Sugammadex Sodiumianopikisa anopikisa weanosarudza asiri-depolarizing muscle relaxants (myorelaxants), iyo yakatanga kutaurwa muvanhu muna 2005 uye kubvira ipapo yakashandiswa mukiriniki muEurope, United States neJapan.Kuenzaniswa nemishonga yechinyakare anticholinesterase, inogona kupikisa yakadzika nerve block pasina kukanganisa mwero wehydrolyzed acetylcholine pacholinergic synapses, ichidzivirira mhedzisiro yakaipa yeM uye N receptor excitation, uye nekuvandudza zvakanyanya kunaka kwepost-anesthesia kumuka.Izvi zvinotevera kuongororwa kwechangobva kuitika kukiriniki kushandiswa kwesodium shuga munguva yekumuka kweanesthesia.
1. Muchidimbu
Sugammadex Sodium inogadziriswa γ-cyclodextrin derivative iyo inonyatso shandura neuromuscular blocking effect ye steroidal neuromuscular blocking agents, kunyanya rocuronium bromide.Sugammadex Sodium chelates yemahara neuromuscular blockers mushure mejekiseni uye inactivates neuromuscular blockers nekugadzira yakagadzikana mvura-inonyungudika compound kuburikidza ne1: 1 yakasimba kusunga.Nekusunga kwakadai, denderedzwa rekugadzirisa rinoumbwa rinoita kuti kudzoka kweiyo neuromuscular blocker kubva kune neuromuscular junction kusvika kuplasma, nokudaro kudzoreredza neuromuscular blocking effect iyo inogadzira, kusunungura nicotinic acetylcholine-like receptors uye kudzorera neuromuscular excitatory transmission.
Pakati pe steroidal neuromuscular blockers, Sugammadex Sodium ine hukama hwakasimba hwe pecuronium bromide, inoteverwa ne rocuronium, ipapo vecuronium uye pancuronium.Zvakakosha kucherechedza kuti kuve nechokwadi chekukurumidza uye chinoshanda kudzoreredzwa kweiyo neuromuscular blocking mhedzisiro, yakawandisaSugammadex Sodiuminofanira kushandiswa maererano nemyorelaxants mukutenderera.Mukuwedzera, Sugammadex Sodium inopikisa chaiyo ye steroidal neuromuscular blocking agents, uye haikwanisi kusunga benzylisoquinoline non-depolarizing myorelaxants pamwe ne depolarizing myorelaxants, uye naizvozvo, haigoni kudzorera neuromuscular blocking effects yemishonga iyi.
2. Kubudirira kwe sugammadex sodium
Kazhinji, muyero wevanopikisa muscarinic panguva yekumutswa kweanesthetic kunoenderana nehuwandu hwekuvhara neuromuscular.Naizvozvo, kushandiswa kweiyo myoson yekutarisa kunofambisa zvine musoro kushandiswa kwevanopikisa neuromuscular blocking.Iyo myorelaxation yekutarisa inopa kurudziro yemagetsi inounzwa kune tsinga dzeperipheral, zvichikonzera mhinduro yemota (kuzununguka) mumhasuru inoenderana.Simba retsandanyama rinoderera kana kupera mushure mekushandisa myorelaxants.Nekuda kweizvozvo, dhigirii rekuvharika kweuromuscular rinogona kuverengerwa se: yakadzika block [pasina kuzununguka mushure mechina chechitima-chechina (TOF) kana tonic stimulation], yakadzika block (hapana kuzununguka mushure meTOF uye kamwechete kuzununguka mushure me tonic. stimulation), uye ine mwero block (inenge imwe chete twitching mushure meTOF).
