相同浓度的左旋布比卡因、罗比卡因与布比卡因硬膜外腔给药用于剖宫产术时效性的比较

Comparison of safety and efficacy of levobupivacaine,ropivacaine and bupivacaine for epidural anesthesia in subjects undergoing elective cesarean section

目的比较左旋布比卡因、罗比卡因和布比卡因用于硬膜外麻醉剖宫产术的阻滞效果、母婴安全和药物不良反应。方法采用随机双盲法,将48例择期剖宫产手术的足月单胎产妇分为三组:0.5%左旋布比卡因组(L组)17例、0.5%罗比卡因组(R组)15例和0.5%布比卡因组(B组)16例。记录硬膜外腔给药后产妇的感觉阻滞和运动阻滞的起效和持续时间、肌松满意程度、麻醉质量评价、恶心和呕吐等不良反应及术中心率、血压、脉搏血氧饱和度和新生儿1 min和5 min Apgar评分。结果产妇的一般情况、新生儿的Apgar评分组间无显著性差异;三组术中低血压及其他不良事件(恶心和呕吐)的发生率无显著性差异;各组的麻醉质量(术中的疼痛评分和肌松满意度)基本一致;感觉阻滞起效和维持时间组间无显著性差异,运动阻滞改良Bromage评分为1分的起效时间和持续时间组间有显著性差异。结论常用量0.5%左旋布比卡因、罗比卡因和布比卡因用于剖宫产手术的硬膜外麻醉时具有相似的麻醉效能和安全性。

Objective The present study was undertaken to compare the safety and efficacy of levobupivacaine, ropivacaine and bupivacaine in epidural anesthesia for cesarean section. Methods A randomized, double-blind study was conducted in 48 ASA class Ⅰ-Ⅱ Chinese full-term nulliparous parturients undergoing elective cesarean section under epidural anesthesia. Patients were randomized to receive either 15 ml of 0.5% bupivacaine, 0.5% ropivacaine or 0.5% levobupivacaine. The end points of measurements relevant to efficacy included onset, fade-out, and quality of anesthesia. The safety end-point measurements included Apgar scores, maternal ECG, BP, HR, SpO2 and adverse events （hypotension, nausea and vomiting）. Results There were no significant differences among three groups in the profiles of sensory blockade and muscle relaxation quality assessed by obstetricians. Neonatal Apgar scores, maternal demographics, ECG, HR, SpO2 and adverse events did not differ among the groups. Ropivacaine and bupivacaine provided a longer duration of motor blockade than levobupivacaine （P〈0.05）, and ropivacaine needed more time to block the motor nerve （MBS= 1 modified Bromage scores） （P〈0.05）. Conclusion Levobupivacaine, ropivacaine and bupivacaine had similar efficacy and safety profile in epidural anesthesia for cesarean section.