[醫(yī)學(xué)]第九章肌松藥的臨床應(yīng)用(已修改)
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【正文】 2021/11/10 1 CHAPTER NINE CLINICAL USE OF MUSCLE RELAXANTS 第九章 肌松藥的臨床應(yīng)用 江蘇大學(xué)臨床醫(yī)學(xué)院 2021/11/10 2 Part 1 The Rational Use of Muscle Relaxants 第一節(jié) 肌松藥的合理應(yīng)用 2021/11/10 3 ? Muscle relaxants can lead to skeletal muscle relaxation. Their principal pharmacologic effect is to interrupt transmission of synaptic signaling at the neuromuscular junction (NMJ) by antagonism of the nicotinic acetylcholine receptor (AChR) . 2021/11/10 4 Main Goals of Use 一 .應(yīng)用肌松藥的目的 the very important adjuncts for general anesthesia,muscle relaxants can provide adequate paralysis needed tracheal intubation, or relaxation for surgery. 肌松藥是全麻的重要輔助用藥，用于全麻誘導(dǎo)時氣管插管或維持全麻時肌松，避免深麻醉帶來的危害。 2021/11/10 5 2. To be used in the critical patients who are receiving mechanical ventilation care. 危重病人機械通氣時用肌松藥來消除自主呼吸對呼吸機的拮抗。 2021/11/10 6 be used in the treatment of spasmodic diseases. 用于治療痙攣性疾病。 2021/11/10 7 4. To be used in the electric shock treatment.在電休克治療時用其控制肌張力和減少肌強烈收縮引起的并發(fā)癥。 2021/11/10 8 Fundamental Principles of Use 二 . 應(yīng)用肌松藥的基本原則 1. Muscle relaxants should be viewed as adjuncts,not as substitutes for anesthesia. Perfect general anesthesia should include:analgesia, amnesia and relaxation. 肌松藥不能代替麻醉藥，應(yīng)有完善的鎮(zhèn)痛。 2021/11/10 9 2. Strict control of airway. 應(yīng)有嚴(yán)密的呼吸管理。 Muscle relaxants can influence the respiration ability of patients to maintain adequate ventilation, so strict control measures of airway must be given. 2021/11/10 10 3. Proper muscle relaxants and appropriate doses (minimal doses). 選擇合適的肌松藥和最小有效劑量。 2021/11/10 11 4. To avoid inappropriate bined administration. 避免不恰當(dāng)?shù)穆?lián)合用藥。 2021/11/10 12 5. To utilize the synergistic action between muscle relaxants and anesthetics properly. 合理利用麻醉藥與肌松藥的協(xié)同作用。 2021/11/10 13 6. Proper monitoring of neuromuscular function. 最好能夠?qū)∷伤幍淖饔眠M(jìn)行監(jiān)測。 2021/11/10 14 Part 2 Use of Muscle Relaxants During Anesthesia 第二節(jié) 肌松藥在麻醉期間的應(yīng)用 2021/11/10 15 ? There are two important safety issues in practice with muscle relaxants: cardiovascular side effects and adequacy of recovery to normal neuromuscular function. Of the two, the latter is by far the more important. To avoid prolonged residual paralysis or inadequate antagonism of residual blockade or both, the main goal should be to use the lowest possible dose that will provide adequate relaxation for surgery. 2021/11/10 16 For Tracheal Intubation 一．用于氣管插管 To provide the very deep paralysis needed for tracheal intubation, the initial dose in the range two to three times the ED95 is usually given to facilitate the maneuver within one to three minutes, depending on the choice and dose of muscle relaxant. Succinylcholine is still preferred for this critical maneuver. Now, however, there are suitable alternatives among the nondepolarizing relaxants but as yet no replacement 2021/11/10 17 For Maintenance of relaxation 二 . 肌松維持 Maintenance of relaxation by continuous infusion of intermediate and shortacting drugs can be performed and is useful to keep relaxation smooth and to rapidly adjust the depth of relaxation to surgical needs. 2021/11/10 18 Dosage for
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