Sugammadex sodiumbụ onye mmegide ọhụụ nke ndị na-ahụ maka ahụ ike na-adịghị emebi emebi (myorelaxants), bụ nke mbụ a kọrọ na ụmụ mmadụ na 2005 ma ejirila ya mee ihe na Europe, United States na Japan. E jiri ya tụnyere ọgwụ anticholinesterase ọdịnala, ọ nwere ike imegide mgbochi akwara miri emi na-enweghị emetụta ọkwa nke acetylcholine hydrolyzed na cholinergic synapses, na-ezere mmetụta ọjọọ nke mkpali M na N ndị na-anabata ya, ma na-emeziwanye ogo nke edemede anesthesia. Ihe na-esonụ bụ nlebanya nke ngwa ọgwụgwọ sodium sugars n'oge na-adịbeghị anya n'oge mgbakasị ahụ.
1. Nchịkọta
Sugammadex Sodium bụ γ-cyclodextrin gbanwetụrụ nke na-agbanwe kpọmkwem mmetụta mgbochi neuromuscular nke steroidal neuromuscular blocking agents, karịsịa rocuronium bromide. Sugammadex Sodium chelates free neuromuscular blockers mgbe ịgba ọgwụ mgbochi ọrịa na neuromuscular blockers site na-eme a kwụsiri ike mmiri-soluble compound site na 1: 1 njide siri ike. Site na njide dị otú ahụ, a na-emepụta gradient nke na-eme ka nlọghachi nke neuromuscular blocker si na neuromuscular junction na plasma, si otú ahụ na-atụgharị mmetụta mgbochi neuromuscular ọ na-emepụta, na-ahapụ nicotinic acetylcholine-dị ka ndị na-anabata ya na iweghachi nnyefe neuromuscular excitatory nnyefe.
N'ime ndị na-egbochi neuromuscular steroid, Sugammadex Sodium nwere njikọ siri ike maka pecuronium bromide, rocuronium sochiri ya, wee vecuronium na pancuronium. Ọ dị mma ịmara na iji hụ na ngbanwe ngwa ngwa ma dị irè nke mmetụta mgbochi neuromuscular, oke oke nkeSugammadex sodiumEkwesịrị iji ya mee ihe gbasara myorelaxants na mgbasa. Na mgbakwunye, Sugammadex Sodium bụ onye na-emegide ndị na-egbochi neuromuscular steroid, na ọ nweghị ike ijikọ benzylisoquinoline na-abụghị depolarizing myorelaxants yana depolarizing myorelaxants, ya mere, enweghị ike ịgbanwe mmetụta mgbochi neuromuscular nke ọgwụ ndị a.
2. Ịrụ ọrụ nke sugarmadex sodium
N'ozuzu, dose nke muscarin antagonists n'oge anestetiiki edemede na-adabere n'ókè nke neuromuscular mgbochi. Ya mere, iji ihe nleba anya myoson na-eme ka ngwa ngwa nke neuromuscular igbochi antagonists. Ihe nleba anya nke myorelaxation na-enye mkpali eletrik na-enyefe na irighiri akwara dị n'akụkụ, na-eme ka nzaghachi moto (mtụgharị) na uru ahụ kwekọrọ. Ike akwara na-ebelata ma ọ bụ na-apụ n'anya ka ejiri myorelaxants. N'ihi ya, ogo nke mgbochi neuromuscular nwere ike ịdezi dị ka: ngọngọ miri emi [enweghị ntụgharị mgbe ma ọ bụ ụgbọ oloko anọ-nke anọ (TOF) ma ọ bụ mkpali tonic], ngọngọ miri emi (enweghị ntụgharị mgbe TOF na ọ dịkarịa ala otu na-atụgharị mgbe tonic gasịrị. mkpali), na ngọngọ na-agafeghị oke (opekata mpe otu ntugharị mgbe TOF gasịrị).
