新型肌松拮抗药舒更葡糖的临床研究进展

发布时间：2018-04-05 12:47

本文选题：舒更葡糖　切入点：肌松拮抗　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的了解新型肌松拮抗药物舒更葡糖(sugammadex)近年来在临床应用方面的相关研究进展,进一步探索其在肌松拮抗领域的安全、有效应用。方法通过回顾近年以来大量国内外关于舒更葡糖相关文献,总结其作用机制和药物代谢动力学特点、临床相关应用、特殊人群应用、药物相互作用和不良反应等。结果与结论舒更葡糖与氨基甾体肌松药(罗库溴铵、维库溴铵等)在血浆中特异性的紧密结合,从而形成稳定螯合物,通过这种方式降低血浆肌松药的浓度,使神经肌肉接头处的肌松药分子不断顺浓度差转运至血浆继续与之结合,经过肾脏将形成的螯合物排出体外,最终达到拮抗肌松的作用;它能够帮助改善罗库溴铵的严重过敏反应和“无法插管无法通气”的困局,能够安全有效的应用于逆转健康成人罗库溴铵、维库溴铵中深度的神经肌肉阻滞作用以及改良电休克治疗中;目前的临床研究大多支持其可安全有效的用于2-18岁患儿、老年、肥胖及心、肺、肝、肾(除肾衰外)、神经肌肉功能障碍患者,但是缺乏大量的临床研究数据和循证医学支持,尤其罕有2岁以下小儿、孕妇和哺乳期妇女等的临床研究;目前的常规麻醉药物可能不会与之发生药物相互作用,但托瑞米芬、激素避孕药可通过与之结合的方式引起其效能下降和肌松时间延长;舒更葡糖具有较好的安全耐受性,但仍应警惕其不良反应的发生,如潜在的严重过敏反应、延长QTc间期、增加出血风险及神经毒性等。舒更葡糖应用前景美好,对于安全有效的临床麻醉和急救复苏有重要作用。
[Abstract]:Objective to investigate the recent progress in clinical application of a new type of muscle relaxation antagonist Sugammadex in order to explore its safe and effective application in the field of muscle relaxation antagonism.Methods A large number of domestic and international literatures about Shugeng-glucosamine were reviewed in recent years, and the mechanism of action and pharmacokinetic characteristics, clinical application, special population application, drug interaction and adverse reactions were summarized.Results and conclusion Suganose and aminosteroidal muscle relaxants (rocuronium, vecuronium, etc.) bind closely and specifically in plasma to form stable chelates, which can reduce the concentration of muscle relaxants in plasma.The muscle relaxant molecules at the neuromuscular junctions were transported to the plasma continuously in accordance with the concentration difference, and the chelate formed in the kidney was excreted out of the body, finally the antagonistic effect of muscle relaxation was achieved.It can help ameliorate the severe allergic reaction of rocuronium and the difficulty of "no intubation and no ventilation", and can be used safely and effectively to reverse rocuronium in healthy adults.The effect of vecuronium on midrange neuromuscular block and modified electroconvulsive therapy. Most of the current clinical studies support the safe and effective use of vecuronium in children aged 2-18 years, old age, obesity, heart, lung, liver, heart, lung, liver, and so on.Patients with kidney failure, neuromuscular dysfunction, but lack of clinical data and evidence-based medical support, especially in children under 2 years of age, pregnant and lactating women, etc.The current routine anesthetic may not interact with it, but Torrimifen, a hormone contraceptive, can combine it to cause a decline in efficacy and a longer time of muscle relaxation; Suganlutose has a better tolerance for safety.However, the occurrence of adverse reactions, such as potential severe allergic reactions, prolongation of QTc interval, increased risk of hemorrhage and neurotoxicity, should still be observed.Sugeng-glucosamine has a bright future and plays an important role in safe and effective clinical anaesthesia and first aid resuscitation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R971

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