老年患者全身麻醉术后肌松残余的研究进展

Progress of residual neuromuscular blockade after general anesthesia in elderly patients

肌肉松弛(肌松)药诱导的肌肉松弛是手术中气管插管和固定的重要条件之一,术后未完全逆转肌松药效应称为术后肌松残余(postoperative residual neuromuscular block,PRNB)。PRNB可引发患者一系列严重的术后并发症甚至死亡,因此在麻醉实施过程中对其进行早期预防及积极治疗必不可少。随着外科技术飞速发展及人口平均寿命逐渐延长,老年患者的手术需求逐渐增多。与此同时,由于老年患者机体的生理病理变化及合并的基础疾病,其更易发生不同程度的PRNB,可严重损害患者的预后以及增加医疗资源的损耗。近年来,各类短效肌松药和新型拮抗剂(如舒更葡糖钠)等的问世,以及术中肌松监测的临床应用,已经明显降低了年龄相关PRNB所致不良事件的发生率,彻底改变了麻醉实践。同时,以神经肌肉接头结构为主导的基础研究,以及针对老年患者的药代动力学和药效动力学研究,也为降低PRNB对老年患者的危害提供了新的理论依据。该文对临床上老年患者全身麻醉手术后发生PRNB的原因机制、引发的不良事件及临床干预措施的研究进展作一综述,以期为老年患者全身麻醉的肌松管理及术后拮抗提供参考。

Muscle relaxation induced by muscle relaxants is one of the important conditions for endotracheal intubation and fixation,but sometimes muscle functions recover incompletely after operations,which is called postoperative residual neuromuscular block(PRNB).It can cause a series of serious postoperative complications and even death.Hence,it is essential to prevent and treat PRNB in the early stage during anesthesia implementation.With the rapid development of surgical technology and the gradual extension of the life span of the population,the number of operations for elderly patients is gradually increasing.Meanwhile,due to the physiological and pathological changes of the elderly and the combined underlying diseases,the elderly are more likely to suffer from PRNB in different degrees after surgery,which seriously damages the prognosis of elderly patients and increases the loss of medical resources.In these years,the successful application of short-acting muscle relaxants,new antagonists(such as sugammadex),and multi-mode neuromuscular monitoring devices in clinical practice have greatly reduced the incidence of PRNB in elderly patients.Furthermore,the basic researches which mainly based on the neuromuscular junction structure and the pharmacokinetic and pharmacodynamic studies of the elderly provide a new theoretical basis for reducing the harm of PRNB to elderly patients.This paper reviews the research progress of the mechanism,adverse events and clinical interventions of PRNB in elderly patients after general anesthesia surgeries to provide reference for muscle relaxation management and postoperative antagonism in these people.