罗哌卡因、左旋布比卡因与布比卡因低位硬膜外麻醉的比较

Comparison of the effects of ropivacine,levobupivacaine and bupivacaine for lower epidural anesthesia

目的比较罗哌卡因、左旋布比卡因与布比卡因低位硬膜外麻醉的临床效果。方法60例行下腹部手术病人,随机分成三组,每组20例。Ⅰ组:0.5%罗哌卡因;Ⅱ组:0.5%左旋布比卡因;Ⅲ组:0.5%布比卡因。行连续低位硬膜外麻醉。观察感觉阻滞起效时间、感觉阻滞平面上界、运动阻滞起效时间、运动阻滞程度及麻醉质量。结果Ⅰ、Ⅱ和Ⅲ组首次局麻药用量分别为(14.38±1.57)、(14.75±0.50)和(13.80±1.30)ml。Ⅰ组运动阻滞起效时间比Ⅲ组长(P<0.05),Ⅰ组Bromage评分为1分的例数多于Ⅲ组(P<0.05)。与Ⅲ组比较,Ⅰ、Ⅱ组感觉阻滞起效时间、感觉阻滞平面上界差异均无统计学意义。Ⅲ组SBP在感觉阻滞平面达上界及运动阻滞起效时有明显降低(P<0.05)。结论0.5%罗哌卡因、左旋布比卡因或布比卡因连续硬膜外麻醉均可产生良好的感觉和运动阻滞,三种药物药效学相似。

Objective To compare the clinical efficacy of ropivacine,levobupivacaine and bupivacaine for lumbar epidural anesthesia. Methods Sixty ASA Class Ⅰ or Ⅱ patients undergoing lower abdominal surgery received epidural 0.5% ropivacine （group Ⅰ ,n=20） ,0.5% levobupivacaine（group Ⅱ ,n= 20） or 0.5% bupivacaine （group Ⅲ, n= 20）. The onset time of sensory and motor block, degree of motor block, the height of sensory and the quality of anesthesia were compared. Results The first local analgesic dose was （14.38±1.57）.ml for ropivacine, （14.75±0.50） ml for levobupivacaine,and （13.80±1.30） ml for bupivacine 0.5%. The onset time of motor block was longer in group I than that in group Ⅲ （P〈0.05）. The onset time of Sensory,the height of sensory and the quality of anesthesia of three groups were similar. Conclusion Ropivacaine produces an epidrual block with the similar clinical profile as levobupivacaine or bupivacaine.