歲月麻醉

Anesthesia,Joyful Life
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肌鬆需要拮抗嗎 ?

是否常規給予肌鬆拮抗?這是一個似是而非的問題,「to be or not to be,that's a question.」

臨床上沒有標準答案,視個人,各科室情況而定,重點在於:

1.了解拮抗與不拮抗的優缺點。
2. 適量的給予恰當的拮抗劑量。

wangyan810505 在非去極化神經肌肉阻滯藥物的拮抗:臨床現狀 一文裡,有很深入的闡述,值得借鏡。

常規使用新斯的明的缺點:1.心律失常、口乾、支氣管痙攣以及嚴重的心動過緩,甚至有文獻報導發生心跳驟停2.有些作者推測使用新斯的明拮抗增加胃腸吻合口的張力3.對麻醉而言,對神經肌肉阻滯已恢復的患者,應用臨床劑量的新斯的明能夠引起神經肌肉傳道障礙。
理想狀態是在膽鹼酯酶抑制劑僅在需要的時候給予,遺憾的是,在缺乏客觀神經肌肉監測時要確定是否仍殘存肌松作用是比較困難的,因此對於神經肌肉阻滯已完全恢復的患者,醫生偶爾也會蠻目地拮抗。應當指出的是,在TOF比值高達0.5時,給予新斯的明0.04mg/kg仍會改善神經肌肉功能,而不是削弱它。



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