5%利多卡因和0.5%布吡卡因在腰麻中的应用

Clinical application of spinal anesthesia with 5% lidocaine and 0.5% bupivacaine

目的：目的：探讨5％利多卡因用于腰麻的效用性及安全性。方法：对32例ASAⅠ～Ⅱ级择期行下腹部及以下的手术患者，随机分为两组，L组（n=16）予5％利多卡因（含葡萄糖150mg）2ml；B组（n=16）予0．5％布吡卡因2ml（含8％葡萄糖）。分别测定感觉阻滞起效时间、运动阻滞起效时间及Bromage运动阻滞评分，麻醉效果评价，以及给药后1、3、5、10、15min的MAP、HR和术后恶心、呕吐的发生率。结果：L组感觉阻滞起效时间、运动阻滞起效时间均较B组快（P均〈0．01），L组达到Bromage运动阻滞评分Ⅱ、Ⅲ级较B组略多，两组麻醉效果、恶心呕吐发生率无显著性差异，L组给药后2～3minHR及MAP降低明显。结论：5％利多卡因和布吡卡因用于腰麻时的效用性和安全性一样可靠，5％利多卡因起效更快阻滞更完善，但必须密切注意其对血流动力学的影响。

Objective： To study the clinical effectiveness and safety of 5 % lidocaine used for the spinal anesthesia. Methods ： In this randomized,double-blind study, 32 ASA Ⅰ-Ⅱ patients were divided into two groups. Group L received 5% lidocaine 2 ml（heavy, n = 16）and group B,0.5 % bupivacaine 2 ml（ heavy, n = 16 ） followed by respective measurement of the interval affecting sensation block, the motor block and Bromage scales. Anesthesia effect was evaluated on a basis of MAP, HR at 1,3,5, 10 or 15 min after the administration and the frequency of postoperative nausea and vomiting. Results ： Both the interval of affecting sensation block and motor block in group L were much faster than group B （P〈0. 01,P〈0.05）. Bromage scales 2-3 in group L was higher than that in group B, but the anesthesia effect showed no significant difference between the two groups. The decrease of HR and MAP was greater in group L compared with administration after 2 - 3 min. Conclusion ： Both of 5% lidocaine and 0.5% bupivacaine can produce the .same effect on spinal anesthesia with safety. 5% Lidocaine has quicker effect and satisfied block, but hemodynamics must be monitored.