Dabere na nkọwa ndị a dị n'elu, usoro a na-atụ aro nke sodium sugars iji gbanwee ngọngọ na-agafeghị oke bụ 2 mg / kg, na oke TOF nwere ike iru 0.9 mgbe ihe dịka 2 min; Usoro akwadoro iji tụgharịa ngọngọ miri emi bụ 4 mg / kg, yana oke TOF nwere ike iru 0.9 mgbe 1.6-3.3 min. Maka nnabata ngwa ngwa nke anesthesia, rocuronium bromide dị elu (1.2 mg/kg) adịghị atụ aro maka mweghachi nke ngọngọ miri emi mgbe niile. Otú ọ dị, n'ihe banyere nlọghachi mberede na ikuku ventilashion, ngbanwe na 16 mg / kg nkeSugammadex sodiumakwadoro.
3. Ngwa nke Sugammadex Sodium na ndị ọrịa pụrụ iche
3.1. Na ndị ọrịa ụmụaka
Data sitere na ọmụmụ ụlọ ọgwụ nke abụọ na-egosi na Sugammadex Sodium dị irè yana nchekwa na ọnụ ọgụgụ ụmụaka (gụnyere ụmụ ọhụrụ, ụmụ ọhụrụ, ụmụaka na ndị nọ n'afọ iri na ụma) dịka ọ dị na ndị okenye. Meta-analysis nke dabeere na ọmụmụ iri (575 ikpe) na akwụkwọ nyochaghachi azụ azụ n'oge na-adịbeghị anya (okwu 968) kwadoro na oge (median) maka mgbake nke oke nke 4th myoclonic twitch na 1st myoclonic twitch na 0.9 na isiokwu. enyere rocuronium bromide 0.6 mg / kg na Sugammadex Sodium 2 mg / kg na ngosi T2 bụ naanị. 0.6 min na ụmụ ọhụrụ (0.6 min) tụnyere ụmụaka (1.2 min) na ndị okenye (1.2 min). 1.2 min na ọkara nke ndị okenye (1.2 min). Na mgbakwunye, otu nnyocha chọpụtara na Sugammadex Sodium belatara ọnọdụ bradycardia ma e jiri ya tụnyere neostigmine jikọtara ya na atropine. Ọdịiche dị na nhụta nke ihe omume ọjọọ ndị ọzọ dị ka bronchospasm ma ọ bụ ọgbụgbọ na ọgbụgbọ na-esote abụghị ihe dị ịrịba ama. E gosikwara na ojiji Sugammadex Sodium na-ebelata mkpasu iwe nke postoperative na ndị ọrịa ụmụaka, nke nwere ike inye aka na njikwa nke oge mgbake. Na mgbakwunye, Tadokoro et al. egosipụtara n'ọmụmụ ihe nchịkwa ikpe na enweghị njikọ dị n'etiti mmeghachi omume nfụkasị perioperative na nhụsianya n'ozuzu ụmụaka na iji sodium summadex. Ya mere, ntinye nke Sugammadex Sodium dị mma maka ndị ọrịa ụmụaka n'oge oge mkpali nke anesthesia.
3.2. Ngwa na ndị ọrịa agadi
N'ozuzu, ndị ọrịa meworo agadi na-enwekarị mmetụta nke nkwụsị neuromuscular fọdụrụnụ karịa ndị na-eto eto, na mgbake na-atụghị anya site na mgbochi neuromuscular na-eji nwayọọ nwayọọ. N'ime usoro nyocha nke multicenter III nke ụlọ ọgwụ gbasara nchekwa, nrụpụta ọrụ, na pharmacokinetics nke Sugammadex Sodium na ndị ọrịa agadi, ha chọpụtara na Sugammadex Sodium tụgharịrị rocuronium iji mepụta ntakịrị mmụba na ogologo oge mgbochi neuromuscular ma e jiri ya tụnyere ndị ọrịa na-erubeghị afọ 65 (oge pụtara oge). nke 2.9 min na 2.3 min, n'otu n'otu). Otú ọ dị, ọtụtụ nnyocha e mere na-akọ na summadex na-anabata nke ọma site n'aka ndị agadi ọrịa nakwa na ọ dịghị re-akụ nsi na-eme. Ya mere, a na-ahụta na Sugammadex Sodium nwere ike iji ya mee ihe n'enweghị nsogbu na ndị ọrịa agadi n'oge oge edemede nke anesthesia.
