Sugammadex sodiumke mohanyetsi oa morao-rao oa li-relaxants tse sa thekeseleng mesifa (myorelaxants), tse ileng tsa tlalehoa ka lekhetlo la pele ho batho ka 2005 'me esale li sebelisoa ka bongaka Europe, United States le Japane.Ha e bapisoa le lithethefatsi tse tloaelehileng tsa anticholinesterase, e ka hanyetsa methapo e tebileng ea methapo ntle le ho ama boemo ba hydrolyzed acetylcholine ho cholinergic synapses, ho qoba liphello tse mpe tsa M le N receptor excitation, le ho ntlafatsa haholo boleng ba post-anesthesia Awakening.Se latelang ke tlhahlobo ea ts'ebeliso ea morao-rao ea kliniki ea tsoekere ea sodium nakong ea ts'ebetso ea anesthesia.
1. Kakaretso
Sugammadex Sodium ke motsoako oa γ-cyclodextrin o fetotsoeng o fetolang ka ho khetheha phello ea ho thibela neuromuscular ea steroidal neuromuscular blocking agents, haholo-holo rocuronium bromide.Sugammadex Sodium chelates e sa lefelloeng li-neuromuscular blockers ka mor'a hore e ente 'me e thibela li-neuromuscular blockers ka ho etsa motsoako o tsitsitseng o qhibilihisang metsi ka 1: 1 e tlamang ka thata.Ka tlamahano e joalo, ho thehoa gradient ea mahloriso e thusang ho khutla ha "neuromuscular blocker" ho tloha mokolokong oa neuromuscular ho ea ho plasma, ka tsela eo e khutlisa phello ea "neuromuscular blocking" eo e e hlahisang, ho lokolla li-receptor tse kang nicotinic acetylcholine le ho tsosolosa phetiso ea neuromuscular excitatory transmission.
Har'a li-steroidal neuromuscular blockers, Sugammadex Sodium e na le kamano e matla ka ho fetisisa bakeng sa pecuronium bromide, e lateloa ke rocuronium, joale vecuronium le pancuronium.Ke habohlokoa ho hlokomela hore ho netefatsa phetoho e potlakileng le e sebetsang haholoanyane ea liphello tsa ho thibela neuromuscular, palo e feteletseng eaSugammadex sodiumE lokela ho sebelisoa ha e bapisoa le li-myorelaxants tse potolohang.Ho phaella moo, Sugammadex Sodium ke mohanyetsi ea itseng oa steroidal neuromuscular blocking agents, 'me ha e khone ho tlama benzylisoquinoline non-depolarizing myorelaxants hammoho le depolarizing myorelaxants, ka hona, e ke ke ea fetola liphello tsa ho thibela neuromuscular tsa lithethefatsi tsena.
2. Ho sebetsa hantle ha sugammadex sodium
Ka kakaretso, lethal dose ea bahanyetsi ba muscarinic nakong ea ho tsosoa ha anesthetic e itšetlehile ka tekanyo ea "neuromuscular blockade".Ka hona, ts'ebeliso ea leihlo la myoson e thusa ts'ebeliso e utloahalang ea bahanyetsi ba thibelang neuromuscular.Sesebelisoa sa myorelaxation se fana ka ts'usumetso ea motlakase e fanoang methapong ea peripheral, e bakang karabelo ea koloi (ho sisinyeha) mesifa e tsamaellanang.Matla a mesifa a fokotseha kapa a nyamela ka mor'a tšebeliso ea li-myorelaxants.Ka lebaka leo, tekanyo ea "neuromuscular blockade" e ka aroloa ka tsela e kang: "block" e tebileng haholo [ha ho na ho sisinyeha ka mor'a literene tse 'nè kapa tse' nè (TOF) kapa tonic stimulation], block block (ha ho na ho sisinyeha ka mor'a TOF le bonyane ho sisinyeha ho le mong ka mor'a tonic). stimulation), le thibela e itekanetseng (bonyane e le 'ngoe e sisinyehang ka mor'a TOF).
