Sugammadex sodiumndi mdani waposachedwa wamankhwala osankhika amisala (myorelaxants), omwe adanenedwa koyamba mwa anthu mu 2005 ndipo akhala akugwiritsidwa ntchito kuchipatala ku Europe, United States ndi Japan.Poyerekeza ndi mankhwala achikhalidwe a anticholinesterase, amatha kusokoneza mitsempha yakuya popanda kusokoneza mlingo wa hydrolyzed acetylcholine pa cholinergic synapses, kupeŵa zotsatira za M ndi N receptor excitation, ndikuwongolera kwambiri khalidwe la post-anesthesia kudzutsidwa.Zotsatirazi ndikuwunikanso kwaposachedwa kwachipatala kwa shuga wa sodium m'nthawi ya anesthesia.
1. Mwachidule
Sugammadex Sodium ndi chochokera ku γ-cyclodextrin chosinthidwa chomwe chimasinthiratu kutsekeka kwa neuromuscular kwa steroidal neuromuscular blocking agents, makamaka rocuronium bromide.Sugammadex Sodium chelates free neuromuscular blockers pambuyo jekeseni ndipo inactivates neuromuscular blockers popanga khola losungunuka m'madzi losungunuka kupyolera mu 1: 1 yolimba yomanga.Mwa kumangiriza kotereku, kutsika kwapang'onopang'ono kumapangidwa komwe kumathandizira kubwereranso kwa neuromuscular blocker kuchokera ku neuromuscular junction kupita ku plasma, potero kutembenuza kutsekeka kwa neuromuscular komwe kumapanga, kutulutsa nicotinic acetylcholine-like receptors ndikubwezeretsanso kufalikira kwa neuromuscular excitatory transmission.
Pakati pa steroidal neuromuscular blockers, Sugammadex Sodium ili ndi mgwirizano wamphamvu kwambiri wa pecuronium bromide, wotsatiridwa ndi rocuronium, kenako vecuronium ndi pancuronium.Ndizofunikira kudziwa kuti kuwonetsetsa kusinthika mwachangu komanso kothandiza kwa zotsatira zotsekereza za neuromuscular,Sugammadex sodiumIyenera kugwiritsidwa ntchito poyerekeza ndi ma myorelaxants omwe amazungulira.Kuonjezera apo, Sugammadex Sodium ndi mdani wapadera wa steroidal neuromuscular blocking agents, ndipo sangathe kumanga benzylisoquinoline non-depolarizing myorelaxants komanso depolarizing myorelaxants, choncho, sangathe kulepheretsa zotsatira za neuromuscular blocking za mankhwalawa.
2. Kuchita bwino kwa sodium ya sugammadex
Nthawi zambiri, mlingo wa antagonists muscarinic panthawi yotsitsimutsa umadalira kuchuluka kwa kutsekeka kwa neuromuscular.Chifukwa chake, kugwiritsa ntchito chowunikira cha myoson kumathandizira kugwiritsa ntchito mwanzeru otsutsa oletsa neuromuscular.Kuwunika kwa myorelaxation kumapereka kukondoweza kwamagetsi komwe kumaperekedwa kumisempha yozungulira, kuchititsa kuyankha kwagalimoto (kugwedezeka) mu minofu yofananira.Mphamvu ya minofu imachepa kapena kutha pambuyo pogwiritsira ntchito myorelaxants.Zotsatira zake, kuchuluka kwa blockade ya neuromuscular kumatha kuwerengedwa ngati: chipika chakuya kwambiri [palibe kugwedezeka pambuyo pa masitima anayi a anayi (TOF) kapena kukondoweza kwa tonic], chipika chakuya (chopanda kugwedezeka pambuyo pa TOF komanso kugwedezeka kumodzi pambuyo tonic. kukondoweza), ndi chipika chocheperako (osachepera kugwedezeka kumodzi pambuyo pa TOF).