Kubva pane tsananguro dziri pamusoro apa, chiyero chakakurudzirwa cheshuga yesodium kuti idzorere pakati nepakati block ndeye 2 mg / kg, uye chiyero cheTOF chinogona kusvika 0.9 mushure me2 min;iyo inokurudzirwa dhizaini yekudzosera yakadzika block ndeye 4 mg / kg, uye iyo TOF chiyero inogona kusvika 0.9 mushure me1.6-3.3 min.Nekukurumidza induction yeanesthesia, high-dose rocuronium bromide (1.2 mg / kg) haina kukurudzirwa nokuda kwechigadziro chekuchinja kwechivharo chakadzika kwazvo.Zvisinei, munyaya yekudzoka kwekukurumidzira kumhepo yakasikwa, kudzorera ne 16 mg / kg yeSugammadex Sodiuminokurudzirwa.
3. Kushandiswa kweSugammadex Sodium muvarwere vanokosha
3.1.Muvana varwere
Dhata kubva kuchikamu chechipiri chezvidzidzo zvekiriniki zvinoratidza kuti Sugammadex Sodium inoshanda uye yakachengeteka muhuwandu hwevana (kusanganisira vacheche, vacheche, vana uye vachiri kuyaruka) sezvazviri muhuwandu hwevanhu vakuru.Meta-analysis yakavakirwa pazvidzidzo gumi (575 kesi) uye ichangobva kuburitswa retrospective cohort kudzidza (968 kesi) yakasimbisawo kuti nguva (yepakati) yekudzoreredza reshiyo yechina myoclonic twitch kusvika 1st myoclonic twitch kusvika 0.9 muzvidzidzo. yakapiwa rocuronium bromide 0.6 mg / kg uye Sugammadex Sodium 2 mg / kg paT2 mharidzo yaingova 0.6 min mucheche (0.6 min) zvichienzaniswa nevana (1.2 min) uye vakuru (1.2 min).1.2 min nehafu yevakuru (1.2 min).Mukuwedzera, imwe tsvakurudzo yakawana kuti Sugammadex Sodium yakaderedza kuitika kwebradycardia kana ichienzaniswa neostigmine yakasanganiswa neatropine.Kusiyana kwezviitiko zvezvimwe zviitiko zvakashata zvakadai sebronchospasm kana postoperative nausea uye kurutsa kwakanga kusingaverengeki.Yakave yakaratidzawo kuti kushandiswa kweSugammadex Sodium kunoderedza kuitika kwekushungurudzika kwemashure muvarwere vevana, izvo zvinogona kubatsira mukutarisira nguva yekudzorera.Mukuwedzera, Tadokoro et al.yakaratidza mune imwe nyaya-control yekuongorora kuti pakanga pasina kuwirirana pakati peperioperative allergic reactions kune vana general anesthesia uye kushandiswa kwesodium sugammadex.Nokudaro, kushandiswa kweSugammadex Sodium kwakachengeteka muvarwere vevana panguva yekumuka kweanesthesia.
3.2.Kushandiswa muvarwere vakwegura
Kazhinji, varwere vakwegura vanonyanya kukanganiswa nemigumisiro yezvakasara neuromuscular blockade kupfuura varwere vaduku, uye kupora kwepamuviri kubva neuromuscular blockade kunononoka.Mune multicenter phase III yekiriniki yekuongorora yekuchengeteka, kushanda, uye pharmacokinetics yeSugammadex Sodium muvarwere vakwegura, vakawana kuti Sugammadex Sodium yakadzoserwa rocuronium kuti ibudise kuwedzera kuduku munguva yekudzivirira neuromuscular kana ichienzaniswa nevarwere vaduku kudarika makore 65 (zvinoreva nguva). ye2.9 min uye 2.3 min, zvichiteerana).Nekudaro, zvidzidzo zvakati wandei zvakataura kuti sugammadex inoshivirirwa zvakanaka nevarwere vakura uye kuti hapana re-museve toxification inoitika.Nokudaro, inofungidzirwa kuti Sugammadex Sodium inogona kushandiswa zvakachengeteka kune varwere vakwegura panguva yekumuka kweanesthesia.
