左布比卡因硬膜外麻醉对腹部手术病人心肌酶的影响

目的:观察局部麻醉药(局麻药)左布比卡 因硬膜外麻醉对手术病人心肌酶谱的影响,并与布 比卡因作对比,评估其临床应用的安全性。方法:择 期行胆囊切除手术的病人60例,均行硬膜外麻醉, 随机双盲分成2组,左布比卡因组30例、布比卡因 组30例,2组分别用0.56%左布比卡因,或用0.56 %布比卡因,总量均为13mL;注射局麻药前及术后 24h取静脉血测定肝、肾功能及心肌酶谱。结果:2 组术后ALT,AST,BUN,Cr,LDH,α 羟丁酸脱氢酶 (BDH),肌酸激酶(CK)均有增高;与术前比较有显 著差异(P<0.05或P<0.01),组间比较除CK, BDH外均无显著差异(P>0.05),左布比卡因组和布比卡因组CK的增加值分别为(440±s120)U·L-1和(530±135)U·L-1,2组比较差异有非常显著意义(P<0.01)。2组麻醉疗效比较,差异无显著意义。结论:左布比卡因和布比卡因行硬膜外麻醉效果均较好,但以心肌酶的部分指标作比较左布比卡因更安全。

Effect of epidural levobupivacaine anesthesia on myocardiac enzymes of patient in abdominal operation

AIM: To investigate the efficacy and safety of epidural levobupivacaine anesthesia for abdominal operation. METHODS: Sixty American Society of Anesthesiologists Ⅰ-Ⅱ patients under epidural anesthesia for cholecystectomy were randomly divided into two groups :group A with levobupivacaine (n=30)and group B with bupivacaine (n=30). Levobupivacaine (group A) 13 mL(0.56 %) or same bupivacaine (group B) were injected into the epidural space during operation. Before anesthesia and 24 h after operation ,ALT,AST, BUN, Cr and myocardiac enzymes were measured respectively. RESULTS: The levels of AST,ALT,BUN,Cr, LDH, BDH and CK after operation were higher than those before the operation in both groups(P<0.05 or P<0.01). The level of CK after operation was (440±s 120) U·L -1 (group A) or (530±135) U·L -1(group B) higher than those before the operation. There were no significant differences between two groups in ALT, BUN, Cr(P> 0.05). There were significant differences between two groups in BDH and CK (P< 0.05 or P< 0.01). CK after operation was lower in group A than that in group B (P< 0.01). There were no significant differences between two groups in anesthetic effects. CONCLUSION: Extradural anesthesia with bupivacaine or levobupivacaine is equally efficacy but levobupivacaine is safer than bupivacaine.