左旋布比卡因行蛛网膜下隙阻滞的量-效关系

Dose-response relationship of Levobupivacaine spinal anesthesia

目的探讨不同剂量左旋布比卡因行蛛网膜下隙阻滞在妇科手术中的量-效关系。方法60例子宫全切患者随机分为Ⅰ、Ⅱ、Ⅲ3组,分别予相同容积(3mL)、相同比重(1.022)左旋布比卡因腰麻液7.5、11.25及15mg。观察各组血流动力学变化、痛觉阻滞起效和持续时间、痛觉阻滞范围、VAS评分、下肢运动阻滞起效时间和持续时间、Bromage评分、腹肌松弛程度、术后不良反应。结果麻醉后Ⅲ组患者低血压、心动过缓发生率明显高于Ⅰ、Ⅱ组(P<0.05)。Ⅲ组患者痛觉阻滞及下肢运动阻滞起效较Ⅰ、Ⅱ组快(P<0.05)。3组患者痛觉阻滞范围差异无显著无性。Ⅰ组患者痛觉阻滞及下肢运动阻滞持续时间亦较Ⅱ、Ⅲ组短(P<0.05)。Ⅰ组患者VAS评分、Bromage评分均较Ⅱ、Ⅲ组差(P<0.05)。Ⅱ、Ⅲ组患者腹肌松弛效果优于Ⅰ组(P<0.01)。术后不良反应3组间差异无显著性。结论11.25mg左旋布比卡因行蛛网膜下隙阻滞麻醉效果满意,且对血流动力学干扰小。

[Objective] To investigate the clinical effect and dose-response relationship of Levobupivaeaine spinal anesthesia in gynecological operations. [Methods] Sixty patients scheduled for elective hysterectomy were enrolled into group Ⅰ, group Ⅱ and group Ⅲ with 20 cases each. Hyperbaric Levobupivacaine solution with dose of 7.5, 11.25 and 15 rag were respectively employed in the three groups. Hemodynamic changes,onset and duration of sensory blockag, bound of sensory block, VAS csale, onset and duration of lower extremities motor block. Bromage score, coditions of abdominal muscule relaxation,and postoperative adverse effects were observed. [Results] Postoperative incidence of hypotension and bradycardia of group Ⅲ was higher than that of the two other groups （P 〈0.05）. Onset time of sensory block and lower extremities motor block in group Ⅲ was shorter than that in the two other groups （P 〈0.05）. The bound of sensory block showed no difference among the three groups .The duration of sensory block and lower extremities motor block was shorter in group Ⅰ （P 〈0.05）. VAS csale score was higher in group Ⅰ （P 〈0.05）, while Bromage score was lower （P 〈0.05）. Relaxation of abdomonal muscle of group Ⅱ and group Ⅲ was batter than that of group Ⅰ （P〈0.01）. [Conclusion] 11.25 mg hyperbaric Levobupivacaine is effective and safe for spinal anesthesia.