Tschida S J, Hoey L L, Vance-Bryan K
College of Pharmacy, University of Minnesota, Minneapolis, USA.
Pharmacotherapy. 1996 Sep-Oct;16(5):899-904.
Guidelines for selecting nondepolarizing neuromuscular blocking agents (NNMBAs) were developed and implemented by an interdisciplinary team for use in our intensive care units. They suggest pancuronium as the drug of choice if the patient does not have renal insufficiency and is hemodynamically stable. If either of these criteria is not met and hepatic function is normal, vecuronium is recommended. Atracurium is reserved for patients not meeting either criterion. A 12-month retrospective chart review was performed for 24 patients 18 years of age or older who received continuous infusion of an NNMBA beginning 7 months after the guidelines were implemented. Before the guidelines, atracurium, vecuronium, and pancuronium were prescribed for 68% (17), 24% (6), and 8% (2) of patients, respectively. Their use was inappropriate based on organ function and hemodynamic stability in 88% (15), 83% (5), and 0% of patients, respectively. After guideline implementation, atracurium, vecuronium, and pancuronium were prescribed for 33% (8), 21% (5), and 46% (11) of patients, respectively, and use was inappropriate in 38% (3), 60% (3), and 0% of patients, respectively. Overall, the prevalence of inappropriate NNMBA selection decreased from 80% (20) to 25% (6). Further analysis is necessary to determine the associated pharmacoeconomic impact of decreased inappropriate NNMBA prescribing.
一个跨学科团队制定并实施了用于我们重症监护病房的非去极化神经肌肉阻滞剂（NNMBA）选择指南。指南建议，如果患者没有肾功能不全且血流动力学稳定，泮库溴铵为首选药物。如果不符合上述任何一条标准且肝功能正常，推荐使用维库溴铵。阿曲库铵则留给不符合任何一条标准的患者。对24名18岁及以上的患者进行了为期12个月的回顾性病历审查，这些患者在指南实施7个月后开始接受NNMBA持续输注。在指南实施前，分别有68%（17名）、24%（6名）和8%（2名）的患者使用阿曲库铵、维库溴铵和泮库溴铵。根据器官功能和血流动力学稳定性，分别有88%（15名）、83%（5名）和0%的患者使用不当。指南实施后，分别有33%（8名）、21%（5名）和46%（11名）的患者使用阿曲库铵、维库溴铵和泮库溴铵，且分别有38%（3名）、60%（3名）和0%的患者使用不当。总体而言，不恰当选择NNMBA的比例从80%（20名）降至25%（6名）。有必要进行进一步分析，以确定减少不恰当NNMBA处方所带来的相关药物经济学影响。
