Title: NMBA Pearls
题目：神经肌肉阻断剂（NMBA）在危重病人中的应用
Author: Michael Winters

NMBAs are used in critically ill patients for RSI, patient-ventilator asynchrony, reducing intra-abdominal pressure, reducing intracranial pressure, and preventing shivering during therapeutic hypothermia.
NMBA在危重病人中主要用于RSI，病人与呼吸机不同步，降低腹内压，降低颅内压，防止低温治疗过程中的颤抖。
There are a number of alterations in critical illness that affect the action of NMBAs
有许多严重疾病的改变会影响NMBAS的作用
Electrolyte abnormalities
电解质紊乱
Hypercalcemia: decreases duration of blockade
高钙血症：缩短阻滞时间
Hypermagnesemia: prolongs duration of blockade
高镁血症：延长阻滞时间
Acidosis: can enhance effect of nondepolarizing agents
酸中毒：可增强非去极化剂的效应
Hepatic dysfunction: prolongs effects of vecuronium and rocuronium
肝功能障碍：延长维库溴铵和罗库溴铵的效应
In addition, there are a number of medications that may interact with NMBAs此外，
也有一些药物可能会影响NMBA
Increased resistance: phenytoin and carbamazepine
增加耐受力：苯妥英钠和卡马西平
Prolongs effect: clindamycin and vancomycin
延长作用时间：克林霉素和万古霉素
Key complications of NMBAs in the critically ill include:
危重病人使用NMBA主要合并症包括：
ICU-aquired weakness (controversial)
ICU获得性无力（有争议）
DVT: NMBAs are one of the strongest predictors for ICU-related DVT
DVT：NMBA药是最强的预测ICU相关的DVT
Corneal abrasions: prevalence up to 60%
角膜擦伤：患病率高达60％

References
Greenberg SB, et al. The use of neuromuscular blocking agents in the ICU: Where are we know? Crit Care Med 2013; 41:1332-1344.