肌松拮抗药与肌松监测在小儿麻醉中的应用  

Effects of muscle relaxation antagonists and muscle relaxation monitoring in pediatric clinical anesthesia

作　　者：陈泓羊 杨磊[1] 王子宁[2] 杨笛[3] 伍怡萱 左云霞[1] Chen Hongyang;Yang Lei;Wang Zining;Yang Di;Wu Yixuan;Zuo Yunxia(Department of Anesthesiology,West China Hospital of Sichuan University,Innovation Unit of Perioperative Stress Risk Assessment and Clinical Decision of Chinese Academy of Medical Sciences(2018RU012),Chengdu 610041,Sichuan Province,China;West China School of Clinical Medicine of Sichuan University,Chengdu 610041,Sichuan Province,China;Department of Anesthesiology,Sichuan Provincial People's Hospital,Chengdu 610015,Sichuan Province,China)

机构地区：[1]四川大学华西医院麻醉科、中国医学科学院"围术期应激风险评估与临床决策创新单元"(2018RU012),成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川省人民医院麻醉科,成都610015

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第3期262-268,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家重点研发计划(2020YFC2005303);四川大学华西医院学科卓越发展1.3.5工程项目(麻醉学科卓越发展项目)(ZY2016101)。

摘　　要：肌松拮抗药(MRA)是骨骼肌松弛药(SMR)的拮抗剂,主要包括抗胆碱酯酶药(新斯的明、吡斯的明),K+通道阻滞剂和氨基甾类非去极化SMR的特异性拮抗药(舒更葡糖钠)。肌松监测是指连续监测肌肉松弛程度,客观反映SMR作用的消长过程。随着SMR在临床中的广泛应用,肌松药残余阻滞(RBMR)越来越受到麻醉医师关注。RBMR可能导致麻醉恢复期患儿麻醉苏醒延迟、呼吸减弱、缺氧、窒息,甚至死亡。围术期使用MRA,并同时进行肌松监测,可有效预防术后患儿RBMR的发生。相较于成年患者,患儿对缺氧耐受性差,RBMR对麻醉恢复期患儿危害性更大,可能导致更多不良反应。因此,如何降低术后RBMR对麻醉恢复期患儿的不良反应发生率,是麻醉医师需要关注和解决的重要问题之一。笔者拟就MRA的药理学特点,以及术中肌松监测在小儿麻醉中应用的最新研究进展进行阐述。Muscle relaxant antagonists(MRA)are antagonists of skeletal muscle relaxants(SMR),which are mainly divided into anticholinesterase agents,such as neostigmine and pyridostigmine,K+channel blockers and specific antagonists of amino-steroid non-depolarizing SMR(sugammadex).Muscle relaxation monitoring refers to continuous monitoring of degree of muscle relaxation,which can objectively reflecting growth and decline process of effect of SMR.With widespread use of SMR in clinical practice,effects of residual blockade of muscle relaxants(RBMR)have attracted more and more attention from anesthesiologists.RBMR may lead to delayed recovery from anesthesia,hypopnea,hypoxia,asphyxia,and even death in children during anesthesia recovery.Combined use of MRA and muscle relaxation monitoring during perioperative period can effectively prevent occurrence of postoperative RBMR in children during anesthesia recovery.Considering poor tolerance of hypoxia in children,RBMR is more harmful to children during anesthesia recovery and may lead to more adverse reactions than those to adults.Therefore,how to reduce the incidence of adverse reactions of postoperative RBMR to children during anesthesia recovery is one of the important issues that anesthesiologists need to pay attention to and solve.The author intends to describe pharmacological characteristics of MRA and the latest research progress in application of intraoperative muscle relaxation monitoring in pediatric anesthesia.

关 键 词：神经肌肉阻滞药 肌松弛 肌松监测 麻醉恢复期 麻醉品拮抗药 麻醉苏醒延迟 儿童 

分 类 号：R726.1[医药卫生—儿科]