肌松药.ppt

CHAPTER NINE CLINICAL USE OF MUSCLE RELAXANTS第九章肌松药的临床应用 Part 1 The Rational Use of Muscle Relaxants 第一节 肌松药的合理应用 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) . Main Goals of Use一.应用肌松药的目的  1.As the very important adjuncts for general anesthesia,muscle relaxants can provide adequate paralysis needed tracheal intubation, or relaxation for surgery. 肌松药是全麻的重要辅助用药，用于全麻诱导时气管插管或维持全麻时肌松，避免深麻醉带来的危害。 2. To be used in the critical patients who are receiving mechanical ventilation care. 危重病人机械通气时用肌松药来消除自主呼吸对呼吸机的拮抗。 3.To be used in the treatment of spasmodic diseases. 用于治疗痉挛性疾病。 4. To be used in the electric shock treatment.在电休克治疗时用其控制肌张力和减少肌强烈收缩引起的并发症。 Fundamental Principles of Use二. 应用肌松药的基本原则  1. Muscle relaxants should be viewed as adjuncts,not as substitutes for anesthesia. Perfect general anesthesia should include:analgesia, amnesia and relaxation. 肌松药不能代替麻醉药，应有完善的镇痛。 2. Strict control of airway. 应有严密的呼吸管理。 Muscle relaxants can influence the respiration ability of patients to maintain adequate ventilation, so strict control measures of airway must be given. 3. Proper muscle relaxants and appropriate doses (minimal doses). 选择合适的肌松药和最小有效剂量。 4. To avoid inappropriate combined administration. 避免不恰当的联合用药。 5. To utilize the synergistic action between muscle relaxants and anesthetics properly. 合理利用麻醉药与肌松药的协同作用。 6. Proper monitoring of neuromuscular function. 最好能够对肌松药的作用进行监测。 Part 2  Use of Muscle Relaxants During Anesthesia 第二节　肌松药在麻醉期间的应用 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