肌松監(jiān)測(cè)肌松藥規(guī)徐世元

《肌松監(jiān)測(cè)肌松藥規(guī)徐世元》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫(kù)。

1、南方醫(yī)科大學(xué)(第一軍醫(yī)大學(xué))珠江醫(yī)院麻醉科徐世元肌松藥的規(guī)范應(yīng)用與拮抗及監(jiān)測(cè)Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.人們都這么說(shuō)!現(xiàn)在的麻醉好上多了！Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.在運(yùn)動(dòng)神經(jīng)終板制造的矛盾神經(jīng)-肌肉“傳導(dǎo)--

2、阻滯--傳導(dǎo)”Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.殘余肌松作用是麻醉恢復(fù)期的殺手!Tiret(法國(guó)）20萬(wàn)例全麻病人中，麻醉死亡65例。半數(shù)的麻醉死亡是因殘余肌松呼吸抑制。Lunn(英國(guó)）11例全麻后呼吸抑制6例與殘余肌松作用有關(guān)。Australia近20年麻醉死亡的主要原因之－是殘余肌松作用拮抗不全Evaluationonly.CreatedwithAspose.Slidesfor.NE

3、T3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.Canada5%-10%Denmark5%-10%France33%-42%VecuroniumAtracuriumNoreversal,NomonitorEvaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.肌松藥殘余作用最近Nagui等分析1979年至2005年共24組資料、3375例病人。術(shù)

4、中應(yīng)用肌松監(jiān)測(cè)823例，24.4%；應(yīng)用神經(jīng)刺激器543例。其它分析結(jié)果如下參考文獻(xiàn)：NaguibM,KopmanAF,EnsorJE.NeuromuscularmonitoringAndpostperativeresidualcurarization:ameta-analysis.BrJAnaesthesia,2007,98(3):302-316.Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.在肌

5、松監(jiān)測(cè)下新斯的明拮抗后殘余肌松作用長(zhǎng)效肌松藥TOF比值<0.74%—60%<0.953%—93%中效肌松藥TOF比值<0.70%—45%<0.912%—95%Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.肌松監(jiān)測(cè)未減少肌松殘余作用發(fā)生率（對(duì)傳統(tǒng)觀念的否定）臨床估評(píng)法較肌松監(jiān)測(cè)法肌松殘余作用發(fā)生率高神經(jīng)刺激器法肌松殘余作用發(fā)生率較上述兩種方法發(fā)生率低結(jié)論Evaluationonly.Createdwi

6、thAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.臨床麻醉肌松藥規(guī)范應(yīng)用的重要性!Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.一、肌松藥的臨床應(yīng)用劑量Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Cop

7、yright2004-2011AsposePtyLtd.問(wèn)題一：在全麻誘導(dǎo)或維持時(shí)不論病人體重與其ED95，只大約應(yīng)用多少劑量。此種用法在無(wú)肌松監(jiān)測(cè)條件下，難以估測(cè)大致肌松程度，因而不能依據(jù)手術(shù)需要合理調(diào)控肌松藥用量●與其他全麻藥甚至局麻藥、鎮(zhèn)痛藥比較，僅肌松藥可按體重與ED95調(diào)控所需肌松程度，即使無(wú)肌松監(jiān)測(cè)條件，個(gè)體差異大，亦能作出大體判斷Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile5.2.0.0.Copyright2004-2011AsposePtyLtd.●無(wú)論全麻

8、誘導(dǎo)或維持，均應(yīng)按體重—ED95計(jì)算肌松藥用量※全麻誘導(dǎo)、氣管插管、肌松藥用量為2～3個(gè)ED9