Sugammadex sodiumwani sabon abokin gaba ne na zaɓaɓɓun masu shakatawa na tsoka marasa ƙarfi (myorelaxants), wanda aka fara ba da rahoto a cikin ɗan adam a cikin 2005 kuma tun daga lokacin ana amfani da shi a asibiti a Turai, Amurka da Japan.Idan aka kwatanta da magungunan anticholinesterase na gargajiya, yana iya haifar da toshewar jijiyoyi mai zurfi ba tare da shafar matakin acetylcholine na hydrolyzed a cholinergic synapses, guje wa mummunan tasirin M da N mai karɓa, kuma yana haɓaka ingancin farkawa bayan annesthesia.Mai zuwa shine bita na aikace-aikacen asibiti na kwanan nan na sukarin sodium a lokacin farkawa na maganin sa barci.
1. Bayani
Sugammadex Sodium wani γ-cyclodextrin ne wanda aka gyara wanda ke juyar da tasirin toshewar neuromuscular na ma'aikatan toshewar neuromuscular na steroidal, musamman rocuronium bromide.Sugammadex Sodium chelates free neuromuscular blockers bayan allura da kuma hana neuromuscular blockers ta samar da wani barga ruwa mai narkewa fili ta hanyar 1:1 m dauri.Ta hanyar irin wannan ɗaurin, an kafa gradient na maida hankali wanda ke sauƙaƙe dawowar mai hana neuromuscular daga mahaɗar neuromuscular zuwa plasma, ta haka yana mayar da tasirin toshewar neuromuscular da yake samarwa, sakin nicotinic acetylcholine-kamar masu karɓa da kuma dawo da watsawar motsa jiki na neuromuscular.
Daga cikin masu hana cutar neuromuscular na steroidal, Sugammadex Sodium yana da alaƙa mafi ƙarfi don pecuronium bromide, sannan rocuronium, sannan vecuronium da pancuronium.Ya kamata a lura da cewa don tabbatar da sauri da kuma tasiri juzu'i na neuromuscular blocking effects, wani wuce kima adadinSugammadex sodiumYa kamata a yi amfani da dangantaka da myorelaxants a wurare dabam dabam.Bugu da kari, Sugammadex Sodium wani takamaiman antagonist ne na steroidal neuromuscular blocking agents, kuma ba zai iya ɗaure benzylisoquinoline marasa depolarizing myorelaxants da depolarizing myorelaxants, sabili da haka, ba zai iya juyar da neuromuscular toshe tasirin wadannan kwayoyi.
2. Amfanin summadex sodium
Gabaɗaya, adadin masu adawa da muscarinic yayin farkawa na sa barci ya dogara da matakin toshewar neuromuscular.Don haka, yin amfani da na'urar saka idanu na myoson yana sauƙaƙe aikace-aikacen ma'ana na neuromuscular blocking antagonists.Mai saka idanu na myorelaxation yana ba da kuzarin lantarki da aka bayar ga jijiyoyi na gefe, yana haifar da amsawar motsi (jigina) a cikin tsokar da ta dace.Ƙarfin tsoka yana raguwa ko ɓacewa bayan amfani da myorelaxants.A sakamakon haka, za a iya ƙididdige matakin toshewar neuromuscular a matsayin: toshe mai zurfi sosai [babu ɓarna bayan ko dai jirgin ƙasa huɗu na huɗu (TOF) ko haɓakar tonic], toshe mai zurfi (babu ƙwanƙwasa bayan TOF kuma aƙalla ƙwanƙwasa ɗaya bayan tonic). stimulation), da matsakaicin toshe (aƙalla fiɗa ɗaya bayan TOF).