3.3.Shandisa muvakadzi vane pamuviri
Pane diki nhungamiro yekiriniki pakushandiswa kweSugammadex Sodium muvakadzi vane pamuviri, vakaorera uye vanoyamwisa.Zvisinei, zvidzidzo zvemhuka hazvina kuwana mhedzisiro pamazinga eprogesterone panguva yekuzvitakura uye hapana kuberekwa kana kubvisa pamuviri mumakonzo ose, izvo zvingatungamirira kushandiswa kwekliniki yeSugammadex Sodium panguva yekuzvitakura, kunyanya mukutanga kwekutanga.Pakavewo nezviitiko zvakawanda zvekushandiswa kwaamai kweshuga yesodium pasi peanesthesia yezvikamu zvecesarean, uye hapana matambudziko emadzimai kana e fetus akashumwa.Kunyangwe zvimwe zvidzidzo zvakataura zvishoma zvishoma transplacental kutamiswa kweshuga yesodium, pachine kushomeka kwedata rakavimbika.Zvinonzwisisika, vakadzi vane pamuviri vane gestational hypertension vanowanzobatwa ne magnesium sulfate.Kuvharidzirwa kweacetylcholine kusunungurwa kuburikidza neion magnesium kunovhiringidza neuromuscular junction information transduction, kuzorodza tsandanyama yeskeletal, uye kubvisa tsandanyama.Nokudaro, magnesium sulfate inogona kuwedzera neuromuscular blocking effect ye myorelaxants.
3.4.Kushandiswa kwevarwere vane renal insufficiency
Sugammadex Sodium uye sucralose-rocuronium bromide complexes inobudiswa neitsvo se prototypes, kuitira kuti metabolism yeakasungwa pamwe chete neasingasviki Sugammadex Sodium inogara kwenguva refu kune varwere vane renal insufficiency.Nekudaro, data yekiriniki inoratidza izvozvoSugammadex Sodiuminogona kushandiswa zvakachengeteka kune varwere vane chirwere chekupedzisira chechirwere, uye hapana mishumo yekunonoka neuromuscular blockade mushure meSugammadex Sodium muvarwere vakadaro, asi iyi data inongogumira ku48h mushure meSugammadex Sodium administration.Mukuwedzera, iyo sodium sugammadex-rocuronium bromide yakaoma inogona kubviswa nehemodialysis ine high-flux filtration membranes.Zvakakosha kuziva kuti nguva ye rocuronium reversal ne sodium sugammadex inogona kureba kune varwere vane chirwere chetsvo.Naizvozvo kushandisa neuromuscular monitoring kwakakosha.
4. Mhedziso
Sugammadex Sodium inokurumidza kudzosera iyo neuromuscular blockade inokonzerwa nepakati uye yakadzika aminosteroid myorelaxants, uye inoderedza zvakanyanya chiitiko cheyakasara neuromuscular blockade kana ichienzaniswa neyakajairika acetylcholinesterase inhibitors.Sodium sugammadex zvakare inomhanyisa zvakanyanya nguva yekubuda mukati menguva yekumuka, inopfupisa huwandu hwemazuva ekuiswa muchipatara, inomhanyisa kupora kwevarwere, inoderedza mitengo yekuchipatara, uye inochengetedza zviwanikwa zvekurapa.Zvisinei, kusawirirana kweropa uye cardiac arrhythmias zvakataurwa apo neapo panguva yekushandiswa kweSugammadex Sodium, saka zvichiri kudiwa kuti uve wakangwarira panguva yekushandiswa kweSugammadex Sodium uye kutarisa kuchinja kwezviratidzo zvinokosha zvevarwere, mamiriro eganda uye ECG.Zvinokurudzirwa kutarisa skeletal tsandanyama kuputika nemhasuru yekuzorora yekutarisa kuti uone kudzika kweiyo neuromuscular blockade uye kushandisa inonzwisisika dose ye.sodium sugammadexkuti uwedzere kuvandudza hutano hwenguva yekumuka.
Nguva yekutumira: Sep-27-2021