The number of infusions in China is much higher than the international level

The business club reported on January 5th that a green poster was unusually prominent in front of the sub-clinic of the Infectious Diseases Department of the People's Hospital of Peking University. On this one-person poster, the characters “infusion therapy does not mean to be faster” are printed, and people can see the door of the infection department at a glance.

However, this eye-catching poster did not produce the desired publicity. In the early morning of the second day of 2011, patients hanging bottles had been stuffed with beds.

"The holiday is over and we have to rush to work. There is no way to ask for leave. Infusion is faster," said one girl. Because there were too many patients hanging bottles, she was "squeezed" to the corridor outside the ward.

Looking at the scene in the department, "Drinking Bottles," Yang Xia is full of helplessness. "Even if we have a small department like ours, we have to lose at least 60 bottles a day," said Yang Xia. "We will also advise patients not to infuse fluids, but many times they are unable to persuade them."

According to statistics from the World Health Organization, of the 16 billion injections that occurred in 2004 in the world, China had occurred 5 billion times, making it the world's largest "injecting power." At the 18th joint meeting of the Standing Committee of the 11th National People's Congress held recently, Zhu Zhixin, deputy director of the National Development and Reform Commission, also stated that in 2009 China's medical infusion of 10.4 billion bottles, with an average population of 1.3 billion, was equivalent to The Chinese people hung eight bottles a year, far higher than the average of 2.5 to 3.3 bottles in the international market.

As long as there is no problem in digestion and absorption, the effects of oral medicine and infusion are quite similar.

Yang Xia often finds that foreigners who come here to see a doctor here are usually taking a small amount of medicine to go. "I really haven't seen any infusion." Can be replaced with domestic patients, "it seems like no infusion can not cure the disease like."

In 1831, when the British doctor Thomas Latta tried for the first time to use a blood transfusion tool to input a saline solution to a patient, the experimental treatment was to save a dying cholera patient. Until today, intravenous injection technology has continued to develop, and even a trocar that has not been removed for a week or two has appeared. However, in Western countries, infusion has always been the “last resort” that doctors will not use as a last resort. In general, intravenous injection is the only way to increase the risk of venous access to the human body in emergency patients, critically ill patients, and those who cannot eat.

Just in China, Gao Yan, chief physician of Peking University People's Hospital Infectious Diseases, faced such an embarrassment. "Whether it's going to work, going to school, or being accompanied by an older family member, many people are asked to make a bite at the door. If the doctors don't agree, they will pat the table." The chief physician tried to imitate the anger of these patients. "I'm so uncomfortable. The temperature of the fever is so high. Your doctor is not at all sympathetic to me!"

In the impression of the average person, the greatest benefit of infusion is "be faster," and even some doctors will make such an explanation. Fang Zhouzi, a doctor of biochemistry, believes that this statement is “in some cases correct” because the intravenous drug can be completely absorbed and the drug effect is faster. In ten seconds, the drug concentration in the blood can be effective. range. "But in other cases, it is only an illusion or psychological effect," Fang said. "The cold is a bit like this."

Yang Xia also holds the same view. In order to prove that the speed of infusion and oral medications is "evenly matched," she took out several common medication instructions from the folder. Among them, the instructions for the anti-inflammatory antibiotic moxifloxacin commonly used in the introduction, moxifloxacin was "rapidly and almost completely absorbed" after oral administration, and the absolute bioavailability totaled about 91%; the other antibacterial anti-inflammatory drug cefaclor was described in It was also stated that pharmacokinetics demonstrated that the drug was "absorbed well" after oral administration.

"A lot of people feel that they don't use medicine. It's fine to come to the hospital to hang a bottle. This is not the case," said Yang Xia. She explained that any medicine has its own metabolic pattern. Oral medicine must be taken on time and in accordance with the package instructions in order to achieve its desired effects. Many people often forget to take medicines at home. Infusions in hospitals are honestly measured on time, resulting in misunderstandings and feeling that "infusion is faster."

She still remembered an acute cold patient who had not taken any medicine for a day and found herself in hospital. She insisted on infusion. Finally, under his own persuasion, he waited another day to heal.

"Any disease has its own development law and recovery cycle." Yang Xia said, "In fact, as long as there is no problem in digestion and absorption, the effects of oral medicine and infusion are quite the same."

With comparable effects, oral medicines have a more realistic advantage than injection therapy, which is the low price. Gao Yan, for example, said that a box of oral levofloxacin tablets, the price is 12 yuan, can eat for 3 days; and the same drugs, intravenous injection of more than 100 yuan a day, 3 days down to nearly 400 yuan, equivalent to oral drugs 30 times.

Treating colds with infusions is not only wasteful but also risky

Not only that, intravenous injections on the "battlefield" such as colds and fevers are often referred to as "cannons to fight mosquitoes." Not only is it wasteful, but there are hidden risks that may cause additional "injury."