Malingana ndi matanthauzo omwe ali pamwambawa, mlingo woyenera wa shuga wa sodium kuti usinthe chipika chapakati ndi 2 mg / kg, ndipo chiŵerengero cha TOF chikhoza kufika ku 0.9 pambuyo pa 2 min;mlingo woyenera kuti usinthe chipika chakuya ndi 4 mg / kg, ndipo chiŵerengero cha TOF chikhoza kufika 0.9 pambuyo pa 1.6-3.3 min.Poyambitsa opaleshoni yofulumira, mlingo waukulu wa rocuronium bromide (1.2 mg / kg) sukulimbikitsidwa kuti mutembenuzire chizolowezi chakuya kwambiri.Komabe, ngati mwadzidzidzi kubwerera ku mpweya wabwino wachilengedwe, kusinthika ndi 16 mg/kg waSugammadex sodiumakulimbikitsidwa.
3. Kugwiritsa ntchito Sugammadex Sodium kwa odwala apadera
3.1.Mu odwala ana
Deta yochokera ku maphunziro azachipatala a gawo lachiwiri ikuwonetsa kuti Sugammadex Sodium ndi yothandiza komanso yotetezeka mwa ana (kuphatikiza makanda, makanda, ana ndi achinyamata) monga momwe zilili mwa anthu akuluakulu.Kuwunika kwa meta kutengera maphunziro 10 (milandu 575) komanso kafukufuku waposachedwa wapagulu (968 milandu) adatsimikiziranso kuti nthawi (yapakatikati) yobwezeretsanso chiŵerengero cha 4th myoclonic twitch to 1st myoclonic twitch to 0.9 mu maphunziro. kupatsidwa rocuronium bromide 0.6 mg / kg ndi Sugammadex Sodium 2 mg / kg pa chiwonetsero cha T2 chinali 0.6 min yokha mwa makanda (0.6 min) poyerekeza ndi ana (1.2 min) ndi akuluakulu (1.2 min).1.2 min ndi theka la akuluakulu (1.2 min).Kuonjezera apo, kafukufuku wina anapeza kuti Sugammadex Sodium inachepetsa chiwerengero cha bradycardia poyerekeza ndi neostigmine pamodzi ndi atropine.Kusiyana kwa zochitika zina zoyipa monga bronchospasm kapena postoperative nseru ndi kusanza sikunali kofunika kwambiri.Zasonyezedwanso kuti kugwiritsa ntchito Sugammadex Sodium kumachepetsa chiopsezo cha postoperative kwa odwala omwe ali ndi ana, zomwe zingakhale zothandiza pakuwongolera nthawi yobwezeretsa.Kuphatikiza apo, Tadokoro et al.adawonetsa mu kafukufuku wowongolera milandu kuti panalibe kugwirizana pakati pa machitidwe osagwirizana ndi perioperative kwa ana opha ululu wamba ndi kugwiritsa ntchito sodium sugammadex.Choncho, kugwiritsa ntchito Sugammadex Sodium ndi otetezeka kwa odwala ana panthawi yodzuka ya anesthesia.
3.2.Kugwiritsa ntchito odwala okalamba
Nthawi zambiri, odwala okalamba amatha kutengeka kwambiri ndi zotsalira za neuromuscular blockade kuposa odwala achichepere, ndipo kuchira kodziwikiratu kuchokera ku blockade ya neuromuscular kumachedwa.Mu kafukufuku wazachipatala wamtundu wachitatu wokhudzana ndi chitetezo, mphamvu, ndi pharmacokinetics ya Sugammadex Sodium mwa odwala okalamba, adapeza kuti Sugammadex Sodium inatembenuza rocuronium kuti ipangitse kuwonjezereka pang'ono kwa nthawi ya neuromuscular blockade poyerekeza ndi odwala ochepera zaka 65 (nthawi zambiri). ya 2.9 min ndi 2.3 min, motsatana).Komabe, kafukufuku wambiri wanena kuti sugammadex imaloledwa bwino ndi odwala okalamba komanso kuti palibe kutulutsanso muvi komwe kumachitika.Choncho, zimaganiziridwa kuti Sugammadex Sodium ingagwiritsidwe ntchito mosamala kwa odwala okalamba panthawi yodzuka ya anesthesia.
