硬膜外麻醉下两种布比卡因对心肌毒性与肝肾功能的对比观察

目的：对比观察左旋布比卡因和布比卡因对病人心肌酶谱及肝肾功能的影响。方法：择期行胆囊手术的病人60例，随机分成左旋布比卡因（A）组30例和布比卡因（B）组30例，选择T8～9间隙行硬膜外穿刺置管，两组分别注入左旋布比卡因或布比卡因，注射局麻药前及术后24h抽取静脉血测定天门氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、羟丁酸脱氢酶（BDH）、肌酸激酶（CK）。结果：两组术后ALT（丙氨酸转氨酶）、ASF、BUN（血液尿素氮）、CK均略有增高，与术前对照有显著性差异（P〈0．05或P〈0．01），组间对照无显著性差异（P〉0．05）；两组术后ASF、LDH、BDH均有一定程度的升高，与术前对照有显著性差异（P〈0．05），但组间对照无显著性差异（E〉0．05）；而术后CK均明显增加，与术前对照有非常显著差异（P〈0．01），B组增加较A组明显，两组比较有显著性差异（P〈0．05）。结论：使用两种布比卡因进行硬膜外麻醉，麻醉效果均较好，无明显差异；但从心肌酶谱等指标看左旋布比卡因更安全，心肌毒性更低，有一定优越性。

Comparison of effects of two kinds of bupivacaine on myocardium and functions of liver and kidneys

Objective:To compare the effects of levobupivaca ine on myocardium and functions of liver and kidneys with those of bupivacaine. Methods: 60 cases that would undergo selective operation on gallbladder were divided into levobupivacaine group(n=30) and bupivacaine group( n=30). All of these subjects were anesthetized with continuous epidural infusion . Before infusion of the levobupivacaine or bupivacaine and after post - operat ion 24 h, the samples of their venous blood were collected in order to determine the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), l actate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (BDH) and creatine kin ase (CK) of both groups. Results: After the operation, the l evels of ALT, AST, blood urea nitrogen(BUN), LDH and BDH increased at different extent, and were higher significantly than those before the operation(P<0. 01 or 0.05). But the differences of these laboratory indexes were not significa nt between two groups(P>0.05). CK increased very significantly after the o peration than that before the operation(P<0.01), and CK did more remarkabl y in bupivacaine group than in levobupivacaine group(P<0.05). C onclusion: These two kinds of bupivacaines have same anesthetic effects , but it seems that levobupivacaine is safer than bupivacaine based on the chang es of myocardial enzymes.