胆碱R阻断药(09麻醉、生物).ppt

,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,单击此处编辑母版标题样式,Chapter 8,胆碱受体阻断剂,（I）,M-R,阻断剂,Cholinoceptor blocking drugs,M-R blocking drugs,1,Instructional objectives,1.,阐述阿托品的作用、用途、不良反应、禁忌症；,2,.比较山莨菪碱和东莨菪碱的作用特点及用途；,3,.列举阿托品的合成代用品,4,.列举肌松药的分类及代表药,2,M-R阻断药,muscarinic blocking drugs,抗胆碱药,anticholinegics,.,副交感神经阻断药,parasympatholytics,Muscarinic blocking drugs,have no intrinsic activity,and they can produce effects only by blocking the activation of muscarinic receptors by muscarinic agonists or by neuronally released ACh.,3,阿托品,Atropine,东莨菪碱,Scopolamine,山莨菪碱,Anisodamine,中枢作用：氧桥,，羟基,东莨菪碱,阿托品山莨菪碱,5,【,Mechanism of action,】(,作用机理,),1.（,-,）M-R；2.大剂量:（,-,）N,N,-R,【,Pharmacological actions,】（,药理作用,）,腺体,眼,平滑肌,心脏,CNS,阿托品,Atropine,1.,腺体（,glands,）,（-）,腺体分泌,汗腺,、,唾液腺,泪腺,、,呼吸道腺体,胃壁细胞,6,2.眼（,eye,）,(1),扩瞳（,mydriasis,）,atropine,Please compare,atropine,with,pilocarpine,(,-,),瞳孔括约肌,M,-,R,开大肌功能占优势,瞳孔扩大,(,dilate the pupil,),7,(2),升高眼内压 (,increase intraocular pressure,),Atropine,扩瞳,虹膜退向四周边缘,根部变厚,前房角间隙,房水回流,眼内压,。,(3),调节麻痹,（,paralysis accommodation,）,Atropine,(,-,),睫状肌,M-R,睫状肌松驰,悬韧带拉紧,晶状体扁平,视远物清楚,，近物模糊。,8,3.,平滑肌,（,smooth muscle,）,松弛内脏平滑肌,Relaxes visceral smooth muscle.,Characteristics,(,特点,),(1),作用强度与平滑肌的功能状态有关；,(2)作用强度顺序,：,胃肠道,膀胱,输尿管,胆管、支气管,、,子宫。,10,5.,血管与血压,(,Vessels,blood pressure,),Therapeutic dose,-无明显作用,原因：多数血管缺乏胆碱能神经支配,Large dose,-,扩张,血管,6.CNS,兴奋,抑制,-atropine blush（,脸红,）,The mechanism is unknown.,Excitation followed by depression.,12,2,.,抑制腺体分泌,Inhibition of the secretion of the glands,(1),麻醉前给药,（,premedication,）,(2),盗汗,（,severe night sweat,）,(3),流涎,(,salivation,),3.,眼科,(,ophthalmologic disorders,),(1),虹膜睫状体炎,(2),验光配镜,(3),扩瞳，检查眼底,14,4.,缓慢型心律失常,(1)心动过缓,(,Bradycardia,),(2)迷,走,N,过度兴奋所致传导阻滞,Note:,at too large dose,：,HR,oxygen consumption(,耗氧量,),the risk of ventricular fibrillation（,心室纤颤,）,15,5.,抗休克,（,Anti-shock,）,暴发型流脑、中毒性菌痢、中毒性肺炎,感染性休克(,infectious shock,),解除,血管痉挛，改善,微循环。,6.,有机磷酸酯中毒,Organophosphate intoxication,16,【,Adverse reaction,】(,不良反应,),腺体,：口干,、,皮肤干燥、潮红,、,体温,心脏,：心动过速,眼,：眼内压、视力模糊,平滑肌,：便秘,、,排尿困难,【,Contraindication,】,禁忌症,青光眼,，,前列腺肥大,CNS,：,17,Summary,Atropine,腺,眼,平,心血管,CNS,作用,(,-,),分泌,用途,麻醉前给药,盗汗,流涎,不良反应,口干,体温,禁忌症,发热,扩瞳,眼内压,调节麻痹,虹膜炎验光,眼内压,视力模糊,青光眼,松弛,内脏绞痛,便秘,尿潴留,前列腺肥大,HR,血管扩张,心动过缓传导阻滞,心动过速,心动过速,先兴奋后抑制,有机磷中毒,感染性休克,18,东莨菪碱,（,scopolamine,）,1.外周抗胆碱作用,腺,(,gland,),atropine,心血管系统,atropine,眼,(,eye,),【,Pharmacological actions,】（,药理作用,）,20,1.,麻醉前给药,（,premedication,）,2.,晕动病,(,motion sickness,),3.,帕金森氏病,（,Parkinsons disease,）,【,Clinical Uses,】（,临床用途,）,21,Chapter 9,胆碱受体阻断剂,（II）,N-R,阻断剂,Cholinoceptor blocking drugs,N-R blocking drugs,23,1,神经节阻滞药 (,ganglionic blockers,),(,-,)N,N,-,R (,-,)postganglial fibres of sympathetic and parasympathetic nerves,美加明,樟磺咪芬,【,Mechanism,】(,机理,),【,Clinical Uses,】(,临床用途,),控制性降压,(,controlled hypotension,),24,一,、,去极化型肌松药（非竞争性肌松药）,琥珀胆碱,succinylcholine,【,Mechanism,】,Depolarizing muscular relaxants,司可林,scoline,琥珀胆碱,（）N,M,-R,后膜持久去极化,肌松,26,N-M接头处的兴奋传递过程,轴突末稍AP,Ca,2,内流,释放ACh,终板电位（EPP）,肌细胞膜爆发AP,27,1.作用快、强、短；,2.肌松前有短时肌震颤；,3.过量中毒时不可用新斯的明解救:,(1)无效:N,M,-R 对ACh不起反应；,(2)加重中毒,：,(-)ChE,(-),琥珀胆碱水解,【,Characteristics,】(,特点,),28,筒箭毒碱,(,-,),N,M,-,R,竞争性对抗,ACh,的作用,肌松,二,、,非除化型肌松药（竞争性肌松药）,筒箭毒碱,d-tubocurarine,Non-depolarizing muscular relaxants,【,Mechanism,】机理,30,【,Characteristics,】,1.,作用时间长，连用蓄积；,2,.过量可用新斯的明解救；,3.,阻断,N,节，释放组胺,4,.禁用于重症肌无力、支气管哮喘、严重休克。,阿曲库铵 泮库溴铵 P 83 表 9-2,31,