肌松药的临床应用讲解.pptVIP

Key Hypnosis Analgesia Amnesia Relaxation History In 1942 Griffith and Johnson suggested that d-tubocurarine (dTc) Succinylcholine, introduced by Thesleff and Foldes et al in 1952 In 1967 Baird and Reid first reported pancuronium in the early 1980s of two new muscle relaxants of intermediate duration atracurium and vecuronium The early 1990s witnessed pipecuronium, doxacurium, mivacurium and rocuronium An atracurium isomer, cisatracurium introduced in 1996 Clinical Use Tracheal intubation Operation ICU Cure of spasticity Molecular Features Neuromuscular blocking drugs are quaternary ammonium compounds Nearly all muscle relaxants contain two positive charges Muscle relaxants are generally quite water-soluble The water solubility of relaxants inhibits uptake into hepatocytes Metabolism and/or excretion in the liver is usually not a major pathway of elimination The muscle relaxants are easily excreted by glomerular filtration in the urine Class Depolarizing drug succinylcholine Imbretil（己氨胆碱、氨酰胆碱） PHARMACOLOGY  OF SUCCINYLCHOLINE Rapid hydrolysis by pseudocholinesterase假胆碱酯酶 Factors lowering pseudocholinesterase concentration liver disease Pregnancy Burns oral contraceptives monoamine oxidase inhibitors cytotoxic drugs neoplastic disease anticholinesterase drugs胆碱酯酶抑制剂 Cardiovascular Effects stimulates nicotinic receptors on both sympathetic and parasympathetic ganglia and muscarinic receptors in the sinus node of the heart In low doses, both negative inotropic and chronotropic（负性变力、变频 ）responses may occur. These can be attenuated by prior administration of atropine With large doses, positive responses. cardiac arrhythmias Sinus Bradycardia with high sympathetic tone, such as children in adults and appears more commonly after a second dose of the drug is given approximately 5 minutes after the first prevented by thiopental, atropine, ganglion-blocking drugs, and nondepolarizing muscle relaxants Nodal (Junctional) Rhythms