肌松药的使用.pptxVIP

Neuromuscular management and patient outcomes by Glenn Murphy M.D. 2014 ASA Postoperative residual neuromuscular blockade is a common complication observed in the postanesthesia care unit(PACU) after general anesthesia. Recent large-scale clinical investigations have demonstrated that up to 24% to 42% of surgical patients arrive in the PACU with evidence of incomplete neuromuscular recovery. Although most clinicians are now using intermediate-acting muscle relaxants, the risk of residual neuromuscular block does not appear to be decreasing over time. 术后肌松阻滞残留是全麻后发生在PACU的一个常见并发症。 最近的大型临床研究显示有24%到42%的外科患者在达到PACU时，肌松恢复不完全。 虽然很多临床大夫现在应用的是中效肌松药，不过肌松阻滞残余的风险似乎并没有因此而降低。 Several large database studies have shown an association between neuromuscular blocking agent (NMBA)use and an increased risk of morbidity and mortality in the early period after surgery. Recent clinical trials have demonstrated that residual neuromuscular block in the PACU results in airway obstruction, hypoxemia, and pulmonary complications during recovery from general anesthesia. Patients with residual block are at risk for unpleasant symptoms of muscle weakness and prolonged PACU admission times. 很多大样本数据研究显示肌松药和术后早期并发症发生率和死亡率的增高有明显关系。 最近的临床试验也显示全麻术后患者在PACU期间的肌松阻滞残留会导致气道梗阻、缺氧和呼吸系统并发症。 有肌松阻滞残留的患者也面临肌肉乏力的不适感和PACU停留时间延长的问题 Careful management of neuromuscular blockade in the operating room may reduce the incidence of postoperative residual paralysis and the complications associated with residual block. Several principles related to NMBA dosing, monitoring, and reversal have been shown to reduce the risk of incomplete neuromuscular recovery in postoperative patients. The aim of this review is to provide a “best-available evidence” assessment of methods that can be used by clinicians to reduce the risk of complications due to residual neuromuscular blockade. 手术间内对肌松药使用的认真管理有可能降低术后肌无力的发生率和与肌松残留相关的并发症发生率。 研究表明一些与NMBA剂量、监测和拮抗有关的管理原则可以降低术后肌松恢复不完全的风险。 这篇综述的目的是提供一个“好的和可行”的评估方法，从而指导临床大夫降低与肌松残留相关的并发症发生的风险。 Q1: Does q