等剂量罗哌卡因、左布比卡因和布比卡因腰麻用于剖宫产的效能比较

Comparison of the Same Dose of Ropivacaine,Levobupivacaine,and Bupivacaine for Spine Anesthesia in Patients Undergoing Caesarean Section

目的 比较相同剂量的罗哌卡因、左布比卡因和布比卡因腰麻用于剖宫产的效能,以探讨剖官产的最佳局麻药.方法 将120例ASA Ⅰ-Ⅱ级择期行剖宫产病人,随机分成三组,用0.75%罗哌卡因、左布比卡因和布比卡因各2 ml,分别用脑脊液1 ml配成等比重溶液,用25G腰麻穿刺针,于L2～3间隙穿刺,在60 s内缓慢将2 ml药液注入蛛网膜下腔,比较各组感觉、运动阻滞的起效和恢复时间的异同点.结果 在感觉阻滞起效时间上,左布比卡因＞罗哌卡因＞布比卡因;在恢复时间和最大阻滞时间上罗哌卡因＞布比卡因＞左布比卡因;在最高麻醉平面上布比卡因＞罗哌卡因＞左布比卡因;在运动阻滞起效时间上,左布比卡因＞罗哌卡因＞布比卡因,在最大运动阻滞时间和恢复时间上布比卡因＞罗哌卡因＞左布比卡因;在镇痛效果及肌松上布比卡因＞罗哌卡因＞左布比卡因;在低血压、呼吸困难等不良反应上,布比卡因＞罗哌卡因＞左布比卡因.结论 罗哌卡因不仅具有布比卡因和左布比卡因的优点,而且能克服后两者的缺点,是腰麻下行剖宫产的理想局麻药.

Objective To compare the effects of the same dose of ropivacaine, levobupivacaine and bupivacaine for spine anesthesia in the patients undergoing caesarean section. Methods total of 120 women （ ASA Ⅰ or Ⅲ ） who would be given caesarean section were at random divided into three groups in order to receive one of the following isobaric intrathecal solutions （ containing ropivaeaine, levobupivacaine and bupivecalne, respectively） with cerebrospinal fluid as diluent. The difference of sensory block, motto block and recovery was compared. Results There were differences among the three groups in onset time, block height and the longest duration time of sensory block. As for onset time, block height, and the quality of analesia and muscular relaxation, varions ranks were listed as follow ： levobupivecaine 〉 ropivacaine 〉 bupivacaine, bupivacaine 〉 ropivacaine 〉 lovobupivacaine, and bupivacaine 〉 ropivacaine 〉 levobupivacaine. Conclusion Ropivacaine might be the appropriate choice when Caesarean section is performed.