Dangane da ma'anar da ke sama, shawarar da aka ba da shawarar sodium sugars don juyawa matsakaicin toshe shine 2 mg / kg, kuma rabon TOF zai iya kaiwa 0.9 bayan kimanin 2 min;Matsakaicin shawarar da aka ba da shawarar don jujjuya toshe mai zurfi shine 4 mg / kg, kuma rabon TOF zai iya kaiwa 0.9 bayan 1.6-3.3 min.Don saurin shigar da maganin sa barci, babban adadin rocuronium bromide (1.2 mg/kg) ba a ba da shawarar ga jujjuyawar toshe mai zurfi na yau da kullun ba.Duk da haka, a cikin yanayin dawowar gaggawa zuwa iskar yanayi, juyawa tare da 16 mg / kg naSugammadex sodiumana bada shawarar.
3. Aikace-aikacen Sugammadex Sodium a cikin marasa lafiya na musamman
3.1.A cikin marasa lafiya na yara
Bayanai daga nazarin asibiti na kashi na II sun nuna cewa Sugammadex Sodium yana da tasiri da aminci a cikin yawan yara (ciki har da jarirai, jarirai, yara da matasa) kamar yadda yake a cikin yawan manya.Meta-bincike bisa nazarin 10 (575 shari'o'i) da kuma kwanan nan da aka buga na baya-bayan nan binciken ƙungiya (968 lokuta) ya kuma tabbatar da cewa lokaci (tsakaici) don dawo da rabo na 4th myoclonic twitch zuwa 1st myoclonic twitch zuwa 0.9 a cikin batutuwa. da aka ba rocuronium bromide 0.6 mg / kg da Sugammadex Sodium 2 mg / kg a gabatarwar T2 shine kawai 0.6 min a cikin jarirai (0.6 min) idan aka kwatanta da yara (1.2 min) da manya (1.2 min).Minti 1.2 da rabin na manya (minti 1.2).Bugu da kari, binciken daya gano cewa Sugammadex Sodium ya rage yawan bradycardia idan aka kwatanta da neostigmine hade da atropine.Bambance-bambancen abubuwan da suka faru na wasu abubuwa masu banƙyama irin su bronchospasm ko tashin zuciya da amai ba su da mahimmanci.An kuma nuna cewa yin amfani da Sugammadex Sodium yana rage yawan tashin hankali a cikin marasa lafiya na yara, wanda zai iya taimakawa wajen sarrafa lokacin dawowa.Bugu da kari, Tadokoro et al.An nuna a cikin binciken kula da shari'ar cewa babu alaƙa tsakanin halayen rashin lafiyar ɗan adam zuwa maganin sa barci na yara da kuma amfani da sodium sugammadex.Don haka, aikace-aikacen Sugammadex Sodium yana da aminci ga marasa lafiya na yara yayin lokacin farkawa na sa barci.
3.2.Aikace-aikace a cikin tsofaffi marasa lafiya
Gabaɗaya, tsofaffin marasa lafiya sun fi saurin kamuwa da tasirin toshewar neuromuscular da ke saura fiye da ƙananan marasa lafiya, kuma dawo da kai tsaye daga toshewar neuromuscular yana da hankali.A cikin multicenter Phase III nazarin asibiti na aminci, inganci, da pharmacokinetics na Sugammadex Sodium a cikin tsofaffi marasa lafiya, sun gano cewa Sugammadex Sodium ya juya rocuronium don samar da ƙaramin haɓaka a cikin tsawon lokacin toshewar neuromuscular idan aka kwatanta da marasa lafiya waɗanda ke ƙasa da shekaru 65 (ma'ana sau). na 2.9 min da 2.3 min, bi da bi).Koyaya, binciken da yawa sun ba da rahoton cewa sugammadex yana jure wa tsofaffi marasa lafiya kuma ba a sake dawo da toxification na kibiya ba.Sabili da haka, ana la'akari da cewa Sugammadex Sodium za a iya amfani da shi lafiya a cikin tsofaffi marasa lafiya yayin lokacin farkawa na maganin sa barci.