3.3.Gwiritsani ntchito amayi apakati
Pali malangizo ochepa azachipatala pakugwiritsa ntchito Sugammadex Sodium mwa amayi apakati, chonde komanso oyamwitsa.Komabe, maphunziro a zinyama sanapeze zotsatira pa mlingo wa progesterone pa nthawi ya mimba komanso palibe kubereka kapena kuchotsa mimba mu makoswe onse, zomwe zingatsogolere ntchito yachipatala ya Sugammadex Sodium pa nthawi ya mimba, makamaka mu trimester yoyamba.Pakhala palinso milandu yambiri ya amayi omwe amagwiritsa ntchito shuga wa sodium pansi pa anesthesia wamba pazigawo za cesarean, ndipo palibe zovuta za amayi kapena mwana zomwe zanenedwa.Ngakhale kafukufuku wina wanena za kusuntha kochepa kwa shuga wa sodium, padakalibe chidziwitso chodalirika.Makamaka, amayi apakati omwe ali ndi vuto la kuthamanga kwa magazi nthawi zambiri amathandizidwa ndi magnesium sulphate.Kuletsa kutulutsidwa kwa acetylcholine kudzera mu ma magnesium ayoni kumasokoneza kutumizirana mauthenga a neuromuscular junction, kumasula minofu ya chigoba, komanso kumachepetsa kuphipha kwa minofu.Chifukwa chake, magnesium sulphate imatha kukulitsa kutsekeka kwa neuromuscular ya myorelaxants.
3.4.Ntchito odwala aimpso insufficiency
Sugammadex Sodium ndi sucralose-rocuronium bromide complexes amachotsedwa ndi impso monga ma prototypes, kotero kuti kagayidwe kamene kamamangidwa komanso kusagwirizana ndi Sugammadex Sodium kumatalika kwa odwala omwe ali ndi vuto laimpso.Komabe, deta yachipatala imasonyeza kutiSugammadex sodiumAngagwiritsidwe ntchito mosamala kwa odwala omwe ali ndi matenda a impso otsiriza, ndipo palibe malipoti ochedwa kutsekeka kwa neuromuscular pambuyo pa Sugammadex Sodium kwa odwala oterowo, koma detayi imakhala yochepa kwa 48h pambuyo pa Sugammadex Sodium administration.Kuphatikiza apo, sodium sugammadex-rocuronium bromide complex imatha kuthetsedwa ndi hemodialysis yokhala ndi nembanemba yapamwamba kwambiri yosefera.Ndikofunika kuzindikira kuti nthawi ya kusintha kwa rocuronium ndi sodium sugammadex ikhoza kukhala yaitali kwa odwala omwe ali ndi matenda a impso.Chifukwa chake kugwiritsa ntchito kuwunika kwa neuromuscular ndikofunikira.
4. Mapeto
Sugammadex Sodium imasintha mofulumira kutsekeka kwa neuromuscular komwe kumayambitsidwa ndi aminosteroid myorelaxants ochepa komanso ozama, ndipo amachepetsa kwambiri zochitika zotsalira za neuromuscular blockade poyerekeza ndi ochiritsira acetylcholinesterase inhibitors.Sodium sugammadex imafulumizitsanso kwambiri nthawi yothamangitsidwa panthawi yodzuka, imachepetsa kuchuluka kwa masiku ogonekedwa m'chipatala, imathandizira kuchira kwa odwala, imachepetsa ndalama zogonera kuchipatala, ndikusunga chithandizo chamankhwala.Komabe, matupi awo sagwirizana ndi matenda a mtima arrhythmias akhala lipoti nthawi zina pa ntchito Sugammadex Sodium, kotero m'pofunikabe kukhala tcheru pa ntchito Sugammadex Sodium ndi kuona kusintha kwa odwala'zizindikiro, khungu mikhalidwe ndi ECG.Ndibwino kuti muyang'ane kugunda kwa minofu ya chigoba ndi chowunikira chotsitsimula minofu kuti mudziwe bwino kuzama kwa neuromuscular blockade ndikugwiritsa ntchito mlingo woyenera wasodium sugammadexkupititsa patsogolo ubwino wa nthawi yodzuka.
Nthawi yotumiza: Sep-27-2021