Jelen-Esselborn S, Blobner M, Hölzl J, Felber A R
Institut für Anästhesiologie, Technische Universität, München.
Anaesthesiol Reanim. 1992;17(4):195-205.
Calcium entry blockers are now widely employed in the treatment of cardiovascular diseases and perioperative hypertension. In patients with coronary heart disease nifedipine therapy should be continued perioperatively to avoid coronary artery spasm. Animal experiments have demonstrated that calcium entry blockers potentiate the neuromuscular blockade induced by nondepolarizing blocking agents. In patients, an atracurium-induced neuromuscular depression is prolonged by intravenous nifedipine. In this prospective clinical study we evaluated the effect of chronic oral nifedipine therapy on the duration of neuromuscular block by atracurium. Sixty patients anaesthetized with isoflurane in nitrous oxide/oxygen were recruited for this study. Thirty of these were on chronic oral nifedipine therapy and received their normal morning dose before premedication. The control consisted of 30 patients of similar age and status but not taking any calcium entry blockers. Monitoring included noninvasive blood pressure, heart rate, pharyngeal temperature, physical breathing parameters and neuromuscular transmission with a Datex Relaxograph TM ("train of four"-principle). After inducing hypnosis 0.5 mg/kg atracurium were administered for muscular relaxation. The duration of block from administration of the relaxant to recovery of first twitch height (T1) to 25% of control twitch height was registered as duration of initial block. When T1 reached 25% a repetition dose of 0.2 mg/kg atracurium was injected. The time till recovery of T1 to 25% was recorded as the duration of the repetition dose. Results were compared using Student's t-test for unpaired data. There was a significant prolongation of the duration of initial block from 38 min +/- 10 min in the control group to 46 min +/- 8 min in the therapy group (P < 0.01). The duration of the repetition dose rose from 30 min +/- 8 min in the control group to 38 min +/- 7 min in the therapy group (P < 0.001). Daily nifedipine doses varied from 10 mg in the morning to 40 mg divided into single doses with no influence on the prolongation of neuromuscular block. Our results confirm previous assumptions of synergistic effects of nifedipine and neuromuscular blocking drugs in patients. Chronic oral nifedipine therapy potentiates neuromuscular blockade by atracurium as does nifedipine intravenously. This effect should be considered in the treatment of cardiovascular diseases with nifedipine in the perioperative period.
钙通道阻滞剂目前广泛应用于心血管疾病和围手术期高血压的治疗。对于冠心病患者，围手术期应继续使用硝苯地平治疗以避免冠状动脉痉挛。动物实验表明，钙通道阻滞剂可增强非去极化肌松药引起的神经肌肉阻滞作用。在患者中，静脉注射硝苯地平可延长阿曲库铵引起的神经肌肉抑制作用。在这项前瞻性临床研究中，我们评估了慢性口服硝苯地平治疗对阿曲库铵神经肌肉阻滞持续时间的影响。本研究招募了60例在氧化亚氮/氧气中接受异氟烷麻醉的患者。其中30例接受慢性口服硝苯地平治疗，并在术前用药前服用其正常的晨起剂量。对照组由30例年龄和病情相似但未服用任何钙通道阻滞剂的患者组成。监测包括无创血压、心率、咽部温度、物理呼吸参数以及使用Datex Relaxograph TM（“四个成串刺激”原理）监测神经肌肉传递。诱导催眠后，给予0.5mg/kg阿曲库铵进行肌肉松弛。从给予肌松药到第一个肌颤搐高度（T1）恢复至对照肌颤搐高度的25%的阻滞持续时间被记录为初始阻滞持续时间。当T1达到25%时，注射0.2mg/kg阿曲库铵的重复剂量。记录T1恢复至25%的时间作为重复剂量的持续时间。使用学生t检验对未配对数据进行结果比较。初始阻滞持续时间从对照组的38分钟±10分钟显著延长至治疗组的46分钟±8分钟（P<0.01）。重复剂量的持续时间从对照组的30分钟±8分钟增加至治疗组的38分钟±7分钟（P<0.001）。每日硝苯地平剂量从晨起10mg至分单次剂量服用的40mg不等，对神经肌肉阻滞的延长无影响。我们的结果证实了之前关于硝苯地平与神经肌肉阻滞药物在患者中协同作用的假设。慢性口服硝苯地平治疗与静脉注射硝苯地平一样，可增强阿曲库铵的神经肌肉阻滞作用。在围手术期使用硝苯地平治疗心血管疾病时应考虑到这种作用。
