Sugammadex Sodiumyog ib tug tshiab antagonist ntawm xaiv tsis-depolarizing nqaij relaxants (myorelaxants), uas yog thawj zaug tshaj tawm nyob rau hauv tib neeg nyob rau hauv 2005 thiab txij li thaum tau raug siv nyob rau hauv cov teb chaws Europe, lub tebchaws United States thiab Nyiv.Piv nrog rau cov tshuaj anticholinesterase ib txwm muaj, nws tuaj yeem tiv thaiv cov hlab ntsha sib sib zog nqus yam tsis muaj kev cuam tshuam rau qib ntawm hydrolyzed acetylcholine ntawm cholinergic synapses, zam qhov tsis zoo ntawm M thiab N receptor excitation, thiab zoo heev txhim kho qhov zoo ntawm kev siv tshuaj loog tom qab tsaug zog.Cov hauv qab no yog kev tshuaj xyuas ntawm kev siv tshuaj kho mob tsis ntev los no ntawm cov suab thaj sodium hauv lub sijhawm ntawm kev siv tshuaj loog.
1. Txheej txheem cej luam
Sugammadex Sodium yog ib qho hloov kho γ-cyclodextrin derivative uas tshwj xeeb thim rov qab neuromuscular thaiv cov nyhuv ntawm steroidal neuromuscular thaiv cov neeg ua haujlwm, tshwj xeeb tshaj yog rocuronium bromide.Sugammadex Sodium chelates dawb neuromuscular blockers tom qab txhaj tshuaj thiab inactivates cov neuromuscular blockers los ntawm kev tsim ib tug ruaj khov dej-soluble compound los ntawm ib tug 1: 1 nruj binding.Los ntawm kev khi zoo li no, ib qho kev sib xyaw ua ke yog tsim los pab txhawb kev rov qab los ntawm neuromuscular blocker los ntawm neuromuscular hlws ris mus rau plasma, yog li thim rov qab cov txiaj ntsig neuromuscular thaiv nws tsim, tso cov nicotinic acetylcholine zoo li receptors thiab rov kho cov kab mob neuromuscular excitatory.
Ntawm cov steroidal neuromuscular blockers, Sugammadex Sodium muaj qhov muaj zog tshaj affinity rau pecuronium bromide, ua raws li rocuronium, ces vecuronium thiab pancuronium.Nws yog ib qho tsim nyog sau cia tias txhawm rau txhawm rau ua kom nrawm dua thiab muaj txiaj ntsig zoo ntawm kev thim rov qab neuromuscular thaiv cov teebmeem, ntau dhau ntawmSugammadex Sodiumyuav tsum tau siv txheeb ze rau myorelaxants hauv kev ncig.Tsis tas li ntawd, Sugammadex Sodium yog ib qho tshwj xeeb antagonist ntawm steroidal neuromuscular thaiv cov neeg ua haujlwm, thiab nws tsis tuaj yeem khi benzylisoquinoline uas tsis yog-depolarizing myorelaxants nrog rau depolarizing myorelaxants, thiab yog li ntawd, tsis tuaj yeem thim rov qab neuromuscular thaiv cov teebmeem ntawm cov tshuaj no.
2. Kev ua tau zoo ntawm sugammadex sodium
Feem ntau, cov koob tshuaj muscarinic antagonists thaum lub sij hawm tshuaj loog tsaug zog yog nyob ntawm qhov degree ntawm neuromuscular blockade.Yog li ntawd, kev siv lub myoson saib ua kom yooj yim rau kev siv lub ntsiab lus ntawm neuromuscular thaiv cov antagonists.Lub myorelaxation monitor dispenses hluav taws xob stimulation xa mus rau cov hlab ntsha peripheral, ua rau lub cev muaj zog teb (twitching) hauv cov leeg nqaij.Cov leeg muaj zog txo qis lossis ploj tom qab siv myorelaxants.Raws li qhov tshwm sim, qhov degree ntawm neuromuscular blockade tuaj yeem muab qhab nia raws li: qhov sib sib zog nqus block [tsis muaj twitching tom qab plaub lub tsheb ciav hlau-ntawm-plaub (TOF) los yog tonic stimulation], sib sib zog nqus block (tsis muaj twitching tom qab TOF thiab tsawg kawg ib twitching tom qab tonic. stimulation), thiab nruab nrab thaiv (tsawg kawg yog ib qho twitching tom qab TOF).
