I-Sugammadex yeSodiumngumchasi wenoveli we-non-depolarizing relaxants (myorelaxants), eyaqala ukuxelwa ebantwini ngo-2005 kwaye sele isetyenziswe kwikliniki eYurophu, eUnited States naseJapan.Xa kuthelekiswa neziyobisi zendabuko ze-anticholinesterase, ziyakwazi ukuchasana ne-nerve block block ngaphandle kokuchaphazela izinga le-acetylcholine ye-hydrolyzed kwi-synapses ye-cholinergic, ukuphepha imiphumo emibi ye-M kunye ne-N receptor excitation, kunye nokuphucula kakhulu umgangatho wokuvuswa kwe-post-anesthesia.Oku kulandelayo kukuphononongwa kwesicelo seklinikhi yakutshanje yeswekile ye-sodium ngexesha lokuvuka kwe-anesthesia.
1. Isishwankathelo
I-Sugammadex Sodium i-derivative γ-cyclodextrin eguquliweyo eguqulela ngokuthe ngqo i-neuromuscular blocking effect ye-steroidal neuromuscular blocking agents, ngakumbi i-rocuronium bromide.I-Sugammadex I-Sodium chelates i-block blockers yamahhala ye-neuromuscular emva kokujova kwaye ingasebenzi i-block blockers ye-neuromuscular ngokwenza i-compound ezinzileyo yamanzi e-soluble ngokusebenzisa i-1: i-1 yokubopha ngokuqinileyo.Ngokubophelela okunjalo, i-concentration gradient yenziwa ukuba iququzelele ukubuyiswa kwe-neuromuscular blocker ukusuka kwi-neuromuscular junction ukuya kwi-plasma, ngaloo ndlela ibuyisela i-neuromuscular blocking effect eyivelisayo, ukukhulula i-nicotinic acetylcholine-like receptors kunye nokubuyisela ukuhanjiswa kwe-neuromuscular excitatory transmission.
Phakathi kwe-steroidal neuromuscular blockers, i-Sugammadex Sodium inobudlelwane obuqinileyo be-pecuronium bromide, ilandelwa yi-rocuronium, emva koko i-vecuronium kunye ne-pancuronium.Kuyafaneleka ukuba uqaphele ukuba ukuqinisekisa ukuguqulwa ngokukhawuleza kunye nokusebenza ngakumbi kweziphumo zokuthintela i-neuromuscular, isixa esigqithisileyoI-Sugammadex yeSodiumkufuneka isetyenziswe ngokunxulumene ne-myorelaxants ejikelezayo.Ukongezelela, i-Sugammadex Sodium ngumchasi othile we-steroidal neuromuscular blocking agents, kwaye ayikwazi ukubopha i-benzylisoquinoline non-depolarizing myorelaxants kunye ne-depolarizing myorelaxants, kwaye ngoko ke, ayikwazi ukuguqula imiphumo yokuvimbela i-neuromuscular yala machiza.
2. Ukusebenza kwe-sugammadex sodium
Ngokuqhelekileyo, umthamo wabachasi be-muscarinic ngexesha lokuvuswa kwe-anesthetic kuxhomekeke kwinqanaba le-neuromuscular blockade.Ke ngoko, ukusetyenziswa kwemonitha ye-myoson kuququzelela usetyenziso olunengqiqo lwe-neuromuscular blocking antagonists.I-monitor ye-myorelaxation ihambisa ukuvuselela kombane okunikezelwa kwiimbilini ze-peripheral, kubangela impendulo yemoto (i-twitching) kwisihlunu esihambelanayo.Amandla emisipha ayancipha okanye ayanyamalala emva kokusetyenziswa kwe-myorelaxants.Ngenxa yoko, iqondo le-neuromuscular blockade inokuhlelwa ngolu hlobo: ibhloko enzulu kakhulu [akukho kuxubha emva kololiwe ezine-ezine (TOF) okanye i-tonic stimulation], ibhloko enzulu (akukho kuxubha emva kwe-TOF kwaye ubuncinci ukuxubha emva kwetonic. ukuvuselela), kunye nebhloko ephakathi (ubuncinci i-twitching enye emva kwe-TOF).