Ho itšetlehile ka litlhaloso tse ka holimo, tekanyo e khothalletsoang ea tsoekere ea sodium ho fetola thibela e itekanetseng ke 2 mg / kg, 'me karolelano ea TOF e ka fihla 0.9 ka mor'a metsotso e ka bang 2;tekanyo e khothalletsoang ea ho fetola thibela e tebileng ke 4 mg / kg, 'me karo-karolelano ea TOF e ka fihla ho 0.9 ka mor'a 1.6-3.3 min.Bakeng sa ho kenngoa ka potlako ha anesthesia, tekanyo e phahameng ea rocuronium bromide (1.2 mg / kg) ha e khothalletsoe bakeng sa phetoho e tloaelehileng ea thibelo e tebileng haholo.Leha ho le joalo, tabeng ea ts'ohanyetso ho khutlela moeeng oa tlhaho, ho khutlisetsoa morao ka 16 mg / kg eaSugammadex sodiume khothaletsoa.
3. Kopo ea Sugammadex Sodium ho bakuli ba khethehileng
3.1.Ho bakuli ba bana
Lintlha tse tsoang lithutong tsa kliniki tsa mohato oa II li fana ka maikutlo a hore Sugammadex Sodium e sebetsa hantle ebile e bolokehile ho batho ba bana (ho kenyeletsoa masea, masea, bana le bacha) joalo ka ho batho ba baholo.Tlhahlobo ea meta e thehiloeng lithutong tse 10 (maemo a 575) le phuputso e sa tsoa hatisoa ea morao-rao (maemo a 968) le eona e tiisitse hore nako (bohare) ea ho hlaphoheloa ha karo-karolelano ea 4th myoclonic twitch ho 1st myoclonic twitch ho 0.9 litabeng e fuoe rocuronium bromide 0.6 mg / kg le Sugammadex Sodium 2 mg / kg ho tlhahiso ea T2 e ne e le metsotso e 0.6 feela ho masea (0.6 min) ha e bapisoa le bana (1.2 min) le batho ba baholo (1.2 min).1.2 mets le halofo ea batho ba baholo (1.2 min).Ho phaella moo, phuputso e 'ngoe e fumane hore Sugammadex Sodium e fokolitse sekhahla sa bradycardia ha se bapisoa le neostigmine e kopantsoeng le atropine.Phapang ea liketsahalo tse ling tse mpe tse kang bronchospasm kapa ho nyekeloa ke pelo ka mor'a ho sebetsa le ho hlatsa e ne e se ea bohlokoa ka lipalo.Ho boetse ho bontšitsoe hore tšebeliso ea Sugammadex Sodium e fokotsa ts'oaetso ea ts'oaetso ka morao ho bakuli ba bana, e ka thusang ho laola nako ea ho hlaphoheloa.Ho phaella moo, Tadokoro et al.e bonts'itse thutong ea taolo ea linyeoe hore ho ne ho se na kamano lipakeng tsa ts'ebetso ea pherioperative allergic ho anesthesia e akaretsang ea bana le ts'ebeliso ea sodium sugammadex.Ka hona, tšebeliso ea Sugammadex Sodium e bolokehile ho bakuli ba bana nakong ea ho tsosoa ha anesthesia.
3.2.Kopo ho bakuli ba tsofetseng
Ka kakaretso, bakuli ba seng ba hōlile ba kotsing ea ho ba le litlamorao tsa "neuromuscular blockade" e setseng ho feta bakuli ba banyenyane, 'me ho hlaphoheloa ka tšohanyetso ho tsoa ho "neuromuscular blockade" ho lieha.Phuputsong ea bongaka ea "multicenter III" ea polokeho, katleho le pharmacokinetics ea Sugammadex Sodium ho bakuli ba tsofetseng, ba fumane hore Sugammadex Sodium e khutlisetsa rocuronium ho hlahisa keketseho e nyane ea nako ea "neuromuscular blockade" ha e bapisoa le bakuli ba ka tlase ho lilemo tse 65. ea 2.9 mets le 2.3 mets, ka ho latellana).Leha ho le joalo, liphuputso tse 'maloa li tlalehile hore sugammadex e mamelloa hantle ke bakuli ba tsofetseng le hore ha ho na chefo ea motsu e hlahang hape.Ka hona, ho nkoa hore Sugammadex Sodium e ka sebelisoa ka mokhoa o sireletsehileng ho bakuli ba tsofetseng nakong ea ho tsosoa ha anesthesia.
