两种腰麻液用于剖宫产手术效果的比较

目的 比较0.75%左旋布比卡因1.5 ml与0.75%左旋布比卡因1.5 ml+10%葡萄糖1.0 ml在剖宫产手术中腰麻的效果.方法 60名孕单胎产妇分为2组,分别用0.75%左旋布比卡因1.5 ml(A组)和0.75%左旋布比卡因1.5 ml+10%葡萄糖1.0 ml(B组)行硬腰联合麻醉(CSEA),比较2种方...     

脂肪乳剂对左旋布比卡因致离体豚鼠心脏停跳的复苏作用

目的 探讨脂肪乳剂及其联合应用肾上腺素或血管加压素对左旋布比卡因中毒的离体豚鼠心脏停跳的复苏作用.方法 24只豚鼠随机分成4组,建立Langendorff离体心脏灌注模型,用300μmo1/L左旋布比卡因灌注离体豚鼠心脏使之停跳后,分别应用台氏液(T组)、0.2%脂肪乳剂(L组)、0.2%脂肪乳剂联合0.5μg/mL肾上腺素(LE组)、0.2%脂肪乳剂联合7.5 U/L血管加压素(LV组)灌注使之复跳,记录各组灌注后从心脏停跳至恢复窦性心律的时间(复跳时间)以及复跳稳定后2 min时的心率、心肌收缩力、冠状动脉流量、心电图PR间期,并在透射电子显微镜下观察左心室心肌超微结构的改变.结果 与T组相比,L组的复跳时间显著缩短(P＜0.05).与L组相比,LE组的复跳时间显著缩短(P＜0.05),冠状动脉流量显著增加(P＜0.05).LV组与L组间各项指标的差异均无统计学意义(P值均＞0.05).与T组相比,L组的心肌组织线粒体损伤减轻.结论 脂肪乳剂有加快左旋布比卡因中毒的离体豚鼠心脏恢复窦性心律的作用,肾上腺素对其作用有促进效果,但血管加压素对其并无明显影响,脂肪乳剂对复苏心肌组织的损害程度也有减轻作用.     

盐酸左布比卡因的合成

以N-(2′,6′-二甲基苯基)-2-哌啶酰胺为起始原料,经烷基化、拆分、成盐合成盐酸左布比卡因,总收率19%.     

Postoperative Analgesic Effect of Locally Infiltrated Levobupivacaine in Fleur-de-Lys Abdominoplasty

Background This prospective double-blind study compared the analgesic properties of locally infiltrated levobupivacaine with those of ropivacaine in fleur-de-lys abdominoplasty. Methods A total of 46 patients subjected to fleur-de-lis abdominoplasty under general anesthesia were included. The patients were randomly assigned to receive local infiltration of the peri-incisional and dissected area with the following solutions: group A (placebo group, n = 15) received 100 ml of saline 0.9%, group B (n = 15) received 50 ml of ropivacaine 0.75% in 50 ml of saline 0.9%, and group C (n = 16) received 60 ml of levobupivacaine 0.25% in 40 ml of saline 0.9%. The anesthetic technique was standardized for all the groups. The patients were asked to assess their pain at rest on a visual analog scale (VAS) at 2 h, 4 h, and 24 h postoperatively. Data were analyzed by mixed analysis of variance (ANOVA), simple ANOVA, and repeated measures ANOVA, followed by Tukey’s test. Results Groups B and C did not differ significantly in their VAS scores at 2 h postoperatively, but group C experienced significantly less pain (p < 0.001) than either the control group or the B group at 4 h and 24 h postoperatively. Group B also registered significantly lower VAS scores (p < 0.001) than the placebo group at 4 h postoperatively. Conclusions It is concluded that for mini abdominoplasty, adequate analgesia is achieved for at least 4 h postoperatively by local tissue infiltration with either ropivacaine or levobupivacaine. However, in terms of intensity and duration of analgesia, levobupivacaine was found to be more effective than ropivacaine in reducing postoperative pain associated with mini abdominoplasty.     

