国产盐酸氯普鲁卡因临床效应分析

目的 分析研究国产盐酸氯普卡因冻干粉与针剂分别应用于硬膜外麻醉、臂丛神经阻滞、局部浸润麻醉的效果。方法 采用随机双盲目的方法分组进行研究。硬膜外麻醉45例,分为3组（每组15例）：Ⅰ组1．7％利多卡因,Ⅱ组氯普鲁卡因粉剂稀释为3％,Ⅲ组3％氯普鲁卡因针剂;臂丛神经阻滞40例,分为4组（每组10例）;I组1．33％利多卡因,Ⅱ组2％普鲁卡因,Ⅲ组氯普鲁卡因粉剂稀释为2％,Ⅳ组2％氯普鲁卡因针刺;局部浸润麻醉30例（每例10例）分为3组：Ⅰ组1％普鲁卡因,Ⅱ组氯普鲁卡因粉剂稀释为1％,Ⅲ组1％氯普鲁卡因针剂。结果 硬膜外组中除Ⅲ组运动消失时间明显短于Ⅰ组外（P＜0．05）,其余指标无明显统计学差异;臂全神经阻滞组中,实验组疼痛恢复及运动恢复时间少于对照组I组,有统计学差异（P＜0．01）,实验组Ⅲ组疼痛及运动恢复时间均比对照组Ⅱ组长（P＜0．05）;局部浸润麻醉组中两实验组疼痛消失迅速,疼痛恢复时间均长于对照组,Ⅲ组短于Ⅱ组。结论 国产盐酸氯普鲁卡因麻醉起效迅速,性能稳定,粉剂比针剂更佳;作用维持时间介于盐酸普鲁卡因与利多卡因之间。     

Local anaesthetic agents

Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pK_a and the ambient pH. Local anaesthetic agents, being weak bases, are bound in the plasma to α1-acid glycoproteins, influencing duration of action. Esters undergo hydrolysis by esterases in the plasma. Amides are subject to phase I and II hepatic cytochrome P450 metabolism. The development of the S-enantiomers, levobupivacaine and ropivacaine, has not been without some controversy with regards to therapeutic benefits when assessed by clinical potency models such as the minimum local analgesic concentration (MLAC). Drugs derived from biological toxins that target and bind to the sodium ionophore are gaining acceptance for use as analgesics in chronic pain.     

氯普鲁卡因复合吗啡用于经尿道前列腺电切术后镇痛观察

目的 观察氯普鲁卡因复合吗啡用于经尿道前列腺电切(TUVP)术后镇痛的效果.方法 选择60～75岁择期行前列腺电切术患者90例,随机分为吗啡组(M组)、吗啡 氯普鲁卡因组(MC)组以及吗啡 布比卡因组(MB组),使用视觉模拟评分(VAS评分)评价各组患者术后疼痛的程度;记录患者膀胱痉挛的次数及使用杜冷丁肌注辅助镇痛的情况;观察患者术后恶心、呕吐及下肢肌力恢复等情况.结果 在3组患者术前一般情况和手术情况差异无显著性的情况下,MC及MB组患者术后VAS评分显著低于M组(P<0.05),而MC组及MB组之间比较无明显差异(P>0.05);运动阻滞的恢复MB组较M组及MC组要明显延迟(P<0.05),M组及MC组之间则差异无显著性(P>0.05);M组患者膀胱痉挛的次数及使用杜冷丁肌注辅助镇痛的次数则明显多于MC及MB组(P<0.05),MC组及MB组之间比较差异无显著性(P>0.05);术后3组患者药物副作用比较,M组患者术后恶心、呕吐情况较另外两组多见(P<0.05).结论 使用氯普鲁卡因复合吗啡用于老年病人前列腺手术电切术后镇痛能有效地减轻患者的疼痛,并且不会增加术后镇痛副作用的发生率及延长术后下肢肌力的恢复.     

氯普鲁卡因及芬太尼缩短硬膜外罗哌卡因起效时间的临床观察

目的：探讨妇科手术患者复合氯普鲁卡因及芬太尼对罗哌卡因硬膜外麻醉起效时间的影响。方法：择期妇科手术患者60例，随机分为Rc，Rf，R三组，硬膜外分别给予0．75％罗哌卡因18ml＋氯普鲁卡因200mg＋生理盐水2ml；0．75％罗哌卡因18ml＋芬太尼0．1mg／2ml；0．75％罗哌卡因18ml＋生理盐水2ml。记录感觉阻滞最高平面、感觉阻滞起效时间、血流动力学改变及不良反应。结果：感觉阻滞平面迭T10的时问Rc、Rf组均明显短于R组，Rc组短于Rf组；最高阻滞平面Rc、Rf组均明显短于R组。结：论氯普鲁卡因200mg与芬太尼0．1mg均可缩短罗哌卡因硬膜外阻滞起效时间，且复合氯普鲁卡因200mg较芬太尼0．1mg起效时间更短。     

