左旋布比卡因与罗哌卡因应用于小儿骶管阻滞麻醉中的比较

Study of levo-bupivacaine and ropivacaine for pediatric caudal anaesthesia

目的：观察比较罗哌卡因与左旋布比卡因用于小儿骶管阻滞麻醉的临床效果区别。方法：选择先天性马蹄内翻足施行矫形术的患儿24例，随机分为N组和L组。N组骶管阻滞选用0．3％耐乐品1ml／kg；L组选用0．2％速卡1ml／kg。两组患儿骶管阻滞成功后均予静脉微泵输注丙泊酚加芬太尼混合液．按丙泊酚2mg／kg·h速度输注，术毕前5—10min停止输注。观察麻醉起效时间、麻醉维持时间及各时间点的MAP、HR变化。结果：N组的麻醉起效时间为7．3±2．8min、维持时间103±12min。L组的麻醉起效时间为16．3±3．8min、维持时间104±11min。两组的麻醉起效时间有显着性差异（P〈0．01）；维持时间则无显着性差异。两组患儿麻醉起效后的MAP和HR明显低于基础值，组内比较也有显着性差异（P〈0．01）。两组间比较．麻醉起效时的MAP和HR则无显着性差异。结论：小儿骨科下肢手术选用0．3％罗哌卡因或0．2％左旋布比卡因1ml／kg施行骶管阻滞麻醉，结合静脉持续榆注丙泊酚以保持小儿镇静是安全可行的。罗哌卡因组的麻醉起效明显快于左旋布比组，而两组的麻醉维持时间及循环影响方面无明显区别。

Objective To observe the effects of levo-bupivacaine or ropivacaine for pediatric caudal block. Methods Twenty four clubfoot children scheduled for orthopedic operations were randomized to receive a caudal block of 1ml/kg with ropivacaine 0.3% （Group N, n=12） or levo-bupivacaine 0.2% （Group L, n= 12）. Both groups were given intravenously propofol plus fentanyl mixture （propofol 200 mg with fentanyl 100μg） for hypnosis during operation. The timing of onset and maintenance of caudal block were recorded and the changes of MAP and HR at relevant timing were also recorded. Results The timing of onset in Group N were 7.3 ＋ 2.8 min and in Group L were 16.2±3.8 min （ P 〈0.01）. The timing of maintenance were 104±11 min in group N and 103±12min in group L（p=0.891, P〉0.05）. The MAP and HR in the timing of onset were significant less than the baseline in both groups （P〉0.05）. Conclusion The use of levo-bupivacaine or ropivacaine in pediatric caudal block is effective and safe. The timing of onset of ropivacaine is significantly faster than that of levo-bupivacaine. The timing of maintenance and the changes of hemodynamics are no significantly difference in both groups.