3.3.Sebelisa ho bakhachane
Ho na le tataiso e nyane ea kliniki mabapi le ts'ebeliso ea Sugammadex Sodium ho basali ba baimana, ba nonneng le ba anyesang.Leha ho le joalo, lithuto tsa liphoofolo ha li fumane phello ea maemo a progesterone nakong ea bokhachane 'me ha ho na ho tsoaloa kapa ho ntša mpa ho likhoto tsohle, tse neng li tla tataisa tšebeliso ea meriana ea Sugammadex Sodium nakong ea bokhachane, haholo-holo nakong ea pele ea trimester.Hape ho bile le linyeoe tse 'maloa tsa tšebeliso ea' mè ea tsoekere ea sodium tlas'a anesthesia e akaretsang bakeng sa likarolo tsa cesarean, 'me ha ho na mathata a bokhachane kapa a lesea a tlalehiloeng.Le hoja liphuputso tse ling li tlalehile phetisetso e nyenyane ea transplacental ea tsoekere ea sodium, ho ntse ho e-na le khaello ea lintlha tse tšepahalang.Ka ho hlakileng, basali ba bakhachane ba nang le khatello ea mali ea bokhachane hangata ba phekoloa ka magnesium sulfate.Thibelo ea ho lokolloa ha acetylcholine ka li-ion tsa magnesium ho sitisa phetisetso ea tlhahisoleseling ea neuromuscular junction, e khatholla mesifa ea marapo, 'me e imolla mesifa ea mesifa.Ka hona, magnesium sulfate e ka ntlafatsa phello ea ho thibela neuromuscular ea myorelaxants.
3.4.Kopo ho bakuli ba nang le ho haella ha renal
Sugammadex Sodium le sucralose-rocuronium bromide complexes li ntšoa ke liphio e le li-prototypes, e le hore metabolism ea Sugammadex Sodium e tlanngoeng hammoho le e sa koaloang e lelefale ho bakuli ba nang le bothata ba renal.Leha ho le joalo, lintlha tsa kliniki li fana ka maikutlo a joaloSugammadex sodiume ka sebelisoa ka mokhoa o sireletsehileng ho bakuli ba nang le lefu la renal la ho qetela, 'me ha ho na litlaleho tsa ho lieha ha neuromuscular blockade ka mor'a Sugammadex Sodium ho bakuli ba joalo, empa lintlha tsena li lekanyelitsoe ho 48h ka mor'a tsamaiso ea Sugammadex Sodium.Ho phaella moo, motsoako oa sodium sugammadex-rocuronium bromide o ka felisoa ka hemodialysis e nang le li-membrane tsa filtration tse phahameng.Ke habohlokoa ho hlokomela hore nako ea phetoho ea rocuronium ka sodium sugammadex e ka ba nako e telele ho bakuli ba nang le lefu la renal.Ka hona, ts'ebeliso ea "neuromuscular monitoring" e bohlokoa.
4. Qetello
Sugammadex Sodium ka potlako e fetola "neuromuscular blockade" e bakoang ke li-aminosteroid myorelaxants tse itekanetseng le tse tebileng, 'me e fokotsa haholo ts'ebetso ea ho thibela neuromuscular e setseng ha e bapisoa le li-inhibitors tse tloaelehileng tsa acetylcholinesterase.Sodium sugammadex e boetse e potlakisa haholo nako ea ho tsosoa nakong ea ho tsosoa, e khutsufatsa palo ea matsatsi a ho kena sepetlele, e potlakisa ho hlaphoheloa ha bakuli, e fokotsa litšenyehelo tsa sepetlele, 'me e boloka lisebelisoa tsa bongaka.Leha ho le joalo, ka linako tse ling ho 'nile ha tlalehoa maikutlo a ho kula le arrhythmias ea pelo nakong ea tšebeliso ea Sugammadex Sodium, kahoo ho ntse ho hlokahala hore u be seli nakong ea tšebeliso ea Sugammadex Sodium le ho boloka liphetoho tsa matšoao a bohlokoa a bakuli, maemo a letlalo le ECG.Ho kgothaletswa ho lekola ho honyela ha mesifa ea skeletal ka mochine oa khatholoho ea mesifa ho fumana ka nepo botebo ba "neuromuscular blockade" le ho sebelisa lethal dose le lekaneng.sodium sugammadexho ntlafatsa ka ho eketsehileng boleng ba nako ea ho tsosoa.
Nako ea poso: Sep-27-2021