左布比卡因、罗哌卡因与丁卡因用于腰麻-硬膜外联合阻滞疗效比较

[目的]通过比较左布比卡因、罗哌卡因及丁卡因用于腰麻-硬膜外联合阻滞的效果,探讨用于剖宫产术及下肢手术的安全性和实用性.[方法]分别选择ASAⅠ,Ⅱ级剖宫产术和下肢手术患者各90例,剖宫产术穿刺点选择L2~3间隙,下肢手术选择L3~4间隙.将同种术式患者随机分为左布比卡因组、罗哌卡因组及丁卡因组,每组各为30例,记录感觉和运动阻滞起效时间及麻醉后血压、心率和恶心呕吐的发生率.[结果]剖宫产术丁卡因组患者运动阻滞起效时间明显短于其他组,低血压与恶心呕吐发生率明显高于其他组;下肢手术罗哌卡因组运动阻滞起效时间明显长于其他组,罗哌卡因对心血管系统的影响明显小于左布比卡因和丁卡因.[结论]3种麻醉药物中丁卡因的麻醉效果迅速,但副作用较多;罗哌卡因对心血管系统的影响小,但需要充分的肌肉松弛,效果欠佳;左布比卡因效果在前两者之间.左布比卡因适用于剖宫产术和下肢手术,罗哌卡因适用于伴有心血管系统疾病的手术患者.

Comparison of blocking effectiveness of levobupivacaine,ropivacaine and dicaine on combined spinal-epithedral anaesthesia

OBJECTIVE To study the blocking effectiveness of levobupivacaine,ropivacaine and dicaine used in combined spinal-epithedral anaesthesia and to find out which drug was more suitable to cesarean section and lower extremity surgery.METHODS90 patients of ranked ASA Ⅰ,Ⅱ in cesarean section and lower extremity surgery were separately selected,and the injection point was chosen between L2～3 in cesarean section sea and between L3～4 in lower extremity surgery.The patients with isotype of operation were randomly divided into levobupivacaine,ropivacaine and dicaine groups（each group n=30）,and it was recorded that the sensory and motor blocking time,blood pressure,heart rate,incidence of nausea and vomiting.RESULTSThe motor block time in cesarean section was faster and the incidence of hypotension,nausea and vomiting was significantly higher in dicaine group than in other two groups.The motor block time in lower extremity surgery was notably slower in the ropivacaine group than in other two groups,and the ropivacaine had obviously less influence than the levobupivacaine and dicaine.CONCLUSIONSOut of 3 of anaesthetic drugs,the dicaine has a rapid anaesthetic effect but more side effects,the ropivacaine has less influence for cardiovascular system but lower effects to need sufficient muscle relaxation,and the effects of levobupivacaine is between the ropivacaine and dicaine.The levobupivacaine is more suitable for anaesthesia in cesarean section and lower extremity surgery,and the ropivacaine is more suitable for anaesthesia in patients with cardiovascular system disorders.