Raws li cov lus txhais saum toj no, qhov pom zoo koob tshuaj sodium qab zib kom rov qab qis qis yog 2 mg / kg, thiab TOF piv tuaj yeem ncav cuag 0.9 tom qab li 2 min;Cov koob tshuaj pom zoo kom rov qab sib sib zog nqus block yog 4 mg / kg, thiab TOF piv tuaj yeem ncav cuag 0.9 tom qab 1.6-3.3 min.Rau kev siv tshuaj loog sai sai, koob tshuaj rocuronium bromide (1.2 mg / kg) tsis pom zoo rau kev hloov pauv niaj hnub ntawm qhov tob tob.Txawm li cas los xij, thaum muaj xwm txheej ceev rov qab mus rau qhov cua, rov qab nrog 16 mg / kg ntawmSugammadex Sodiumpom zoo.
3. Kev siv Sugammadex Sodium hauv cov neeg mob tshwj xeeb
3.1.Hauv cov neeg mob menyuam yaus
Cov ntaub ntawv los ntawm theem II cov kev tshawb fawb soj ntsuam qhia tias Sugammadex Sodium muaj txiaj ntsig zoo thiab muaj kev nyab xeeb hauv cov menyuam yaus (xws li cov menyuam mos, menyuam mos, menyuam yaus thiab cov tub ntxhais hluas) raws li nws nyob hauv cov neeg laus.Ib qho kev ntsuam xyuas meta raws li 10 qhov kev tshawb fawb (575 tus neeg mob) thiab kev tshawb fawb tsis ntev los no tau tshaj tawm rov qab los ntawm kev tshawb fawb (968 tus neeg mob) kuj tau lees paub tias lub sijhawm (nruab nrab) rau kev rov qab los ntawm qhov piv ntawm 4th myoclonic twitch rau 1st myoclonic twitch rau 0.9 hauv cov ntsiab lus. muab rocuronium bromide 0.6 mg / kg thiab Sugammadex Sodium 2 mg / kg ntawm T2 nthuav qhia tsuas yog 0.6 min hauv cov menyuam mos (0.6 min) piv rau cov menyuam yaus (1.2 min) thiab cov laus (1.2 min).1.2 min thiab ib nrab ntawm cov neeg laus (1.2 min).Tsis tas li ntawd, ib txoj kev tshawb nrhiav pom tias Sugammadex Sodium txo qhov tshwm sim ntawm bradycardia piv nrog neostigmine ua ke nrog atropine.Qhov sib txawv ntawm qhov tshwm sim ntawm lwm cov xwm txheej tsis zoo xws li bronchospasm lossis postoperative xeev siab thiab ntuav tsis yog qhov tseem ceeb.Nws kuj tau pom tias kev siv Sugammadex Sodium txo qhov tshwm sim ntawm kev ntxhov siab tom qab phais hauv cov neeg mob, uas tuaj yeem pab tau rau kev tswj xyuas lub sijhawm rov qab los.Tsis tas li ntawd, Tadokoro et al.tau pom nyob rau hauv cov ntaub ntawv-tswj txoj kev tshawb no hais tias tsis muaj kev sib raug zoo ntawm perioperative allergic tshuaj loog rau menyuam yaus thiab kev siv ntawm sodium sugammadex.Yog li ntawd, daim ntawv thov ntawm Sugammadex Sodium muaj kev nyab xeeb rau cov neeg mob hauv cov menyuam yaus thaum lub sijhawm pw tsaug zog ntawm kev siv tshuaj loog.
3.2.Kev siv rau cov neeg laus
Feem ntau, cov neeg laus muaj kev cuam tshuam ntau dua rau cov teebmeem ntawm cov seem neuromuscular thaiv ntau dua li cov neeg mob hluas, thiab kev rov qab los ntawm cov neuromuscular blockade qeeb dua.Nyob rau hauv ib tug multicenter theem III kev tshawb fawb soj ntsuam ntawm kev nyab xeeb, kev ua tau zoo, thiab pharmacokinetics ntawm Sugammadex Sodium nyob rau hauv cov neeg mob laus, lawv pom tias Sugammadex Sodium reversed rocuronium los tsim ib tug me ntsis nce nyob rau hauv lub sij hawm ntawm neuromuscular blockade piv nrog rau cov neeg mob hnub nyoog qis dua 65 xyoo (lub sij hawm lub sij hawm. ntawm 2.9 min thiab 2.3 min, ntsig txog).Txawm li cas los xij, ntau qhov kev tshawb fawb tau tshaj tawm tias sugammadex tau txais txiaj ntsig zoo los ntawm cov neeg mob laus thiab tsis muaj qhov cuam tshuam rov qab los.Yog li, nws tau txiav txim siab tias Sugammadex Sodium tuaj yeem siv nyab xeeb rau cov neeg mob laus thaum lub sijhawm ua kom tsaug zog ntawm cov tshuaj loog.
