《肌松药的临床应用》课件.ppt

第八章肌松药的临床应用;目的与要求;Key;History;ClinicalUse;MolecularFeatures;Musclerelaxantsaregenerallyquitewater-soluble

Thewatersolubilityofrelaxantsinhibitsuptakeintohepatocytes

Metabolismand/orexcretionintheliverisusuallynotamajorpathwayofelimination

Themusclerelaxantsareeasilyexcretedbyglomerularfiltrationintheurine;Class;PHARMACOLOGY

OFSUCCINYLCHOLINE;CardiovascularEffects;SinusBradycardia

withhighsympathetictone,suchaschildren

inadultsandappearsmorecommonlyafteraseconddoseofthedrugisgivenapproximately5minutesafterthefirst

preventedbythiopental,atropine,ganglion-blockingdrugs,andnondepolarizingmusclerelaxants;Nodal(Junctional)Rhythms

suppressingthesinusmechanismandallowingtheemergenceoftheatrioventricularnodeasthepacemaker

preventedbyprioradministrationofdTc;VentricularArrhythmias

lowersthethresholdoftheventricletocatecholamine-inducedarrhythmias

Circulatingcatecholamineconcentrationsincrease4-foldandpotassiumincreasesbyone-third

Otherstimuli,suchasendotrachealintubation,hypoxia,hypercarbia,andsurgery,areprobablyadditivetotheeffectofsuccinylcholine

;Complications;IncreasedIntraocularPressure

IncreasedIntragastricPressure

Pregnancy

Ascites

Bowelobstruction

Hiatushernia

IntracranialPressure

MusclePains;Nondepolarizingdrug

SteroidalCompounds

Pancuronium,Pipecuronium,Vecuronium,RocuroniumandRapacuronium

无组胺释放作用，主要经肾排泄，可松弛迷走神经

松弛迷走神经

中度Pancuronium,Rapacuronium

轻度Rocuronium

无Pipecuronium,Vecuronium;亲脂/亲水的水平决定肝脏摄取

亲脂性强Vecuronium，RocuroniumandRapacuronium中短效、效能低、作用快、肝脏摄取代谢比例大，Vecuronium30~40%经肝去乙酰基代谢

亲脂性弱Pancuronium长效、效能高、作用慢、肝脏摄取代谢比例小，15~20%经肝代谢;Benzylisoquinolinium（苄基异喹啉）Compounds

d-Tubocurarine，Metocurine，Doxacurium，Atracurium，CisatracuriumandMivacurium

有组胺释放作用，可经肾排泄，不松弛迷走神经

组胺释放作用

显著d-Tubocurarine

中度Metocurine甲筒箭毒

轻度Atracurium，Mivacurium

无Doxacurium，C