65．巴活朗

出处：按学科分类—医药、卫生 军事医学科学出版社《临床常用进口药物手册》第378页（6334字）

【中文释文】：

(泮库溴铵)

巴活朗供静脉注射，它含有泮库溴铵(pancuronium bromide)，一种氨基类的脂醇，与箭毒剂一样，能有效地将运动神经兴奋阻断，不能传至横纹肌的感受器，因而肌终板没有发生去极化，巴活朗并无内泌素的作用。

巴活朗比其他同类剂更好，因有下列的特殊性质。

1．并不招致分泌组织胺，所以不致引起支气管缩小。

2．并无神经节传导阻断的作用，所以不致引起低血压。

3．巴活朗并不影响脉率或血压，所以不致引起心动过速及低血压。

4．注射新斯的明及阿托品便很快能将巴活朗的作用全部抵消。

5．巴活朗的效力是很快生效的，比其他同类剂更快。

6．巴活朗适用于手术高危病人。

〔适应证〕

巴活朗为施麻醉时的辅助药。例如在腹部，肛门，胸部及眼部的外科手术时，其作用是松弛肌肉。

巴活朗最适用于施骨科手术。例如回复骨脱位及骨折，其作用也是松弛肌肉。

注射后2～2．5min便发挥最大效力，其功效维持大约45min。如需施插管手术时，在注射后1．5min便可进行。

注射更大剂量或增加剂量，并无特别问题。

〔用法及剂量〕

巴活朗是供静脉注射之用，每千克体重需注射巴活朗0．02～0．08mg。成人平常需注射4～6mg，在施手术时，可再注射不超过2mg剂量。初量(4～6mg)等于筒箭毒碱的20～30mg。

惯用大剂量的麻醉师，可注射超过以上介绍的剂量。

不可将巴活朗于其他溶液混在同一注射器内，因pH的变更，可能引起沉淀。

〔禁忌〕

巴活朗不适用于患有重症肌无力的病人。

〔警告〕

由于部分巴活朗是经尿道排出体外，所以必须小心使用此药剂于患有肾病的病人。

〔预防〕

麻醉药例如乙醚，氟烷或环丙烷能增加巴活朗的阻断功效，同时会影响呼吸肌系，所以如用这类麻醉药时，病人必需配上呼吸机。如静脉注射2．5mg新斯的明和1．2mg阿托品可令病人恢复自发呼吸。最重要的是必须确定显示自发、深重及规律呼吸时，始可离开手术室。如施插管手术用琥珀胆碱时，必须确定该药力全失后，始可使用巴活朗。

使用同类药剂于孕妇前，必须详细考虑各种情况，因此类药剂对于孕妇，可能引致并发病。

在分娩时，不宜使用此药剂。因试验结果尚未确定是否影响新生婴儿的肌紧张度。

〔贮藏〕

如将巴活朗放在冰箱内，药性能可保持至包装上所指示的期限，否则只能保持6周。

〔包装〕

每安瓿含有2ml(2mg／ml)

〔生产厂家〕

荷兰奥斯欧家农大药厂

(附本品别名：溴化潘科罗宁，潘佛隆，泮库溴安，潘龙，巴夫龙，Mioblock)

【外文释文】：

Pavulon is intended for intravenous administration．The active substance is pancuronium bromide，an aminosteroid which，similar to curarizing agents，effectively blocks transmission of motor nerve impulses to the striated muscle receptors．Endplate depolarization does not ocCur．

Pancuronium bromide has no hormonal action．

Pavulon possesses a number of important properties which compare favourably with those of other similarly acting preparations：

·It does not induce the liberation of histamine，thus causing no bronchoconstriction．

·There is no ganglion blocking action so that hypotension does not occur．

·Pavulon has no specific influence on the pulse rate or blood-pressure．Consequently，tachycardia and hypotension which may be observed with other preparations of similar action do not occur．

·Pavulon’s action is rapidly and completely antagonized by administration of neostigmine／atropine．

·Pavulon has a more rapid onset of action than other non-depolarizing blocking compounds．

·Pavulon is suitable for administration to“poor risk”patients．

Indications

The use of Pavulon is indicated as an aid to anaesthesia，to act as a muscle relaxantin certain surgical operations such as abdominal，anal，open chest and ophtalmic surgery．It is also very suitable as a relaxant in orthopaedic manipulations such as the correction and setting of luxations and fractures．

Maximal effect is obtained 2 to 2．5 minutes after administration．Intubation，if necessary，can be carried out 1．5 minutes after the administration of the normal dose．The effects last for about 45 minutes depending on the initial dose level and on anaesthetic technique．

The administration of a higher dose or an additional dose presents no special problems．

Mode of administration and dosage

Pavulon is prepared for intravenous administration．The active dose lies in a range of 0．02-0．08 mg per kg body weight．Adults usually receive from 4-6 mg．Up to 2 mg can be given as an additional dose during surgery．The initial dose(4-6 mg)corresponds to approximately 20-30 mg of tubocurarine．

Anaesthetists accustomed to administering larger doses can exceed the recommended doses．

It is not advisable to mix Pavulon with other solutions in the same syringe as any change in the pH might bring about precipitation．

Contra-indications

The use of Pavulon is contra-indicated for patients with myastenia gravis．

Warning

As Pavulon is excreted in a partly unchanged state it is advisable to take the necessary care when administering it to patients with disturbed kidney function．

Precautions

As with other non-depolarizing preparations，the administration of ether，halothane or cyclopropane increases the activity of Pavulon；the respiratory muscles are also affected by Pavulon；for this reason all patients should be connected up to a respirator．The patient’s own respiration can be restored by the intravenous administration of 2．5 mg neostigmine methylsulphate together with 1．2 mg atropine sulphate．It is very important to ensure that the patient is breathing spontaneously，deeply and regularly before he leaves the operating theatre．When using suxamethonium for intubation，for instance，it should be ascertained that the effect of this muscle relaxant has worn off before administering Pavulon．Since it is difficult to determine what the implications of the use of such preparations during pregnancy might be，it is advisable to weigh up the advantages and disadvantages of the administration of such preparations one against the other when considering their administration during pregnancy．

As long as the results or the trials aimed at excluding a possible effect on the muscle tonus of the newly born child are not yet known，the use of this preparation of childbirth is not recommended．

Storage and stability

In general Pavulon should be stored in a refrigerator and can then be kept until the expiry date printed on the pack．Without refrigeration Pavulon remains stable for 6 weeks．

Pack

Ampoules with 2 ml containing 2 mg per ml．

In correspondance please quote packing number．

Manufacturer

N．V．Organon Oss Holland