左旋布比卡因、布比卡因与罗哌卡因硬膜外麻醉效应的比较

目的:比较0.75%左旋布比卡因、布比卡因和罗哌卡因硬膜外阻滞效应,并观察手术期间血流动力学变化。方法:将90例ASA~级,拟在硬膜外麻醉下行腰椎手术病人随机分成左旋布比卡因组(LB组)、布比卡因组(B组)和罗哌卡因组(R组),每组30例,分别观察各组药物对机体运动、感觉阻滞效应和血流动力学变化。结果:感觉阻滞起效时间,总感觉阻滞持续时间,运动阻滞起效时间和最大运动阻滞程度,LB组与B组无显著性差异,而LB组与R组有显著性差异;运动阻滞完全时间LB组明显短于B组(P<0.05);感觉阻滞完善时间3组间无显著性差异;血流动力学指标各组间无显著性差异(P>0.05)。结论:0.75%左旋布比卡因可为硬膜外麻醉下腰椎手术提供良好的麻醉效果,且其麻醉作用与布比卡因相似,而较相同浓度罗哌卡因强。

A comparative study on the effects of levobupivacaine used for lumbar epidural anesthesia

Objective: To investigate the effect of 0.75% levobupivacaine used for lumbar epidural anesthesia, and compare it with ropivacaine and bupivacaine at the same concentration. Methods: 90 ASAⅠ~Ⅱ patients of either sex, aged 35~60y, undergoing abdominal vertebrae operation were randomly divided into 3 groups. The observaction group was levobupivacaine group (LB group), control group Ⅰ was bupivacaine group,(B group), and control group Ⅱ was ropivacaine group(R group), 30 patients in each group. An epidural catheter was placed at L1~2 and advanced approximately 3cm in the epidural space toward head. Patients of LB group,B group and R group received 0.75% levobupivacaine,0.75% bupivacaine and 0.75% ropivacaine respectively. Sensory and motor block, ECG, SaO_2 and the changes of hemodynamics at immediate pre-injection,10,20,30,45 and 60min after injection were observed. Results: There was no significant difference in the onset time of sensory and motor block,the maintenance time of sensory block and the degree of motor block between LB group and B group, but they were different when compared with R group. The time of maximum motor block was shorter in LB group than in B group significantly (P<0.05). There was no significant difference in the time of maximum sensory block in 3 groups. The safety variables including the changes in MAP, HR, SaO_2 during the pre- and post-injection showed little difference in 3 groups too (P>0.05). Conclusion:0.75% levobupivacaine for lumbar epidural block is safe and effective for abdominal vertebrae operation, and there was similar efficacy between levobupivacaine and bupivacaine, but the former was more effective than ropivacaine at the same concentration.