(ji)特發性(xing)水(shui)腫(zhong)(zhong)等；②急性(xing)腎(shen)(shen)功(gong)(gong)能(neng)衰(shuai)竭少尿期，慢性(xing)腎(shen)(shen)功(gong)(gong)能(neng)衰(shuai)竭尿量減少而對利尿藥反應不佳者；③高血(xue)壓；④低鉀血(xue)癥。 （2）根(gen)據臨床需要，檢查血(xue)清中(zhong)鈉、鉀、氯離子濃(nong)度(du)；血(xue)液(ye)中(zhong)酸堿(jian)濃(nong)度(du)平(ping)衡(heng)指標(biao)、腎(shen)(shen)功(gong)(gong)能(neng)及(ji)血(xue)壓和心肺功(gong)(gong)能(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用。

老人注意事項：
補(bu)液量和速度(du)應(ying)嚴格控制(zhi)。

【藥物(wu)相互作(zuo)用(yong)】 作(zuo)為藥物(wu)溶劑或稀釋劑時，應注意藥物(wu)之間的配伍禁忌(ji)。

 【藥理作用(yong)(yong)】氯(lv)化(hua)鈉(na)是(shi)一種電解(jie)質補充藥物(wu)。鈉(na)和氯(lv)是(shi)機體(ti)(ti)重要(yao)的(de)電解(jie)質，主要(yao)存在于細(xi)胞(bao)外(wai)(wai)液(ye)，對維(wei)持正常的(de)血液(ye)和細(xi)胞(bao)外(wai)(wai)液(ye)的(de)容量和滲(shen)透(tou)壓(ya)起著(zhu)非常重要(yao)的(de)作用(yong)(yong)。正常血清(qing)(qing)鈉(na)濃(nong)度為(wei)135～145mmol/L，占血漿陽離(li)子的(de)92%，總滲(shen)透(tou)壓(ya)的(de)90%，故血漿鈉(na)量對滲(shen)透(tou)壓(ya)起著(zhu)決定性作用(yong)(yong)。正常血清(qing)(qing)氯(lv)濃(nong)度為(wei)98～106mmol/L，人體(ti)(ti)中鈉(na)、氯(lv)離(li)子主要(yao)通過(guo)下丘腦、垂(chui)體(ti)(ti)后葉和腎(shen)臟進(jin)行調節，維(wei)持體(ti)(ti)液(ye)容量和滲(shen)透(tou)壓(ya)的(de)穩定。

【貯藏】 密(mi)閉保存。

【批準(zhun)文號】 國藥準(zhun)字H20123400

【生(sheng)產(chan)企業(ye)】 企業(ye)名稱：湖南科倫制藥有限公司