"From our medical perspective, intravenous injection is an invasive and invasive method of administration." Gao Yan said, "It may also cause a lot of adverse reactions."

In drug treatment, different drugs may have certain side effects. When people use oral tablets or capsules, the drugs enter the bloodstream through the digestive system. This process is relatively slow and the adverse reactions caused are relatively light. Some impurities that may cause allergies may be broken down in the digestive tract.

When people use the intravenous injection method, the drug can directly enter the blood circulation system through the needle tube, “fast and fierce” causes adverse reactions such as fever, dermatitis, skin rash, and even severe shock or death.

On November 15th, 2010, a nurse from Chongqing personally changed the drug gatifloxacin to pazufloxacin mesylate during the infusion process, resulting in a 47-year-old Chongqing woman Luo Youju’s condition worsening, even once Wuyi; Just a month later, a one-year-old boy in Hohhot was rushed to the hospital because of diarrhea. As a result, the child continued to cry and vomit during the infusion, and then his breathing became weaker and eventually died.

"In this regard, our lesson is very profound." Gao Yan said.

Other risks lie hidden in the operation. If the infusion device is contaminated during production and storage, or if the skin at the infusion site is not fully sterilized, the infusion process will also serve as a bridge for viruses and germs to easily enter the body. At the most serious time, this may cause pathogens to spread throughout the body with the blood, causing life-threatening sepsis.

The staff of the WHO representative office in China once said that in some provinces in China, the proportion of injections without using sterile syringes and needles has reached 30%.

Even if completely sterilized, the infusion still has other risks: if the concentration of the liquid used in the drip is too thin or too thick, it may break the electrolyte balance after entering the body; if the infusion rate is too fast, or if too much liquid is inputted , It may also cause high blood pressure, heart failure, and pulmonary edema. Even if bubbles or blood clots are mixed in the liquid of the needle tube, the blood vessels will be blocked and the heart will stop beating.

"We often say that if you can take oral medicines, do not choose infusion therapy." Gao Yan said, "This is a common knowledge in the medical community."

The fact that the patients get together is a microcosm of the abnormal relationship between doctors and patients in China.

Although the side effects of oral medications are small, the price is cheap, the efficacy is basically the same as that of infusion, almost “overwhelming” in competition, and can return to reality, these advantages seem to be completely ignored by people. Every season in the high incidence of respiratory diseases, patients with needles and hanging bottles are seen everywhere in the hospital. Some people commented that such a scene is simply a “bottle forest.”

Gao Yan remembers that when he was a doctor in 1986, it was not a common treatment. In the 1990s, as people's living standards improved, they also paid more and more attention to health problems. Some patients started asking for doctors and hoped to use better medicine. That is, from that time onwards, the phenomenon of “standing bottles” has become more and more common in hospitals.

Fang Zhouzi, who once lived in the United States, said that he has never seen the scene of infusions everywhere in the United States. In an article, he speculated that: “The proliferation of domestic drugs should have cultural factors. When patients go to hospital for treatment, they think that they should receive advanced and thorough treatment as far as possible, and the treatment seems to be more advanced than taking medicine. Much more thorough."

Many people speculate that economic benefits are also an important reason for the influx of infusions in Chinese hospitals today. This problem, known as "taking medicine to support medical care," is driving the status quo of "drowning bottles everywhere" intensifying. Liu Youning, chairman of the Chinese Medical Association's Respiratory Disease Branch, once said in an interview that some doctors and medical institutions seldom spread the scientific concept of "cold can cure without cure" to patients. Instead, they are overly medically driven by interests. Also deepen the patient's misperceptions.

“There are also individual doctors who can only take patients' surgery in order to compete for performance and get kickbacks.” Liu Youning said.

Yang Xia also listened to the patient and described his medical experience: he had not yet performed a blood test. Instead, he only measured the body temperature, and the doctor directly asked the patient to play "three elements." This kind of intravenous injection of antibiotics, hormones, and vitamins is very fast, but "potentially more harmful": "Antibiotics are not standardized and are likely to produce resistance; hormones are not free to use." She even saw a patient with a rash after hanging a bottle in this way.

Yang Xia, on the other hand, often uses great efforts to persuade patients to give up infusions and choose medications. "Most patients will respect the opinions of doctors, but it is too persistent, and we will compromise." Yang Xia said, "You know that we still listen to patients in this medical environment."

Fang also agrees that Chinese doctors may not be able to learn from American doctors, and that they will be sent away if they don't prescribe medications or open analgesic antipyretics. "This will not only be considered irresponsible by the patient. In case the patient develops a more serious illness due to a cold, the doctor's trouble is greater," he said.

“The fact that the patients get together in hospitals is a microcosm of the abnormal relationship between doctors and patients in the country.” Fang said.

Today, the status quo of the "big bottle country" continues. On January 2nd, just before the big poster, "The infusion treatment was not equal to good," an old man finally accompanied the children with his bottle. She feels "so much peace of mind".