Ngokusekelwe kwiinkcazo ezingentla, i-dose ephakanyisiweyo yeeshukela ze-sodium ukuguqula ibhloko ephakathi i-2 mg / kg, kwaye umlinganiselo we-TOF unokufikelela kwi-0.9 emva kwe-2 min;umthamo onconywayo wokuguqula ibhloko enzulu yi-4 mg / kg, kwaye umlinganiselo we-TOF unokufikelela kwi-0.9 emva kwe-1.6-3.3 min.Ukungeniswa ngokukhawuleza kwe-anesthesia, i-dose ephezulu ye-rocuronium bromide (1.2 mg / kg) ayikhuthazwa ukuguqulwa kwesiqhelo kwibhloko enzulu kakhulu.Nangona kunjalo, kwimeko yokubuyela ngokukhawuleza kwi-ventilation yendalo, ukuguqulwa kwe-16 mg / kgI-Sugammadex yeSodiumkuyacetyiswa.
3. Ukusetyenziswa kweSugammadex Sodium kwizigulane ezikhethekileyo
3.1.Kwizigulane zabantwana
Idatha evela kwizifundo zeklinikhi zeSigaba II zibonisa ukuba i-Sugammadex Sodium iyasebenza kwaye ikhuselekile kubantwana babantwana (kubandakanywa ne-neonates, iintsana, abantwana kunye nabaselula) njengoko kunjalo kubantu abadala.Uhlalutyo lwe-meta olusekelwe kwizifundo ze-10 (iimeko ze-575) kunye ne-retrospective cohort esanda kupapashwa (iimeko ze-968) nazo zaqinisekisa ukuba ixesha (eliphakathi) lokubuyisela umlinganiselo we-4th myoclonic twitch ukuya kwi-1st myoclonic twitch ukuya kwi-0.9 kwizifundo. inikwe i-rocuronium bromide 0.6 mg / kg kunye ne-Sugammadex Sodium 2 mg / kg kwintetho ye-T2 kuphela i-0.6 min kwiintsana (i-0.6 min) xa kuthelekiswa nabantwana (i-1.2 min) kunye nabantu abadala (i-1.2 min).I-1.2 min kunye nesiqingatha sabantu abadala (i-1.2 min).Ukongezelela, uphando oluthile lufumene ukuba i-Sugammadex Sodium yanciphisa iziganeko ze-bradycardia xa kuthelekiswa neostigmine edibene ne-atropine.Umahluko kwiziganeko zezinye iziganeko ezimbi ezifana ne-bronchospasm okanye isicaphucaphu emva kokusebenza kunye nokuhlanza kwakungabalulekanga ngokwezibalo.Kwakhona kuye kwaboniswa ukuba ukusetyenziswa kwe-Sugammadex Sodium kunciphisa iziganeko ze-postoperative agitation kwizigulane zabantwana, ezinokuba luncedo ekulawuleni ixesha lokubuyisela.Ukongeza, uTadokoro et al.kubonisiwe kuphononongo lolawulo lwetyala ukuba akukho nxu lumano phakathi kwe-perioperative allergic reactions kwi-anesthesia yabantwana kunye nokusetyenziswa kwe-sodium sugammadex.Ngoko ke, ukusetyenziswa kweSugammadex Sodium kukhuselekile kwizigulane zabantwana ngexesha lokuvuka kwe-anesthesia.
3.2.Ukusetyenziswa kwizigulane ezikhulileyo
Ngokubanzi, izigulana ezindala zichaphazeleka ngakumbi kwiziphumo ze-neuromuscular blockade eseleyo kunezigulana ezincinci, kwaye ukuchacha ngokuzenzekelayo kwi-neuromuscular blockade kuhamba kancinci.Kwinqanaba lesithathu lekliniki yophando lwezonyango lokhuseleko, ukusebenza kakuhle, kunye ne-pharmacokinetics ye-Sugammadex Sodium kwizigulane ezisebekhulile, bafumanisa ukuba i-Sugammadex Sodium iguqule i-rocuronium ukuvelisa ukunyuka okuncinci kwixesha le-neuromuscular blockade xa kuthelekiswa nezigulane ezingaphantsi kweminyaka engama-65 (amaxesha aqhelekileyo). ye-2.9 min kunye ne-2.3 min, ngokulandelelana).Nangona kunjalo, uphando oluninzi luye lwaxela ukuba i-sugammadex inyamezeleke kakuhle ngabaguli abakhulileyo kwaye akukho nto i-toxification ye-toxification eyenzekayo.Ngoko ke, kucatshangelwa ukuba i-Sugammadex Sodium ingasetyenziselwa ngokukhuselekileyo kwizigulane ezisebekhulile ngexesha lokuvuka kwe-anesthesia.
