探討Diphenylhydantoin及d-Tubocurariner減低Succinylcholine引起副作用的效應

THE STUDY OF PRETREATMENT WITH DIPHENYLHYDANTOIN OR D-TUBOCURARINE ON SUCCINYLCHOLINE-INDUCED ADVERSE EFFECTS

郭文雄(Wein-Shung Kuo)；何善台(Shung-Tai Ho)；胡幼圃(Oliver Yoa-Pu Hu)；李正華(Cheng-Hwa Li)；黃啟顯(Chii-Shean Hwing)

Diphenylhydantoin ； d-Tubocurarine ； Succinylcholine ； Fas ciculation ； Myalgia

Acta Anaesthesiologica Sinica

28卷3期（1990 / 09 / 01）

323 - 328

繁體中文

小劑量非去極化肌肉鬆弛劑常用來減低或避免Succinylchdine（SCh）產生的副作用。此法效果雖然不錯，但造成神經肌肉的運動終板對SCh的感性降低，需要增加SCh的劑量才能達到滿意的鬆施效果。Hartman等醫師最近指出Diphenylhydantoin（DPH）不但可以抑制SCh誘發肌肉顫動（Fasciculation）的發生，而且可以增加SCh的鬆弛效果。所以本實驗比較DPH與d-Tubocuraine（d-TC）減低SCh副作用的效果。選擇欲接受全身麻醉的54個ASA I～II的病人，分別以Phacabo（生理食鹽水）、DPH及d-TC作為SCh的麻醉前給藥，觀察及比較病人肌肉顫動、術後24小時肌肉疼痛，插管難易程度與血中鉀離子、CK（Creatine kinase）及DPH濃度。DPH可以減低肌肉顫動的發生，但不會減輕肌肉的疼痛，也不影響插管的難易度；血中鉀離子濃度沒有增加或減少；雖然CK有增加，但不一定為SCh的效果，只能代表肌肉有損傷的現象；DPH也無法減低CK的增加；血中DPH濃度8.49±1.55mg/mL，表示使用的小劑量，沒有臨床安全的顧慮。總而言之，要減少SCh副作用，除了使用小劑量非去極化肌肉鬆弛劑以外，DPH也是另一個選擇用藥。尤其在神經外科病人，DPH又有抗癲癇作用，可謂一舉兩得，是一個理想的預先給藥。

Intravenous succinylcholine (SCh) is widely used as a muscle relaxant but it is often associated with adverse effects, including muscle fasciculations, postoperative myalgia, elevated serum potassium (K^+) and creatine phosphokinase (CPK), etc. The present study was undertaken to evaluate the effects of pretreatment with Diphenylhydantoin (DPH) or d-Tubocurarine (d-TC) on SCh-induced adverse effects. 54 ASA I-II adult patients were randomly divided into 3 groups of 18 patients each. Four min before injection of SCh, group A received 1 ml of normal saline as a control group, group B DPH 2.5mg kg^(-1), and group C d-TC 50 μg kg^(-1). Anesthesia was induced with thiopentone 3-4 mg kg^(-1) and then SCh was given to facilitate tracheal intubation. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen. Muscle fasciculations, postoperative 24 hours myalgia, intubating conditions and levels of serum K^+, CPK and DPH were recorded in every patient. All data were analyzed with Chi-Square and ANOVA tests. DPH and d-TC significantly decreased the incidence of fasciculations, whereas there were no differences regarding intubating condition, post-operative myalgia, and serum K^+ among three groups. DPH concentration was 8.49±1.55 μg ml^(-1), Serum CPK was increased postoperatively in three groups. Pretreatment with DPH 2.5 mg kg^(-1) or d-TC 50 μg kg^(-1) effectively decreased SChinduced fasciculations and did not affect intubating condition facilitated with SCh 1.5 mg kg^(-1). Nevertheless, these pretreatment did not improve postoperative myalgia and decrease serum CPK. The reason why pretreatment with DPH or d-TC did not get tracheal conditions worse than control group is not clear. In conclusion, the effects of pretreatment with DPH 2.5 mg kg^(-1) on SCh-induced tracheal conditions and adverse effects are similar to those of pretreatment with d-TC 50 μg kg^(-1).