Spinal 2-chloroprocaine: effective dose for ambulatory surgery

Background: There is an interest in finding a safe, short-acting spinal anaesthetic, suitable for ambulatory surgery. In this prospective study, we evaluated the effective dose of plain 2-chloroprocaine (2-CP) for lower limb surgery, including knee arthroscopy and saphenectomy.
Methods: Sixty-four ASA physical status I–III patients undergoing elective lower limb surgery were randomly allocated to one of the four local anaesthetic groups for spinal anaesthesia in a double-blind manner. The patients ( n =16 patients in each group) received 35, 40, 45 or 50 mg of 10 mg/ml isobaric 2-CP.
Results: In all patients, anaesthesia was sufficient for the planned surgery. The median peak block height (T9) was similar in all four groups ( P =0.66). Time to complete sensory block regression was faster in the 35 mg group (111 min, mean) and in the 40 mg group (108 min) than in the 50 mg group (134 min, P =0.005). No differences in time to complete motor block regression were observed ( P =0.3). Home discharge time was faster in the 35 mg group (123 min) and in the 40 mg group (122 min) than in the 50 mg group (165 min, P =0.001). No complications related to spinal anaesthesia were observed and no transient neurologic symptoms (TNS) were reported at the 3-day follow-up.
Conclusion: Spinal 2-CP, 10 mg/ml 35, 40, 45 and 50 mg provide reliable sensory and motor block for ambulatory surgery, while reducing the dose of 2-CP to 35 and 40 mg resulted in a spinal block of faster ambulation.     

氯普鲁卡因诱导体外人宫颈癌细胞抑癌基因CDH1、APC和P16启动子去甲基化及基因表达

 摘要：目的 观察氯普鲁卡因(CP)对人宫颈癌细胞HeLa和CaSki的抑癌基因CDH1、APC及P16启动子甲基化水平和基因表达的影响。方法 用不同终浓度的CP（0、1、1.5、2、3和4 mmol/L）处理癌细胞系HeLa和CaSki及正常人脐静脉内皮细胞HUVEC,MTT法检测细胞生长抑制率;用甲基化特异性PCR (MSP) 和RT-PCR检测1.5 mmol/L CP处理后各细胞CDH1、APC及P16启动子甲基化状态及基因表达水平。结果 1.5 mmol/L CP作用96 h后,HeLa和CaSki抑制率分别为 (66.17±5.82) % 和 (69.12±6.89) %,显著高于HUVEC的 (21.78±3.12) %, 1.5 mmol/L CP处理宫颈癌细胞96 h后,CDH1、APC及P16基因启动子均有不同程度去甲基化,3种基因mRNA均增强或者恢复了表达。结论 CP可以抑制人宫颈癌细胞HeLa和CaSki增殖,诱导HeLa和CaSki的CDH1、APC及P16基因启动子去甲基化,并可增加或者恢复相应基因的表达。     

氯普鲁卡因防治罗库溴铵注药痛效果研究

目的观察应用氯普鲁卡因减轻罗库溴铵注药痛的效果。方法拟行择期需行气管内插管全身麻醉患者150例,麻醉诱导时用限时法给予肌松药,按麻醉诱导时给予罗库溴铵前预先静脉注射的药物,将患者随机分为五组,每组30例。Ⅰ组生理盐水3 ml,Ⅱ组利多卡因30 mg/3 ml,Ⅲ组氯普鲁卡因30 mg/3 ml,Ⅳ组氯普鲁卡因60mg/3 ml,Ⅴ组氯普鲁卡因90 mg/3 ml。左手背静脉穿刺,置入20 G静脉套管针。为了药物能较长时保留在静脉中,在患者左前臂包裹气压止血带,加压至70 mmHg,以3 ml/10 s的速度在左手背静脉注入各组预先给予的药物,30 s时松开止血带。随即在10 s内注射插管剂量的罗库溴铵0.6 mg/kg,由一名事先不知用药情况的麻醉医师专职观察且询问患者疼痛情况,选用Ambesh四分疼痛评定法为标准,进行评分、记录。同时观察记录在注射罗库溴铵完毕及术后24 h副作用等情况。结果 I组罗库溴铵注药痛发生率97%,中度、重度疼痛77%,轻度疼痛20%;Ⅱ组患者77%无注药痛与Ⅲ组73%相似。3个氯普鲁卡因处理组疼痛轻,重度疼痛(0～1/30),Ⅳ组疼痛更轻,中度、重度疼痛(0/30);尤其Ⅴ组100%无注药痛。Ⅱ、Ⅲ、Ⅳ、Ⅴ组与Ⅰ组比较发生罗库溴铵注药痛的程度轻,Ⅴ组罗库溴铵注药痛程度最轻。结论预注利多卡因、氯普鲁卡因均能减轻罗库溴铵的注药痛,其中预注氯普鲁卡因90mg效果最好。     

盐酸氯普鲁卡因的临床研究进展

盐酸氯普鲁卡因属苯甲酸酯类的局部麻醉药,是在普鲁卡因的结构基础上引入-Cl基因,在化学结构上形成了麻醉效应强、麻醉后恢复快的优点.可以安全广泛的应用于临床麻醉.此文就盐酸氯普鲁卡因的硬膜外麻醉、脊髓麻醉、局部浸润麻醉、外周神经阻滞和区域静脉麻醉等方面的临床研究进展进行综述.