抗惊厥药物对维库溴铵神经肌肉阻滞时效的影响

Influences of anticonvulsants on the neuromuscular blocking action of vecuromium

目的 观察抗惊厥药物对维库溴铵时效的影响。方法 择期神经外科手术患者 32例 ,ASAⅠ～Ⅱ级。A组 (对照组 ,n =12 )未服用抗惊厥药物 ;B组 (n =10 )术前服用抗惊厥药物≤ 10d ;C组 (n =10 )术前服用抗惊厥药物超过一年。均采用异氟醚 异丙酚静吸复合麻醉 ,用四个成串刺激监测三组患者静注维库溴铵 0 1mg/kg后的时 效关系。 结果 A、B、C组起效时间无显著性差异 (P >0 0 5 ) ;完全阻滞时间分别为 (2 7 0± 2 2 )min、(2 0 4± 1 4)min和 (12 9± 1 2 )min ,临床作用时间分别为 (37 8± 2 9)min、(30 4± 1 2 )min和 (19 8± 1 5 )min ,B组与A组比较P <0 0 5 ,C组与A、B两组相比P <0 0 1;恢复指数A组 (13 8± 1 9)min、B组 (8 9± 1 1)min、C组 (7 3± 1 0 )min ,C组与A组间有显著性差异 (P <0 0 5 )。结论 术前长期或围术期服用抗惊厥药物可明显缩短维库溴铵的完全阻滞时间、临床作用时间 ,降低其恢复指数。

Objective To investigate the influence of anticonvulsants on the neuromuscular blocking action of vecuroniumMethods Thirty-two patients ASA grade Ⅰ-Ⅱ,scheduled for selective neurosurgery, were allocated into three groups according to whether or not anticonvulsant was administered before surgery, group A (n=12) without any anticonvulsant administration as control, group B (n=10) with the anticonvulsant administration for less than 10 days ,and group C (n=10) with the anticonvulsant administration for more than 1 yearAnesthesia was maintained with propofol and isofluraneFollowing intravenous administration with vecuronium,01mg·kg -1, the neuromuscular function was monitored using Biometer acceleromyography to measure response of the adductor pollicis to train-of-four (TOF) stimulation of the ulnar nerveResults The onset times of muscular relaxation in group A,B and C were (41±03)min, (35±03)min and (39±03)min,respectively, without significant differences among three groups (P>005)The complete block times were (270±22)min, (204±14)min and (129±12)min respectively, with significant differences among three groups (P<005)The clinical block times were (378±29)min, (304±12)min and (198±15)min in group A,B and C separately, with significant differences among three groups (P<005)The recovery index in group A,B and C were (138±19)min, (89±11)min and (73±10)min respectively, only with significant difference between group A and C (P<005)Conclusions Long-term administration with anticonvulsants before surgery can greatly reduce the neuromuscular blocking action of vecuronium during operation