左布比卡因骶管麻醉在小儿手术中的应用

目的:对小儿病人实施新的局部麻醉剂左布比卡因骶管麻醉,将左布比卡因及布比卡因的临床作用及血液动力学影响进行比较,并对左布比卡因的药效学进行了分析。方法:将78名2004年6～12月在我院施行择期手术的小儿随机分为A、B两组,每组39例,A组注入0.25%左布比卡因0.8ml/kg;B组注入0.25%布比卡因0.8ml/kg。术后在苏醒室监测病人的麻醉镇痛时间、血液动力学改变并观察两组的麻醉时间及运动恢复时间。结果:所有小儿均获得满意的麻醉效果,两组的镇痛时间类似,A组的镇痛时间为223±37min,B组的镇痛时间为216±29min,差异不显著。所有小儿均出现明显的平均动脉压下降及心率减慢,A组的平均动脉压及心率分别下降到74±19mmHg及70±16次/min,而B组为77±18mmHg及73±21次/min,两组差异不显著。结论:左布比卡因骶管麻醉提供了有效的小儿麻醉镇痛。麻醉效果与布比卡因类似而心脏毒性较低。     

小儿骶管应用左旋布比卡因复合舒芬太尼对术后镇痛作用的观察

目的 观察小儿骶管应用左旋布比卡因复合舒芬太尼对术后镇痛的影响.方法 收集2010年4月至2011年4月在我院住院的2-6岁择期行下腹部、会阴和下肢手术60例患儿.随机分成左旋布比卡因组（Ⅰ组）和左旋布比卡因复合不同浓度舒芬太尼组（Ⅱ组）和（Ⅲ组）,每组20例.入室后开放静脉通路,监测平均动脉压（MAP）、心率（HR）及脉搏血氧饱和度（SpO2）.麻醉诱导均采用静脉注射氯胺酮1 mg/kg,异丙酚2 mg/kg,置人喉罩进行机械通气.然后行骶管穿刺,成功后Ⅰ组注入0.25％左旋布比卡因,Ⅱ组注入0.25％左旋布比卡因与舒芬太尼0.5μg/ml混合液,Ⅲ组注入0.25％左旋布比卡因与舒芬太尼1.0 μg/ml混合液,三组均按l ml/kg缓慢注入.分别于术后2、4、8、12、16、24h观察镇痛效果,记录镇痛评分、镇痛时间、苏醒时间及不良反应.结果 术后4、8、12 h镇痛评分Ⅱ组和Ⅲ组明显低于Ⅰ组,差异有统计学意义（P＜0.05）;术后8h镇痛评分Ⅲ组低于Ⅱ组,差异有统计学意义（P＜0.05）;术后2、16、24h的镇痛评分三组相比差异无统计学意义（P＞0.05）;Ⅱ组和Ⅲ组的镇痛时间明显长于Ⅰ组（P＜0.05）,Ⅲ组比Ⅱ组的镇痛时间明显延长（P＜0.05）,三组患儿术后苏醒时间差异无统计学意义（P＜0.05）,三组患儿术后均无呼吸抑制.Ⅱ和Ⅲ组各有1例患儿在术后出现面部皮肤瘙痒及1例患儿出现运动阻滞,术后约3h运动功能完全恢复,Ⅲ组有1例患儿在术后出现恶心呕吐.结论 0.25％左旋布比卡因复合0.5 μg/ml及1.0μg/ml舒芬太尼均可安全应用于小儿骶管麻醉及术后镇痛,且可增强术后镇痛效果,延长左旋布比卡因镇痛持续时间,不良反应少,而复合1.0μg/ml舒芬太尼组的术后镇痛效果更好.     

舒芬与左布比卡因复合在妇科腹腔镜术后镇痛作用

目的:探讨舒芬太尼复合左布比卡因局部浸润在妇科腹腔镜手术后镇痛效果.方法:选择全麻腹腔镜下卵巢及子宫肌瘤手术患者120例(ASA Ⅰ～Ⅱ级)随机分为治疗组与对照组各60例,治疗组用0.05％舒芬太尼注射液15μg+0.25％左布比卡因75mg加生理盐水至30al,对照组0.05％舒芬太尼注射液15μg+生理盐水至30ml,手术结束术者在腹腔创面喷洒15ml,退出腔镜后在脐切口及下腹两个切口共三个切口每个部位注射5ml,两组注射方法相同.全麻药物均按体重给药并在一个时间点停药,记录停药后苏醒期反应、呼吸频率、血压、心率及疼痛反应和手术后1h、6h、12h、24h及48h的VAS评分.结果:治疗组苏醒期血压、心率与对照组比较差异有显著性P＜0.05,苏醒后安静无疼痛、在术后备时间点VAS评分较对照组差异有显著性P＜0.05.结论:舒芬太尼复合左布比卡因局部注射在妇科腹腔镜手术后具有良好的镇痛镇静效果及安全性.     

