卡马西平对维库溴铵肌松时效的影响

Influences of carbamzepinum on the neuromuscular blocking action of vecuroniun

目的 观察卡马西平对维库溴铵肌松时效的影响。方法 择期神经外科手术患者 4 2例 ,ASAⅠ -Ⅱ级 ,A组 (n =10 )肿瘤组 ,无癫痫病史及抗惊厥药服用史 ;B组 (n =10 )癫痫病史 2 2天至 2年 ,未服用抗惊厥药 ;C组 (n =12 )癫痫病史 2 7天至 2年 ,持续服用卡马西平控制病情 ;D组 (n =10 )癫痫病史 9- 12年 ,持续服用卡马西平控制病情。麻醉诱导均采用芬太尼 2 μg/kg、异丙酚 2mg/kg、瑚珀胆碱 1.5mg/kg。TOF(四个成串刺激 )恢复 10 0 %后 ,采用异氟醚 (1MAC)维持麻醉 ,持续 15min时 ,静注维库溴铵 0 .1mg/kg ,用肌松监测仪监测四组TOF的变化。结果 维库溴铵的起效时间四组间均无显著差异 (P >0 .0 5 ) ,临床作用时间 ,TOF恢复 75 %的时间 ,恢复指数 ,A、B组间无显著差异 (P >0 .0 5 ) ,但C、D组分别比A、B组明显缩短 (P <0 .0 5 ) ,D组又比C组明显缩短 (P <0 .0 5 )。结论 术前服用卡马西平可降低维库溴铵的肌松作用 ,缩短肌松恢复时间 。

Objectives To investigate the influences of carbamzepinum on the neuromuscular blocking action of vecuronium.Methods Forty-two patients ASA gradeⅠ-Ⅱ, scheduled for selective neurosurgery,were allocated into four group,group A (n=10) without epilepsy and any anticonvulsant administration; group B (n=10) with epilepsy for 22 days to 2 years,without any anticonvulsant administration;group C (n=12) with epilepsy and carbamzepinum administration for 27 days to 2 years;group D (n=10) with epilepsy and carbamzepinum administration for 9-12 years.Anesthesia was induced with intravenous fentany 2μg/kg and propofol 2mg/kg and succinycholine 1.5mg/kg.When TOF returned to 100%, anesthesia was induced with isoflurane for anesthesia maintenance.After lasting 15min,vecuroniun was intravenously infused at 0.1mg/kg.The onset time and degree of neuromuscular blockade were monitored with train-of-four (TOF) technique.Results There are no significant differences among groups in the onset times of muscular relaxation.The time of clinical muscular relaxation, the time of TOF recovery to 75% and recovery index in group C and D were shorter than in group A and B (P<0.05), respectively, and in group D were shorter than in group C (P<0.05),but there are no significant differences between group A and B (P>0.05).Conclusions Long-term administration with carbamzepinum before surgery can greatly reduce the neuromuscular blocking action of vecuronium during operation, shorten recovery of the neuromuscular blocking action, and along with carbamzepinum administration, the degree of the influence is more and more stronger.