3.3.Amfani a cikin mata masu ciki
Akwai ɗan jagorar asibiti kan amfani da Sugammadex Sodium a cikin mata masu juna biyu, masu haihuwa da masu shayarwa.Duk da haka, nazarin dabbobi bai sami wani tasiri a kan matakan progesterone a lokacin daukar ciki ba kuma babu haihuwa ko zubar da ciki a cikin dukkanin berayen, wanda zai jagoranci amfani da Sugammadex Sodium na asibiti a lokacin daukar ciki, musamman a farkon watanni na farko.Har ila yau, an sami wasu lokuta da yawa na amfani da sukari na sodium a cikin mahaifa a karkashin maganin sa barci na gabaɗaya don sassan cesarean, kuma ba a sami rahoton wata matsala ta uwa ko tayi ba.Ko da yake wasu nazarin sun ba da rahoton ɗan ƙaramin canja wuri na sodium sugars, har yanzu akwai rashin ingantaccen bayanai.Musamman ma, mata masu ciki masu fama da hauhawar jini suna yawan bi da su tare da magnesium sulfate.Hana sakin acetylcholine ta hanyar ions na magnesium yana tsoma baki tare da watsa bayanan junction na neuromuscular, yana shakatawa tsokar kwarangwal, kuma yana kawar da spasm na tsoka.Don haka, magnesium sulfate na iya haɓaka tasirin toshewar neuromuscular na myorelaxants.
3.4.Aikace-aikace a cikin marasa lafiya tare da rashin gazawar koda
Sugammadex Sodium da sucralose-rocuronium bromide complexes ana fitar da su ta hanyar kodan azaman samfura, don haka metabolism na ɗaure da rashin ɗaure Sugammadex Sodium ya tsawaita a cikin marasa lafiya da ƙarancin gazawar koda.Duk da haka, bayanan asibiti sun nuna cewaSugammadex sodiumana iya amfani da shi cikin aminci a cikin marasa lafiya da ke fama da cututtukan koda na ƙarshe, kuma babu rahoton jinkirin toshewar neuromuscular bayan Sugammadex Sodium a cikin irin waɗannan marasa lafiya, amma waɗannan bayanan suna iyakance ga 48h bayan gudanar da Sugammadex Sodium.Bugu da ƙari, ana iya kawar da hadaddun sodium sugammadex-rocuronium bromide ta hanyar hemodialysis tare da membranes tacewa mai girma.Yana da mahimmanci a lura cewa tsawon lokacin juyar da rocuronium tare da sodium sugammadex na iya tsawaita a cikin marasa lafiya da cututtukan koda.Don haka amfani da saka idanu neuromuscular yana da mahimmanci.
4. Kammalawa
Sugammadex Sodium da sauri yana jujjuya toshewar neuromuscular da ke haifar da matsakaici da zurfin aminosteroid myorelaxants, kuma yana da matukar mahimmanci yana rage abubuwan da suka rage na toshewar neuromuscular idan aka kwatanta da masu hana acetylcholinesterase na al'ada.Sodium summadex kuma yana haɓaka lokacin extubation yayin lokacin farkawa, yana rage adadin kwanakin asibiti, yana hanzarta dawo da marasa lafiya, yana rage farashin asibiti, yana adana albarkatun likita.Duk da haka, an ba da rahoton halayen rashin lafiyan da arrhythmias na zuciya lokaci-lokaci yayin amfani da Sugammadex Sodium, don haka har yanzu wajibi ne a kula yayin amfani da Sugammadex Sodium da kuma lura da canje-canjen alamun masu mahimmanci na marasa lafiya, yanayin fata da ECG.Ana ba da shawarar yin saka idanu kan ƙanƙanwar ƙwayar ƙwanƙwasa tare da saka idanu na shakatawa na tsoka don ƙayyadaddun ƙayyadaddun zurfin toshewar neuromuscular da amfani da madaidaicin kashi nasodium summadexdon kara inganta ingancin lokacin farkawa.
Lokacin aikawa: Satumba-27-2021