- 作者： 李世俊; 何善台
- 作者服務機構： 三軍總醫院外科部麻醉部; 國防醫學院外科學科麻醉學科
- 中文摘要：
五位經確定診斷患有重症肌無力症(myasthenia gravis)及十二位無神經肌肉病變之患者，因外科手術需要而施予全
身麻醉，在病人經麻醉誘導後，由靜脈注射不同劑量(18μg,36μg,72μg kg¯1）Verapamil以觀察其對誘發肌電圖（e-
voked electromyograph)、心電圖P-R interval、心跳及血壓之影響。實驗結果顯示Verapamil在72μg kg¯1之劑量下
具有統計意義，延長心電圖之P-R interval，由0.122±0.04增加為0.152±0.005秒，心跳由每分鐘78.7±9.5降為69.6
±6.6次，但對血壓則無明顯影響，再以上述對心臟血管系統之影響比較兩組間的差異亦無統計意義。此外，由結果還顯
示Verapamil於重症肌無力症病患在36μg kg¯1及72μg kg¯1之劑量下可使誘發肌電圖由原先100%分別降低為84.50±
3.30%及79.25±3.52％，且兩者與未給Verapamil前相較，其抑制神經肌肉之傳導作用在統計上具有意義，但對無神經
肌肉病變之患者則無影響。本實驗結果發現Verapamil可增強重症肌無力症患者之肌肉鬆弛作用，可以提供在臨床上當
此類病患需使用該等藥物時需特別小心，以避免因肌肉鬆弛而造成呼吸衰竭。本實驗之結果未能闡明該等抑制神經肌肉
傳導作用之機轉，則有待未來再做進一步探討。
r - 英文摘要：
The effects of intravenous verapamil（18μg, 36μg, 72μg kg¯1）on neuromuscular transmission were
studied in the integrated electromyographic (IEMG) responses of indirectly stimulated thenar muscles of
five myasthenia gravis patients and 12 other patients without neuromuscular diseases anesthetized with
thiopentone, pethidine and nitrous oxide in oxygen. In all subjects, verapamil 72μg kg¯1 significantly pro-
longed the P-R interval of the electrocardiogram from 0.122±0.004 to 0.152±0.005 see and decreased the
heart rate from 78.7±9.5 to 69.6±6.6 beat min¯1, but it had no effect on arterial blood pressure. Verapa-
mil 36μg, 72μg kg¯1 significantly inhibited the IEMG to 84.50±3.30% and 79.25±3.52% of control value,
respectively, in the myasthenia gravis patients. However, these doses did not influence the IEMG of normal
subjects. The specific site and mechanism of verapamil's neuromuscular blocking action remain unclear. It
is concluded that verapamil can produce neuromuscular blocking action in myasthenia gravis patients and
that therefore caution is needed in administering verapamil to such patients.
a - 中文關鍵字： verpamil; myasthenia gravis; neuromuscular transmission
- 英文關鍵字： --
