PERSISTENT PARALYSIS IN CRITICALLY ILL PATIENTS AFTER LONG-TERM ADMINISTRATION OF VECURONIUM
PERSISTENT PARALYSIS IN CRITICALLY ILL PATIENTS AFTER LONG-TERM ADMINISTRATION OF VECURONIUM
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DOI：
10.1056/nejm199208203270804
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发表时间：
1992-08-20
影响因子：
158.5
通讯作者：
MILLER, RD
中科院分区：
文献类型：
--
作者：
SEGREDO, V;CALDWELL, JE;MILLER, RD
背景资料。肌松药维库溴铵有时用于促进机械通气。在危重病患者停止长期服用维库溴铵(即两天以上)后，可能会发生长达七天的神经肌肉麻痹。我们调查了临床因素和维库溴铵及其代谢物的血浆浓度在导致这种延长的神经肌肉阻滞中的作用。我们研究了16名危重成人患者(8名女性和8名男性)，他们接受了维库溴铵至少连续两天的机械通气。比较维库溴铵的临床因素和血药浓度，以及维库溴铵的活性代谢物3-去乙酰维库溴铵。此外，我们在没有长期神经肌肉阻滞的患者中进行了详细的药代动力学研究。在终止维库溴铵治疗后，16名患者中有7名患者出现了长时间的神经肌肉阻滞，持续时间从6小时到7天以上。这7名患者，其中6名是女性，与9名没有长期神经肌肉阻断的患者相比，他们的血浆镁浓度更高，动脉血pH值更低。他们的血浆中3-脱乙酰维库溴铵浓度也更高，肾功能衰竭的发生率也更高(7例患者中有7例，而9例患者中有4例，P
Background. The muscle relaxant vecuronium is sometimes administered to facilitate mechanical ventilation. Neuromuscular paralysis lasting up to seven days may occur after the termination of long-term administration (i.e., more than two days) of vecuronium in critically ill patients. We investigated the role of clinical factors and plasma concentrations of vecuronium and its metabolite in causing this prolonged neuromuscular blockade.Methods. We studied 16 critically ill adult patients (8 women and 8 men) who had received vecuronium to facilitate mechanical ventilation for at least two consecutive days. Clinical factors and plasma concentrations of vecuronium and 3-desacetylvecuronium, the active metabolite of vecuronium, were compared in patients with and without prolonged neuromuscular blockade. In addition, we performed detailed pharmacokinetic studies in the patients without prolonged neuromuscular blockade.Results. Seven of the 16 patients had prolonged neuromuscular blockade, lasting from six hours to more than seven days, after the termination of vecuronium therapy. These seven patients, six of whom were women, had higher plasma magnesium concentrations and lower arterial blood pH values than the nine patients without prolonged neuromuscular blockade. They also had higher plasma concentrations of 3-desacetylvecuronium and a higher frequency of renal failure (seven of seven patients vs. four of nine patients, P