王焱林(肌松药不良反应与防治2009)wuhan(1).pptVIP

 武汉大学中南医院 王焱林 肌松药已成为现代麻醉不可缺少的辅助用药 新一代肌松药对人体产生的不良反应逐渐减少，但仍有很多不足之处 应熟悉肌松药常见的不良反应，并随时给予积极的预防和治疗 Adverse reactions to neuromuscular blocking agents Neuromuscular blocking agents (NMBAs) 在麻醉期间所发生的严重不良反应中占主导地位 大多数高敏反应是 免疫源性(IgE-mediated) 或与组胺释放直接刺激有关 Adverse reactions of Muscle relaxants  Muscle relaxants and their metabolites may interact with muscarinic and nicotinic receptors in other organs and the ganglionic system, for example in the cardiovascular system Direct stimulation of mast cells, with consequent release of histamine, after administration of muscle relaxants may clinically impose as toxic reactions Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000 789 patients who experienced immune-mediated (anaphylaxis) or nonimmune-mediated (anaphylactoid) reactions were referred to one of the 40 participating centers. 过敏反应 in 518 cases (66%) 类过敏反应 in 271 cases (34%) reactions were diagnosed, respectively Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000 最常见的过敏反应原因： neuromuscular blocking agents (NMBAs) (n = 306, 58.2%), latex (n = 88, 16.7%), and antibiotics (n = 79, 15.1%). Rocuronium (n = 132, 43.1%) and succinylcholine (n = 69, 22.6%) were the most frequently incriminated NMBAs. Anaphylactoid reactions after cisatracurium administration in six patients six cases of anaphylactoid reaction after the administration of the muscle relaxant cisatracurium. These incidents challenge existing views of a substantially reduced anaphylactoid potential of cisatracurium relative to other muscle relaxants Krombach J, Hunzelmann N, Koster F,et al. Anesth Analg. 2001 Nov;93(5):1257-9. 肌松药不良反应的临床表现 (1) 皮肤征象：皮肤搔痒，面部、颈部和躯干部红斑，严重时呈弥漫性，并可出现荨麻疹和粘膜水肿 循环系统： 有头晕、心悸、出汗、胸骨后压迫感 心率增快，血压下降，有时出现心律失常甚至心力衰竭 还可引起冠状动脉痉挛，当有冠状动脉硬化时，情况更加严重 肌松药不良反应的临床表现(2) 呼吸系统：肺循环阻力增加，可出现刺激性咳嗽、喘息继之哮喘发作、喉头水肿、支气管痉挛和肺水肿 消化系统：可出现恶心呕吐、腹胀、腹痛、腹泻等 术后残留肌松作用：苏醒延迟、低氧血症、呼吸道梗阻以及心脏停搏 肌松药不良反应 组胺释放作用 对植物神经功能的干扰 残余肌松作用 组胺释放作用 组胺释放是所有肌松药