3.3.Siv rau cov poj niam cev xeeb tub
Muaj cov lus qhia me me ntawm kev siv Sugammadex Sodium hauv cov poj niam cev xeeb tub, xeeb tub thiab lactating.Txawm li cas los xij, kev tshawb fawb tsiaj tau pom tias tsis muaj kev cuam tshuam rau cov qib progesterone thaum cev xeeb tub thiab tsis muaj kev yug menyuam lossis kev rho menyuam hauv txhua tus nas, uas yuav qhia txog kev siv tshuaj Sugammadex Sodium thaum cev xeeb tub, tshwj xeeb tshaj yog nyob rau thawj peb lub hlis twg.Kuj tseem muaj ntau qhov xwm txheej ntawm niam txiv siv cov suab thaj sodium nyob rau hauv cov tshuaj loog rau kev phais, thiab tsis muaj teeb meem ntawm niam lossis menyuam hauv plab.Txawm hais tias qee qhov kev tshawb fawb tau tshaj tawm qhov hloov pauv me me ntawm cov suab thaj sodium, tseem tsis muaj cov ntaub ntawv ntseeg tau.Qhov tseem ceeb, cov poj niam cev xeeb tub uas muaj ntshav siab feem ntau tau kho nrog magnesium sulfate.Inhibition ntawm acetylcholine tso tawm los ntawm magnesium ions cuam tshuam nrog neuromuscular hlws ris cov ntaub ntawv transduction, relaxes skeletal leeg, thiab relieves nqaij spasm.Yog li, magnesium sulfate tuaj yeem txhim kho cov nyhuv neuromuscular thaiv ntawm myorelaxants.
3.4.Kev siv rau cov neeg mob lub raum tsis txaus
Sugammadex Sodium thiab sucralose-rocuronium bromide complexes raug tso tawm los ntawm ob lub raum ua qauv, kom cov metabolism ntawm kev khi thiab tsis muaj Sugammadex Sodium ntev rau cov neeg mob lub raum tsis txaus.Txawm li cas los xij, cov ntaub ntawv kho mob qhia tiasSugammadex Sodiumtuaj yeem siv tau nyab xeeb rau cov neeg mob uas muaj cov kab mob hauv lub raum kawg, thiab tsis muaj cov ntaub ntawv qhia txog kev ncua ntev neuromuscular blockade tom qab Sugammadex Sodium hauv cov neeg mob, tab sis cov ntaub ntawv no tsuas yog txwv rau 48h tom qab Sugammadex Sodium tswj.Tsis tas li ntawd, sodium sugammadex-rocuronium bromide complex tuaj yeem raug tshem tawm los ntawm hemodialysis nrog high-flux filtration membranes.Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias lub sij hawm ntawm rocuronium thim rov qab nrog sodium sugammadex yuav ntev rau cov neeg mob raum.Yog li ntawd, kev siv cov tshuaj neuromuscular yog qhov tseem ceeb.
4. Cov lus xaus
Sugammadex Sodium sai thim rov qab cov neuromuscular blockade tshwm sim los ntawm nruab nrab thiab muaj txiaj ntsig aminosteroid myorelaxants, thiab nws txo qis qhov tshwm sim ntawm residual neuromuscular blockade piv nrog cov pa acetylcholinesterase inhibitors.Sodium sugammadex kuj tseem ua rau lub sijhawm rau extubation thaum lub sijhawm sawv, ua kom cov hnub nyob hauv tsev kho mob sai, ua kom cov neeg mob rov zoo, txo cov nqi pw hauv tsev kho mob, thiab txuag kev kho mob.Txawm li cas los xij, kev ua xua thiab mob plawv arrhythmias tau raug tshaj tawm qee zaus thaum siv Sugammadex Sodium, yog li nws tseem yuav tsum tau ceev faj thaum siv Sugammadex Sodium thiab soj ntsuam cov kev hloov pauv ntawm cov neeg mob cov cim tseem ceeb, cov tawv nqaij mob thiab ECG.Nws raug nquahu kom saib xyuas cov leeg pob txha caj qaum nrog cov leeg nqaij so kom pom lub hom phiaj txiav txim siab qhov tob ntawm neuromuscular blockade thiab siv cov koob tshuaj tsim nyog.sodium sugammadextxhawm rau txhim kho qhov zoo ntawm lub sijhawm sawv.
Post lub sij hawm: Sep-27-2021