Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
Anesthesiology. 2011 Jul;115(1):28-35. doi: 10.1097/ALN.0b013e31822079fa.
Statins cause structural changes in myocytes and provoke myotoxicity, myopathy, and myalgias. Thus, patients taking statins may be especially susceptible to succinylcholine-induced muscle injury. The authors tested the hypothesis that succinylcholine increases plasma concentrations of myoglobin, potassium, and creatine kinase more in patients who take statins than in those who do not and that succinylcholine-induced postoperative muscle pain is aggravated in statin users.
Patients who took statins for at least 3 months and those who had never used statins were enrolled. General anesthesia was induced and included 1.5 mg/kg succinylcholine for intubation. The incidence and degree of fasciculation after succinylcholine administration were recorded. Blood samples were obtained before induction and 5 and 20 min and 24 h after succinylcholine administration. Patients were interviewed 2 and 24 h after surgery to determine the degree of myalgia.
The authors enrolled 38 patients who used statins and 32 who did not. At 20 min, myoglobin was higher in statin users versus nonusers (ratio of medians 1.34 [95% CI: 1.1, 1.7], P = 0.018). Fasciculations in statin users were more intense than in nonusers (P = 0.047). However, plasma potassium and creatine kinase concentrations were similar in statin users and nonusers, as was muscle pain.
The plasma myoglobin concentration at 20 min was significantly greater in statin users than nonusers, although the difference seems unlikely to be clinically important. The study results suggest that the effect of succinylcholine given to patients taking statins is likely to be small and probably of limited clinical consequence.
他汀类药物会引起心肌细胞结构改变，并引发肌毒性、肌病和肌痛。因此，服用他汀类药物的患者可能特别容易受到琥珀酰胆碱引起的肌肉损伤。作者检验了这样一个假设，即琥珀酰胆碱会增加服用他汀类药物的患者的血浆肌红蛋白、钾和肌酸激酶浓度，高于未服用他汀类药物的患者，并且他汀类药物使用者的术后肌肉疼痛会因琥珀酰胆碱而加重。
纳入至少服用他汀类药物 3 个月的患者和从未使用过他汀类药物的患者。全身麻醉诱导，包括 1.5mg/kg 琥珀酰胆碱用于插管。记录琥珀酰胆碱给药后的肌束震颤发生情况和严重程度。在诱导前、琥珀酰胆碱给药后 5 分钟、20 分钟和 24 小时采集血样。在手术后 2 小时和 24 小时对患者进行采访，以确定肌肉疼痛的程度。
作者纳入了 38 名服用他汀类药物的患者和 32 名未服用他汀类药物的患者。在 20 分钟时，服用他汀类药物的患者的肌红蛋白高于未服用他汀类药物的患者（中位数比值 1.34[95%CI:1.1,1.7]，P=0.018）。服用他汀类药物的患者的肌束震颤比未服用他汀类药物的患者更强烈（P=0.047）。然而，服用他汀类药物的患者和未服用他汀类药物的患者的血浆钾和肌酸激酶浓度相似，肌肉疼痛也是如此。
在 20 分钟时，服用他汀类药物的患者的血浆肌红蛋白浓度明显高于未服用他汀类药物的患者，尽管这种差异似乎没有临床意义。研究结果表明，给予服用他汀类药物的患者琥珀酰胆碱的效果可能很小，并且可能具有有限的临床意义。