3.3.Ukusetyenziswa kwabasetyhini abakhulelweyo
Kukho isikhokelo esincinci seklinikhi malunga nokusetyenziswa kweSugammadex Sodium kubasetyhini abakhulelweyo, abachumileyo nabancancisayo.Nangona kunjalo, uphando lwezilwanyana alufumananga umphumo kumanqanaba eprogesterone ngexesha lokukhulelwa kwaye akukho kuzalwa okanye ukukhipha isisu kuzo zonke iigundane, eziza kukhokela ukusetyenziswa kwekliniki ye-Sugammadex Sodium ngexesha lokukhulelwa, ngakumbi kwi-trimester yokuqala.Kukho nenani leemeko zokusetyenziswa komama kweeshukela ze-sodium phantsi kwe-anesthesia jikelele kumacandelo e-cesarean, kwaye akukho zingxaki zomama okanye zomntwana ezichazwe.Nangona ezinye iiphononongo ziye zanika ingxelo encinci yokudluliselwa kweswekile yesodium, kusekho ukunqongophala kwedatha ethembekileyo.Ngokucacileyo, abafazi abakhulelweyo abane-hypertension yokukhulelwa bahlala bephathwa nge-magnesium sulfate.Ukuvinjelwa kokukhululwa kwe-acetylcholine ngokusebenzisa i-ion ye-magnesium iphazamisa ukuhanjiswa kolwazi lwe-neuromuscular junction, ikhulula i-skeletal muscle, kwaye ikhulula i-muscle spasm.Ke ngoko, i-magnesium sulfate inokuphucula impembelelo yokuthintela i-neuromuscular ye-myorelaxants.
3.4.Ukusetyenziswa kwizigulane ezinokungasebenzi kakuhle kwezintso
I-Sugammadex I-Sodium kunye ne-sucralose-rocuronium bromide complexes ikhutshwe yizintso njengeprototypes, ukwenzela ukuba i-metabolism eboshiweyo kunye ne-Sugammadex Sodium engapheliyo ithatha ixesha elide kwizigulane ezinokukhubazeka kwezintso.Nangona kunjalo, idatha yeklinikhi ibonisa ukubaI-Sugammadex yeSodiuminokusetyenziswa ngokukhuselekileyo kwizigulane ezinesifo se-renal ekupheleni, kwaye akukho ngxelo yokulibaziseka kwe-neuromuscular blockade emva kwe-Sugammadex Sodium kwizigulane ezinjalo, kodwa ezi nkcukacha zikhawulelwe kwi-48h emva kokulawulwa kwe-Sugammadex Sodium.Ukongezelela, i-sodium sugammadex-rocuronium bromide complex inokupheliswa nge-hemodialysis kunye ne-high-flux filtration membranes.Kubalulekile ukuba uqaphele ukuba ixesha lokuguqulwa kwe-rocuronium kunye ne-sodium sugammadex inokongezwa kwizigulane ezinesifo sezintso.Ngoko ke ukusetyenziswa kwe-neuromuscular monitoring kubalulekile.
4. Isiphelo
I-Sugammadex Sodium iguqula ngokukhawuleza i-blockade ye-neuromuscular ebangelwa yi-aminosteroid myorelaxants ephakathi kunye nenzulu, kwaye iyanciphisa kakhulu iziganeko ze-neuromuscular blockade eseleyo xa kuthelekiswa ne-acetylcholinesterase inhibitors eqhelekileyo.I-sodium sugammadex iphinda ikhawuleze ngokukhawuleza ixesha lokukhupha ngexesha lokuvuswa, linciphisa inani leentsuku zokulala esibhedlele, likhawuleza ukubuyiswa kwezigulane, linciphisa iindleko zesibhedlele, kwaye ligcina izixhobo zonyango.Nangona kunjalo, ukuphendulwa kwe-allergies kunye ne-cardiac arrhythmias kuye kwaxelwa ngamanye amaxesha ngexesha lokusetyenziswa kwe-Sugammadex Sodium, ngoko ke kusafuneka ukuba uqaphele ngexesha lokusetyenziswa kwe-Sugammadex Sodium kunye nokugcina utshintsho lweempawu ezibalulekileyo zezigulane, iimeko zesikhumba kunye ne-ECG.Kuyacetyiswa ukuba kubekwe iliso ukufinyezwa kwemisipha ye-skeletal kunye ne-monitor yokuphumla kwe-muscle ukujonga ngokuchanekileyo ubunzulu be-neuromuscular blockade kunye nokusebenzisa idosi efanelekileyo.sodium sugammadexukuphucula ngakumbi umgangatho wexesha lokuvuka.
Ixesha lokuposa: Sep-27-2021