[醫(yī)學(xué)]第九章肌松藥的臨床應(yīng)用(編輯修改稿)
2024-11-12 17:57 本頁面
【文章內(nèi)容簡介】 . 影響肌松藥的藥代動力學(xué) ? Renal failure influences the pharmacology of nondepolarizing muscle relaxants by producing either decreased elimination of the drug, or its metabolites via the kidney, or decreased activity of enzymes that metabolize the drug. Consequently, the duration of action of muscle relaxants may be prolonged in patients with renal failure. ? Patients with hepatobiliary disease may exhibit prolonged block with many muscle relaxants . 2021/11/10 30 表 2 肌松藥經(jīng)腎清除 藥 名 清除占注藥量的百分比（ %） 氯筒箭毒堿 4060 氯二甲箭毒 80100 加拉碘胺 100 泮庫溴胺 6080 阿庫氯胺 090 法扎溴胺 7090 阿曲庫胺 5 維庫溴胺 1020 羅庫溴胺 1020 美維松 10 杜什氯胺 6090 哌庫溴胺 6090 琥珀膽堿 0 2021/11/10 31 Pharmacodynamics 二 .影響肌松藥的藥效動力學(xué) 2021/11/10 32 state and electrolyte 水、電解質(zhì)和酸堿平衡 Both metabolic and respiratory acidosis may augment a nondepolarizing neuromuscular blockade. Hypopotassaemia, hypernatremia, hypocalcemia, and hypermagnesemia do enhance the blockade from nondepolarizing muscle relaxants and diminish the ability of neostigmine to antagonize the blockade. 2021/11/10 33 2. Temperature 低溫 Hypothermia significantly prolongs the duration of most kinds of muscle relaxants 2021/11/10 34 3. Age 年齡 Neonates and infants are more sensitive than adults to the neuromuscular blocking effects of ,the infants have a large volume of distribution and slower clearance, so it leads to a longer elimination halflife,which means that in infants dTC may require less frequent dosing than in older children. 2021/11/10 35 The pharmacodynamics of muscle relaxants are altered in elderly of decreases in total body water,increases in total body fat,decreases in hepatic and renal blood flow and decreases in cardiac reserve, it can prolong the duration of action of most kinds of muscle relaxants. 2021/11/10 36 4. Myasthenia Gravis and Myasthenic Syndrome 重癥肌無力和肌無力綜合征 2021/11/10 37 Myasthenia patients are often extremely sensitive to nondepolarizing relaxants and are usually somewhat resistant to succinylcholine. 重癥肌無力：對非去極化肌松藥異常敏感，對去極化肌松藥輕度拮抗，且呈現(xiàn)出 Ⅱ 相
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