3.3. Jiri na ụmụ nwanyị dị ime
Enwere obere ntuziaka ụlọ ọgwụ maka ojiji Sugammadex Sodium n'ime ụmụ nwanyị dị ime, ndị na-amụ nwa na ndị na-enye nwa. Agbanyeghị, ọmụmụ anụmanụ achọpụtaghị mmetụta ọ bụla na ọkwa progesterone n'oge ime yana enweghị ịmụ nwa ma ọ bụ ite ime na oke niile, nke ga-eduzi iji ọgwụ Sugammadex Sodium eme ihe n'oge ime ime, ọkachasị na trimester mbụ. Enweelakwa ọtụtụ ikpe nke nne na-eji shuga sodium eme ihe n'okpuru nchịkwa izugbe maka akụkụ cesarean, na enweghị nsogbu nke nne ma ọ bụ nwa ebu n'afọ ka akọpụtabeghị. Ọ bụ ezie na ụfọdụ ọmụmụ akọpụtala obere nnyefe nke sodium sugars transplacental, a ka nwere enweghị data a pụrụ ịdabere na ya. N'ụzọ doro anya, ndị inyom dị ime nwere ọbara mgbali elu na-ejikarị magnesium sulfate. Mgbochi nke ntọhapụ acetylcholine site na ion magnesium na-egbochi ntụgharị ozi neuromuscular junction, na-eme ka ahụ ike skeletal dị jụụ, ma na-ebelata spasm muscle. Ya mere, magnesium sulfate nwere ike ịkwalite mmetụta mgbochi neuromuscular nke myorelaxants.
3.4. Ngwa na ndị ọrịa nwere ụkọ akụrụngwa
Sugammadex Sodium na sucralose-rocuronium bromide complexes na-apụ apụ site na akụrụ dị ka ihe atụ, nke mere na metabolism nke bound yana Sugammadex Sodium na-agbatị ogologo oge na ndị ọrịa nwere ụkọ akụrụ. Otú ọ dị, data ụlọ ọgwụ na-egosi naSugammadex sodiumenwere ike iji ya mee ihe n'enweghị nsogbu na ndị ọrịa nwere ọrịa akụrụ na njedebe, na enweghị akụkọ gbasara mgbochi neuromuscular na-egbu oge mgbe Sugammadex Sodium dị na ndị ọrịa dị otú ahụ, mana data ndị a nwere oke na 48h mgbe nchịkwa Sugammadex Sodium gasịrị. Na mgbakwunye, enwere ike ikpochapụ ihe mgbagwoju anya sodium sugammadex-rocuronium bromide site na hemodialysis na akpụkpọ anụ nzacha dị elu. Ọ dị mkpa iburu n'uche na oge ntụgharị rocuronium na sodium summadex nwere ike ịgbatị ogologo oge na ndị ọrịa nwere ọrịa akụrụ. Ya mere, iji nlekota neuromuscular dị mkpa.
4. Nkwubi okwu
Sugammadex Sodium na-agbanwe ngwa ngwa mgbochi neuromuscular nke sitere na aminosteroid myorelaxants dị oke ma dị omimi, ọ na-ebelata nke ọma ihe mgbochi mgbochi neuromuscular fọdụrụnụ ma e jiri ya tụnyere acetylcholinesterase inhibitors. Sodium summadex na-emekwa ka oge a na-ekpo ọkụ na-amụba ngwa ngwa n'oge edemede, na-ebelata ọnụ ọgụgụ nke ụbọchị ụlọ ọgwụ, na-eme ka mgbake nke ndị ọrịa dịkwuo ngwa, na-ebelata ụgwọ ụlọ ọgwụ, na-echekwa akụrụngwa ọgwụ. Agbanyeghị, a na-akọpụta mmeghachi omume nfụkasị na obi arrhythmias mgbe ụfọdụ n'oge ojiji Sugammadex Sodium, yabụ ọ ka dị mkpa ịmụrụ anya n'oge ojiji Sugammadex Sodium na ịhụ mgbanwe nke akara ndị dị mkpa nke ndị ọrịa, ọnọdụ akpụkpọ ahụ na ECG. A na-atụ aro ka ị nyochaa mkpụkọ akwara skeletal site na iji ihe nleba anya izu ike akwara iji chọpụta nke ọma omimi nke mgbochi neuromuscular ma jiri usoro ezi uche dị na ya.sodium summadexiji meziwanye ogo nke oge edemede.
Oge nzipu: Sep-27-2021