左旋布比卡因头皮神经阻滞在开颅手术中的应用

目的 对比研究开颅手术中使用左旋布比卡因头皮神经阻滞复合全身麻醉对循环指标的影响及手术相关麻醉费用情况。方法 2011年3月至2013年8月神经外科需要开颅手术患者60例随机分为两组：对照（D）组（n=30）和左旋布比卡因（L）组（n=30）。麻醉诱导插管后L组采用0.25%左旋布比卡因行患侧相关头皮神经阻滞,D组不实行神经阻滞但常规按时给予舒芬太尼和肌松药,两组手术中均采用丙泊酚持续输注维持麻醉。记录术中镇痛、镇静药用药量、循环相关指标、拔管后疼痛视觉模拟评分（VAS）值及手术相关麻醉费用。结果 D组与L组比较,手术期舒芬太尼用量[（1.67±0.24）、（0.20±0.11）μg/kg],丙泊酚用量[（5.27±2.15）、（3.62±1.36）mg·kg-1·h-1],拔管后VAS评分[（7.21±1.40）、（3.15±1.20）分],手术相关麻醉费用[（1 683±64）、（1 327±71）元],前者均高于后者（P均〈0.05）;手术开始至苏醒拔管,D组平均动脉压、心率上升较L组明显（P均〈0.05）。结论左旋布比卡因头皮神经阻滞操作简单,安全性高,术中血流动力学稳定,复合全身麻醉能增加麻醉的可控性,术毕苏醒拔管平稳,可降低苏醒期的风险,减少住院时间和手术相关的麻醉费用,是神经外科手术麻醉的一种新的辅助技术。     

高浓度／低容量与低浓度／高容量左旋布比卡因在胸科术后硬膜外镇痛的效果比较

目的：比较高浓度／低容量与低浓度／高容量左旋布比卡因镇痛液在胸科术后硬膜外镇痛中的效果及安全性。方法将开胸手术肺癌患者58例,采用随机数字表法分为高浓度／低容量组（A组）与低浓度／高容量组（B 组）,每组29例,两组术前、术中措施、麻醉及术式均相同,于手术结束前15 min,A组用0．25％左旋布比卡因100 ml,B组用0．125％左旋布比卡因200 ml硬膜外镇痛,两组镇痛时间均为48 h。观察两组术后4 h、8 h、12 h、24 h及48 h视觉模拟镇痛评分（ VAS）、Ramsay镇静评分、Bromage运动神经阻滞评分、心率、平均动脉压、血氧饱和度和不良反应。结果 B组各时点VAS、Bromage运动神经阻滞评分,平均动脉压均低于A组（P均＜0．05）,但B组各时点的Ramsay镇静评分高于A组（P均＜0．05）,两组心率、血氧饱和度比较,差异无统计学意义（P＞0．05）。结论与高浓度／低容量相比,低浓度／高容量左旋布比卡因镇痛液用于胸科术后硬膜外镇痛,具有镇痛、镇静效果好、运动神经阻滞效应轻、平均动脉压波动大等特点。     

The Comparison of the Effects of Different Doses of Levobupivacaine Infiltration on Wound Healing

Introduction-Aim: The easiest method in postoperative analgesia is the infiltration of the wound with local anesthetic drugs. Although many local anesthetic drugs have been used for this type of infiltration, studies on levobupivacaine are rare. The aim of this study was to investigate the effects of different concentrations of levobupivacaine infiltration on wound healing. Method: Forty female Wistar-Albino rats (280–300 g) were included in the study, which were randomly separated into four groups. Rats were infiltrated with 1.25 mg/mL levobupivacaine in group L_1.25 (n = 10), with 2.50 mg/mL levobupivacaine in group L_2.5 (n = 10), with 3.75 mg/mL levobupivacaine in group L_3.75 (n = 10), and with normal saline in control group (n = 10). Breaking-strength measurements, levels of hydroxyproline, and fibrotic index were evaluated in the tissue samples taken from the rats. Results: When the breaking-strength measurements were evaluated, we have found a significant difference between the control and the study groups (p < 0.05). In the intergroup comparison the difference between groups L_1.25 and L_3.75 was statistically significant (p < 0.05). In all of the levobupivacaine groups the levels of hydroxyproline were higher compared to the control group. Also significant differences were observed between groups L_1.25 and L_2.5 and groups L_1.25 and L_3.75 (p < 0.05). The levels of tissue fibrotic index were higher in all of the levobupivacaine groups compared to the control group (p < 0.05) and also a difference was observed between groups L_1.25 and L_3.75 in terms of tissue fibrotic index (p < 0.05). Conclusion: We have concluded that levobupivacaine used in clinical doses have a significant effect on the fastening of wound healing and this effect increases with an increase in the concentration of the levobupivacaine. We believe that levobupivacaine will be more widely preferred in the near future in the postoperative analgesia.