《肌松药的临床应用》ppt课件

《《肌松药的临床应用》ppt课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、第八章肌松药的临床应用目的与要求掌握：肌松药的应用原则以及残留肌松作用的判断熟悉：肌松药的不良反应，影响肌松药作用的因素肌松药的麻醉期间的应用了解：神经肌肉传递功能监测KeyHypnosisAnalgesiaAmnesiaRelaxationHistoryIn1942GriffithandJohnsonsuggestedthatd-tubocurarine(dTc)Succinylcholine,introducedbyThesleffandFoldesetalin1952In1967BairdandReidfirstreportedpancuroniumintheearly1980soft

2、wonewmusclerelaxantsofintermediatedurationatracuriumandvecuroniumTheearly1990switnessedpipecuronium,doxacurium,mivacuriumandrocuroniumAnatracuriumisomer,cisatracuriumintroducedin1996ClinicalUseTrachealintubationOperationICUCureofspasticityMolecularFeaturesNeuromuscularblockingdrugsarequaternaryammo

3、niumcompoundsNearlyallmusclerelaxantscontaintwopositivechargesMusclerelaxantsaregenerallyquitewater-solubleThewatersolubilityofrelaxantsinhibitsuptakeintohepatocytesMetabolismand/orexcretionintheliverisusuallynotamajorpathwayofeliminationThemusclerelaxantsareeasilyexcretedbyglomerularfiltrationinth

4、eurineClassDepolarizingdrugsuccinylcholineImbretil（己氨胆碱、氨酰胆碱）PHARMACOLOGYOFSUCCINYLCHOLINERapidhydrolysisbypseudocholinesterase假胆碱酯酶FactorsloweringpseudocholinesteraseconcentrationliverdiseasePregnancyBurnsoralcontraceptivesmonoamineoxidaseinhibitorscytotoxicdrugsneoplasticdiseaseanticholinesteras

5、edrugs胆碱酯酶抑制剂CardiovascularEffectsstimulatesnicotinicreceptorsonbothsympatheticandparasympatheticgangliaandmuscarinicreceptorsinthesinusnodeoftheheartInlowdoses,bothnegativeinotropicandchronotropic（负性变力、变频）responsesmayoccur.ThesecanbeattenuatedbyprioradministrationofatropineWithlargedoses,positiver

6、esponses.cardiacarrhythmiasSinusBradycardiawithhighsympathetictone,suchaschildreninadultsandappearsmorecommonlyafteraseconddoseofthedrugisgivenapproximately5minutesafterthefirstpreventedbythiopental,atropine,ganglion-blockingdrugs,andnondepolarizingmusclerelaxantsNodal(Junctional)Rhythmssuppressing

7、thesinusmechanismandallowingtheemergenceoftheatrioventricularnodeasthepacemakerpreventedbyprioradministrationofdTcVentricularArrhythmiaslowersthethresholdoftheventricletocatecholamine-inducedarrhythmiasCirc