[关于安全使用神经肌肉阻断剂的指南]
Réka Nemes1, Adrienn Pongrácz1, László Asztalos1
11 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Tanszék, Tassonyi Edömér Neuromaszkuláris Munkacsoport Debrecen, Nagyerdei krt. 98., 4032 Magyarország.
Orvosi hetilap
|April 13, 2025
概括
术后残留神经肌肉阻塞 (PORNB) 是可能导致并发症的风险. 客观的神经肌肉监测,而不是临床症状,对于确保肌肉松效应在输出前已消失 (TOF比率≥0.9) 至关重要,以确保患者的安全.
科学领域:
- 麻醉学和外科手术期间的医学.
- 神经肌肉药理学 神经肌肉药理学
- 患者安全研究 患者安全研究
背景情况:
- 手术后残留神经肌肉阻塞 (PORNB) 仍然是一个重要的临床问题,增加了肺部并发症的风险.
- 最近的指导方针强调客观监测,以减轻PORNB发生率并改善患者的治疗结果.
- 临床症状和主观评估对于检测残留神经肌肉阻塞是不可靠的.
研究的目的:
- 总结基于国际指导方针的安全使用肌肉松剂的建议.
- 强调客观神经肌肉监测在预防PORNB方面的关键作用.
- 为整个外科手术期间监测神经肌肉功能提供指导.
主要方法:
- 客观的神经肌肉监测,特别是使用四次训练 (TOF) 比率,建议所有接受非去极化肌肉松剂的患者.
- 应在手部进行监测,首先在施用肌肉松剂之前对设备进行校准.
- 在手术期间应重复TOF测量,并且必须客观地评估逆转药物的有效性 (尼奥斯蒂格明,苏加马德克斯).
主要成果:
- 客观的神经肌肉监测对于确认神经肌肉功能的恢复至关重要,在输出之前,目标TOF比率≥0.9.
- 临床症状不足以诊断残留的神经肌肉阻塞.
- 该研究详细介绍了基于TOF刺激反应的不同类型肌肉松剂的适当逆转策略.
结论:
- 客观的神经肌肉监测对于接受非脱极化肌肉松剂以预防PORNB的患者来说是强制性的.
- 确保神经肌肉功能完全恢复 (TOF比率≥0.9) 对患者的安全和预防术后并发症至关重要.
- 遵守客观的监测协议可以确保安全的输出管和有效的逆转神经肌肉阻塞.
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