2021年肌内注射法操作并发症.pdf

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1、肌内注射法操作并发症肌内注射法（intramuscular injection）是将少量药液注入肌内组织内的方法。主要用于由于药物或病情因素不宜口服给药：要求药物在短时间内发生疗效而又不适于或不必要采用静脉注射；药物刺激性较强或药量较大，不适于皮下注射者。肌内注射亦可引起一些并发症，如疼痛、神经性损伤、局部或全身感染、疾病传播、硬结形成、针头堵塞及过敏性休克等，由于疾病传播、硬结形成、虚脱、过敏性休克、针头弯曲或针头折断等并发症其发生原因、临床表现及预防处理与皮内注射、皮下注射基本相同，此处不予重复叙述。本节详细叙述肌内注射发生的其它并发症。一、疼痛（一）发生原因肌内注射引起疼痛有多方面原因，

2、如针刺入皮肤的疼痛，推药时药物刺激皮肤的疼痛。一次性肌内注射药物过多、药物刺激性过大、速度过快。注射部位不当，进针过深或过浅等都可引起疼痛。（二）临床表现注射局部疼痛、酸胀、肢体无力、麻木。可引起下肢及坐骨神经疼痛，严重者可引起足下垂或跛行，甚至可出出下肢瘫痪。（三）预防与处理1、正确选择注射部位。2、掌握无痛注射技术。本组结果表明穴位按压肌内注射法，可减轻疼痛，按压的穴位为关元俞、太冲等穴位。进行股内注射前，先用拇指按压注射点10s，尔后常规皮肤消毒，肌内注射。国外有资料指出注射时如按常规操作，注射器内存在少量的空气可减少疼痛。用持针的手掌尺侧缘快速叩击注射区的皮肤（上般为注射区的右侧或下侧

3、）后进针，在一定程度上可减轻疼痛。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页，共 6 页3、配制药液浓度不宜过大，每次推注的药量不宜过快过多。股四头肌及上臂三角肌施行注射时，若药量超过2ml 时，须分次注射。经过临床试验，用生理盐水注射液稀释药物后肌内注射，比用注射用水稀释药物后肌内注射，能减轻病人的疼痛。4、轮换注射部位。预防与处理流程：二、神经性损伤（一）发生原因主要是药物直接刺激和局部高浓度药物毒性引起神经粘连和变性坏死。（二）临床表现注射当时即出现神经支配区麻木、放射痛、肢体无力和活动范围减少。约一周后疼痛减轻。但留有固定麻木区伴肢体功能部分或完全丧失，发

4、生于下肢者行走无力，易跌跤。局部红肿、疼痛，肘关节活动受限，手部有运动和感觉障碍，受累神经损伤程度：根据受累神经支配区运动、感觉障碍程度，分为完全损伤、重度损伤、中度损伤和轻度损伤。分度标准如下：完全损伤：神经功能完全丧失;选择正确注射部位掌握无痛注射技术配制药液浓度不宜过大，每次推注的药量不宜过快过多轮换注射部位精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页，共 6 页文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 H

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10、档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6

11、J5 HO2Z7O2F1G1 ZC10M2X5M1I5文档编码:CC4O6Z4J6J5 HO2Z7O2F1G1 ZC10M2X5M1I5重度损伤：部分肌力、感觉降至1 级;中度损伤：神经支配区部分肌力和感觉降至2 级;轻度损伤：神经支配区部分肌力和感觉降为3 级。（三）预防及处理1、周围神经药物注射伤是一种医源损伤，是完全可以预防的，应在慎重选择药物、正确掌握注射技术等方面严格把关。2、注射药物应尽量选用刺激性小、等渗、pH值接近中性的药物，不能毫无科学根据地选用刺激性很强的药物作肌内注射。3、注射时应全神贯注，注意注射处的解剖关系，准确选择臀部、上臂部的肌内注射位置，避天神经及血管。为儿童注

