Mallon William K, Keim Samuel M, Shoenberger Jan M, Walls Ron M
Department of Emergency Medicine, Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA.
J Emerg Med. 2009 Aug;37(2):183-8. doi: 10.1016/j.jemermed.2008.07.021. Epub 2008 Dec 20.
Two methods of paralysis are available for rapid sequence intubation (RSI) in the emergency department (ED): depolarizing agents such as succinylcholine, and non-depolarizing drugs such as rocuronium. Rocuronium is a useful alternative when succinylcholine is contraindicated. Contraindications to succinylcholine include allergy, history of malignant hyperthermia, denervation syndromes, and patients who are 24-48 h post burn or crush injury. Non-depolarizing drugs have the advantage of causing less pain due to post-paralysis myalgias.
Can rocuronium replace succinylcholine as the paralytic of choice for RSI in the ED?
Four relevant studies were selected from an evidence search and a structured review performed.
For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents were not statistically significantly different. Succinylcholine seems to produce conditions that have higher satisfaction scores.
Succinylcholine remains the drug of choice for ED RSI unless there is a contraindication to its usage.
急诊科（ED）快速序贯诱导插管（RSI）有两种麻痹方法：去极化剂如琥珀酰胆碱，以及非去极化药物如罗库溴铵。当琥珀酰胆碱禁忌时，罗库溴铵是一种有用的替代药物。琥珀酰胆碱的禁忌证包括过敏、恶性高热病史、去神经综合征，以及烧伤或挤压伤后24 - 48小时的患者。非去极化药物的优点是麻痹后肌痛引起的疼痛较轻。
在急诊科，罗库溴铵能否替代琥珀酰胆碱作为RSI的首选麻痹药物？
通过证据检索和结构化综述选择了四项相关研究。
对于临床可接受的插管条件和起效时间的结果，两种药物在统计学上无显著差异。琥珀酰胆碱似乎能产生满意度得分更高的条件。
除非有使用禁忌，琥珀酰胆碱仍然是急诊科RSI的首选药物。
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