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    《ISPN学习》总第506期
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    《ISPN学习》总第691期
    日期:2020-10-14 16:18:00    
     
    《ISPN学习》2020年10月14日总第691期
     
     
    ISPN/RN Review
     
    NMJ Blockers Therapy Across Lifespan
    不同年龄段的神经肌肉接头传递阻滞药治疗

    Drugs that affect the NMJ can be divided into two groups. One group, the nondepolarizing neuromuscular junction blockers, includes those agents that act as antagonists to ACh at the NMJ and prevent depolarization of muscle cells. The other group, the depolarizing neuromuscular junction blockers (of which there is one drug), act as an ACh agonist at the junction, causing stimulation of the muscle cell and staying on the receptor site, preventing it from repolarizing, which results in muscle paralysis with the muscle in a constant, contracted state. Both of these types of drugs are used to cause paralysis for the performance of surgical procedures, endoscopic diagnostic procedures, or facilitation of mechanical ventilation.

    影响神经肌肉接头的药物可分为两类。一类为去极化神经肌肉接头阻滞药,包括在NMJ充当ACh拮抗物阻止肌细胞再极化的药物。另一类为极化神经肌肉接头阻滞药(只有一种药),充当接头Ach激动剂,引起肌细胞兴奋并停留在受体部位,防止其再极化,可导致肌麻痹,使肌肉处于持久的收缩状态。两类药物都用于手术操作、内镜诊断检查时的麻痹或方便机械通气。

    Children 儿童

    Children require very careful monitoring and support after the use of NMJ blockers. These agents are used by anesthetists who are skilled in their use and with full support services available.
    儿童使用NMJ阻滞药后必须密切监测和支持,这些药物由能熟练使用的麻醉医师使用,并可随时提供充分的支持服务。

    The nondepolarizing NMJs are preferable because of the lack of muscle contraction with its resultant discomfort on recovery. Succinylcholine is usually preferred when a very short-acting, rapid-onset blocker is needed (e.g., for intubation).
    因为缺乏肌肉收缩导致恢复时的不适,所以首选非去极化NMJs。需要短效、速效阻滞药时则通常首选琥珀酰胆碱(如插管时)。

    Adults 成人

    Adults need to be monitored closely for full return of muscle function. If succinylcholine is used, they need to be told that they will experience muscle pain and discomfort when the procedure is over.
    必须密切监测成人以期肌肉功能完全恢复。如若使用琥珀酰胆碱,则必须告诉患者,操作结束时会出现肌肉疼痛和不适。

    The NMJs are used during pregnancy and lactation only if the benefit to the mother outweighs the potential risk to the fetus or neonate.
    如果母亲好处超过胎儿或新生儿潜在危险时,可在妊娠期和哺乳期使用NMJs。

    Older Adults 老人

    Because older patients often also have renal or hepatic impairment, they are more likely to have toxic levels of the drug related to changes in metabolism and excretion. The older patient should receive special efforts to provide skin care to prevent skin breakdown, which is more likely with older skin. The older patient may require longer monitoring and regular orienting and reassuring.

    老人经常还会有肾或肝损害,更容易出现与代谢和排泄相关的药物毒性浓度。老年患者应采取专门的措施提供皮肤护理,防止皮肤破裂,因为老年人皮肤更容易出现这种情况。可能要延长老年患者的监护,定期进行引导和安慰。
     
     
    Vocabulary
     
    NMJ – neuromuscular junction 神经肌肉接头
    nondepolarizing – a. 非去极化的
    depolarizing – a. 去极化的,除极的
    repolarizing – n. a. 再极化,复极
    endoscopic – a. 内窥镜(检查)的
    facilitation – n. 方便,简易化
    blocker – n. 阻滞药/剂,阻断药
    preferable – a. 更可取的,较喜爱的
    resultant – a. 作为结果的
    succinylcholine – n. 琥珀酰胆碱
    short-acting – a. 短效的
    rapid-onset – a. 速效的

     
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    Video
     
    NMJ Blocker Therapy

     
    Test

     
    1. Both nondepolarizing and depolarizing NMJ blockers are used in surgical procedures, endoscopic diagnostic procedures, or facilitation of mechanical ventilation because of the fact that:
    A. They cause paralysis by preventing depolarization of muscle cells
    B. They cause paralysis by preventing repolarizing of muscle cells
    C. They cause paralysis by preventing either depolarization or repolarizing of muscle cells
    D. They cause paralysis by preventing depolarization and repolarizing of muscle cells
    2. The nursing instructor has finished her lecture on NMJ blocker therapy for different age groups. The instructor is clear that the nurse students have a good understanding of the lecture if they are able to make the following statement(s). Select all that apply.
    A. Special skin care should be provided to the elderly because of the risk of skin breakdown
    B. Adults may use NMJ blockers freely, though close monitoring is needed
    C. Succinylcholine is preferred in children because of the lack of muscle contraction
    D. Longer monitoring is necessary for all age groups.

     
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     答案 Answers
    1. C. They cause paralysis by preventing either depolarization or repolarizing of muscle cells
    Rationale: Nondepolarizing NMJ blockers cause paralysis by preventing depolarization of muscle cells while depolarizing NMJ blockers by preventing muscle cells from repolarizing.
    2. A. Special skin care should be provided to the elderly because of the risk of skin breakdown
    Rationale: The older patients are more likely to suffer skin breakdown. Special skin care is needed to prevent skin breakdown. Option B: The NMJs are used during pregnancy and lactation only if the benefit to the mother outweighs the potential risk to the fetus or neonate. Option C: Nondepolarizing NMJ blockers are preferable for children because of the lack of muscle contraction. Succinylcholine is a depolarizing NMJ, not nondepolarizing. Option D: Longer monitoring is necessary for older adults.
     

     

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