肌松药的临床应用The.pptVIP

第九章 肌松药的临床应用The clinical use of neuromuscular blockade Department of Anesthesiology The 2nd affiliated hospital of Harbin Medical University Li Haibo 概 述 肌松药是全麻中重要的辅助用药 肌松药是麻醉药吗？ 不是 1942年以前…… 深麻醉---良好肌松 1942年箭毒应用于临床，临床麻醉就发生了革命性的变化： 浅麻醉+肌松药-----良好肌松 Awareness 术中知晓（awareness）是一种严重的全麻术中并发症，会给病人造成巨大的精神损害。尤其易发生于肌松药应用不当的全麻麻醉中。 临床常用肌松药 去极化肌松药 琥珀胆碱suxamethonium,succinylcholine ,scoline 非去极化肌松药 潘库溴铵pancuronium,pavulon 维库溴铵vecuronium 阿曲库铵atracurium,tracrium 哌库溴铵pipecuronium 罗库溴铵rocuronium 美维松mivacurium Succinycholine Dosage: 1-1.5mg/kg, repeated small dose 10mg or 1g in 500 or 1000ml, titrated to effect Side effects and clinical considerations: A. Cardiovascular B . Fasciculations C. Hyperkalemia D. Muscle pains E. Intragastric pressure elevation F. Intraocular pressure elevation G. Generalized contractions H. Prolonged paralysis I. Intracranial pressure Tubocurarine(筒箭毒碱) Dosage for intubation:0.5-0.6mg/kg for intra-operative: 0.15mg/kg 0.05mg/kg Side effects and clinical considerations: hypotension and tachycardia Metocurine甲筒箭毒 Dosage For intubation :0.3mg/kg For intraoperative:0.08mg/kg 0.03mg/kg Side effects and clinical considerations: Hypotension tachycardia ,bronchospasm ,allergic reactions Atracurium Dosage For intubation :0.5mg/kg For intraoperative:0.25mg/kg 0.1mg/kg every 10-20min Side effects and clinical considerations: It must be stored at 2-8℃. laudanosine (N-甲基四氢罂粟碱)toxicity Cistracurium Dosage For intubation :0.1-0.15mg/kg within 2min For infusion:1-2μg/kg/min Side effects and clinical considerations: Laudanosine toxicity, pH and temperature sensitivity, and chemical incompatibility (alkaline solution such as thiopental precipitate) Mivacurium Dosage For intubation :0.1-0.2mg/kg For infusion:4-10μg/kg/min Side effects and clinical considerations: Doxacurium(多沙氯铵