布吡卡因硬膜外阻滞对左心室收缩时间间期的影响

应用无创伤性方法对0.75%布吡卡因硬膜外阻滞59例,对照组1.6%利多卡因、0.16%丁卡因混合液(均不含肾上腺素)30例病人的STI变化进行临床对比研究。两组病人无明显心血管疾患,年龄17～60岁。实验结果表明:上腹部手术硬膜外阻滞后两组的PEP、LVET、1/PEP~2、MAP和HR的变化相似(P>0.05);PEP/LVET与EF的改变:布吡卡因组>利多卡因组(P<0.05～0.01)。而中、下腹部手术的结果却恰恰相反。证明在常用浓度、一般剂量、阻滞范围相同情况下,中胸段硬膜外阻滞对左心功能的抑制以布吡卡因更为严重;下胸、腰段硬膜外阻滞则以利多卡因、丁卡因混合液更为显著。它为临床医师在硬膜外阻滞时选择局麻药提供了科学的依据。

Effect on Left ventricular Systolic Time Intervals during Epidural Block with Bupivacaine

We have made a clinical comparative study of the changes on 59 cases of STI after epidural block with 0.75% bupivacaine and 30 cases of control group with 1.6% lidocaine +0.16% dicaine ( no adrenaline added ) by unbounded technique. The two groups of patients ( 17-60 years of age ) had no clear cardiovascular disease. The test results showed that the changes of PEP, LVET , I/PEP2, MAP and HR after the block in the two groups of the upper abdomenal operations were similar(P>0.05) . The changes of PEP/LVET and EF of bupivacaine group were greater than those of iidocaine group, with a statistical significance (p<0.05- 0.01) . However , the results of middle and low abdomenal operations were just contrary to those of the upper ones. It was proved that the depression of left ventricular function in middle thoracic epidural block with bupivacaine was far serious, while the depression in the low thoracic and lumbal epidural block with Iidocaine + dicaine was more notable. It can provide scientific bases for choosing the local anesthetic in clinic.