术后非去极化肌松药肌松残余拮抗新进展

Update on reversal of postoperative residual nondepolarizing neuromuscular blockade

背景非去极化肌松药在临床麻醉中使用非常普遍，术后不可避免地发生肌松残余作用，其危害主要为呼吸不良事件，严重可导致死亡。目的有效合理的肌松拮抗能降低术后肌松残余的发生率，减少相关并发症，因此，拮抗至关重要。内容阐述非去极化肌松药使用后手术结束时是否需要拮抗、拮抗的时机、拮抗剂的剂量和新的拮抗模式。趋向选择性肌松拮抗可极大地降低，甚至可能避免术后肌松残余作用的发生，将成为未来主要的拮抗模式。

Background Currently, non-depolarizing neuromuscular relaxant have been widely used in anesthesia for many surgical procedures. After administrating the relaxant, postoperative residual neuromuscular blockage （RNMB） ensues inevitably and mainly results in adverse respiratory events or even death occasionally. Objective Adequate reversal of neuromuscular blockage is crucial to decrease the incidence of postoperative RNMB and contribute to reduce the related complications. Content This article is aimed to review the updates on optimal neuromuscular management strategies, including the necessity of postoperative anticholinesterase agents, the most appropriate reversal opportunity and dose, as well as the new mode of selective reversal of RNMB. Trend The selective reversal of RNMB will reduce the occurrence of postoperative RNMB dramatically, and possibly even avoid RNMB. The novel preventing mode will lead the mainstream of preventing postoperative RNMB.