全身麻醉中肌肉松弛拮抗剂应用的研究进展
Progress in the application of muscle relaxant antagonists during general anesthesia
韩乐 1张雨 1邱嘉欣 1谢海玉2
作者信息
- 1. 赣南医科大学第一临床医学院
- 2. 赣南医科大学第一临床医学院;赣南医科大学第一附属医院麻醉手术中心,江西 赣州 341000
- 折叠
摘要
肌肉松弛是气管插管全身麻醉和手术中的必备条件.然而,肌松药所引起的术后肌松残余是一种常见的并发症,可能对患者产生不良影响.为减少这种情况的发生,临床上通常采用肌肉松弛拮抗剂进行对抗,其中包括胆碱酯酶抑制剂、氨基甾体类拮抗剂和新型肌肉松弛拮抗剂.本文对气管插管全麻过程中肌肉松弛拮抗剂的药理学机制及最新的临床应用进行综述.文献复习结果表明,新斯的明的使用须注意给药时机,选择合适剂量.在无任何神经肌肉恢复迹象的情况下,不建议使用新斯的明逆转深度阻滞.舒更葡糖钠能更快更彻底逆转中深度肌肉松弛,其在接受单肺通气的胸外科手术的手术中有较好的效果和较高的安全性.奥美克松钠是一种新型γ-环糊精衍生物,其拮抗甾类肌松药的不良反应较舒更葡糖钠更少,L-半胱氨酸可以快速逆转更他氯铵(Gantacurium)和CW002诱导的神经肌肉阻滞,Calabadion可同时与甾体类和苄异喹啉类肌松药高效结合,迅速逆转肌肉松弛作用.但新型肌肉松弛拮抗剂的临床应用还需进一步研究.在临床实际工作中,麻醉医师可根据临床需要个体化用药,合理使用肌肉松弛拮抗剂.
Abstract
Muscle relaxation is an essential condition in general anesthesia and surgery for tracheal intubation.However,residual muscle relaxants induced by muscle relaxants after surgery is a common complication that may have adverse effects on patients.In order to reduce the occurrence of this situation,muscle relaxant antagonists are usually used in clinical practice,including cholinesterase inhibitors,amino steroid antagonists and new muscle relaxant antagonists.This article reviews the pharmacological mechanism and the latest clinical application of muscle relaxant antagonists during general anesthesia for tracheal intubation.The results of literature review showed that the use of neostigmine should pay attention to the timing of administration and choose the appropriate dose.Reversal of deep block with neostigmine is not recommended in the absence of any sign of neuromuscular recovery.Sugammadex can reverse intermediate and deep neuromuscular blockade faster and more completely.Sugammadex has good efficacy and safety in thoracic surgery with one lung ventilation.Adamgammadex is a novel γ-cyclodextamine derivative,which has fewer adverse reactions against steroidal muscle relaxants than sugammadex.L-cysteine can quickly reverse gantacurium and CW002 induced neuromuscular blockade.Calabadion can be combined with steroids and benzisoquinoline muscle relaxants at the same time to quickly reverse muscle relaxants.However,the clinical application of new muscle relaxant antagonists needs further research.In clinical practice,anesthesiologists should use antagonists rationally and individually according to clinical needs.
关键词
麻醉,全身/舒更葡糖钠/新斯的明/肌张力过低/拮抗剂/神经肌肉阻滞Key words
Anesthesia,general/Sugammadex/Neostigmine/Low muscle tone/Antagonist/Neuromuscular block引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据