12、射时，除要求进针点准确外，还应注意进针的深度和方向。4、在注射药物过程中若发现神经支配区麻木或放散痛，应考虑注入神经内的可能性，须立即改变进针方向或停止注射。5、对中度以下不完会神经损伤要用非手术治疗、热敷，促进炎症消退和药物吸收，同时使用神经营养药物治疗，将有助于神经功能的恢复。对中度以上完全性神经损伤，则尽早手术探查，做神经松解术。预防与处理流程：慎重选择药物、正确掌握注射技术注射应选用刺激性小、等渗、pH值接近中性的药物注射时应全神贯注，注意注射处的解剖关系在注射药物过程中若发现神经支配区麻木或放散痛，须立即改变进针方向或停止注射精品w o r d 学习资料 可编辑资料-精心整理-欢迎下

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15、3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:

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17、W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1

18、 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6

19、T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3三、局部或全身感染（一）发生原因注射部位消毒不严格，注射用具、药物被污染等，可导致注射部位或全身发生感染。（二）临床表现在注射后数小时局部出现

20、红、肿、热和疼痛。局部压痛明显。若感染扩散，可导致全身菌血症、脓毒败血症，病人出现高热、畏寒、谵妄等。（三）预防及处理与皮下注射法相同。出现全身感染者，根据血培养及药物敏感试验选用抗生素。四、针口渗液（一）发生原因反复在同一部位注射药液，每次注射药量过多，局部血液循环差，组织对药液吸收缓慢。（二）临床表现推动药液阻力较大，注射时有少量液体自针眼流出，拔针后液体流出更明显。（三）预防及处理1、选择合适注射部位。选择神经少、肌肉较丰富之处。2、掌握注射剂量。每次注射量以23ml为限，不宜超过5ml。3、每次轮换部位。避免同一部位反复注射。4、注射后及时热敷、按摩，加速局部血液循环，促进药液吸收。5

21、、在注射刺激性药物时，采用 Z字形途径注射法预防药物渗漏至皮下组织或表皮，中度以上完全性神经损伤，则尽早手术探查，做神经松解术中度以下不完会神经损伤要用非手术治疗，使用神经营养药物精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页，共 6 页文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3

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24、1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1

25、HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T

26、10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3

27、 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7

28、L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3以减轻疼痛及组织受损。具体步骤如下：左手将注射部位皮肤拉向一侧。右手持空针，呈 90插入，并固定。小心地以左手的拇指和食指固定注射器基部（但不可松开对组织的牵引），再以右手反抽注射器活塞，确定无回血后，缓慢将药液注入，并等10s，让药物散入肌肉，其间仍保持皮肤呈拉紧状态。拔出针头并松开左手对组织的牵引。不要按摩注射部位，因按摩易组织受损，告诉病人暂时不要运动或穿紧身衣服。预防与处理流程：五、针头堵塞（一）发生原因一次性注射器的针尖锐利、斜面大，抽吸瓶装药品时，极易被橡皮塞堵塞，瓶塞颗粒可随着加入的药

29、物进入液体造成微粒污染或栓塞。针头过细、药液黏稠、粉剂未充分溶解或药液为悬浊液，如长效青霉素等，均可造成针头堵塞。（二）临床表现选择合适注射部位掌握注射剂量每次轮换部位注射后及时热敷、按摩注射刺激性药物时，采用 Z字形途径注射法预防药物渗漏至皮下组织或表皮，以减轻疼痛及组织受损精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 5 页，共 6 页文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V

30、7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U

31、3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:

32、CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4

33、W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1

34、 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6

35、T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B

36、3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3推药阻力大，无法将注射器内的药液推入体内。（三）预防及处理1、根据药液的性质选用粗细适合的针头。2、充分将药液摇混合，检查针头通畅后方可进针。3、注射时保持一定的速度，避免停顿导致药液沉积在针头内。4、如发现推药阻力大，或无法将药液继续注入体内，应拔针，更换针头另选部位进行注射。5、使用一次性注射器加药时，可改变进针角度，即由传统的90改为 45，因为改变进针角度，避开斜面，减少针头斜面与瓶塞的接触面积

37、，减轻阻力。预防与处理流程：如发现推药阻力大，应拔针，更换针头另选部位进行注射根据药液的性质选用粗细适合的针头充分将药液摇混合，检查针头通畅后方可进针注射时保持一定的速度使用一次性注射器加药时，可改变进针角度精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 6 页，共 6 页文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2

38、B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1

39、V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5

40、U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码

41、:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V

42、4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I

43、1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3文档编码:CL10V4W1O4I1 HN7H6T10I2B3 ZM1V7L6L5U3