罗哌卡因与布比卡因行连续蛛网膜下腔麻醉的效果观察

Study of isobaric bupivacaine and ropivacaine in continuous spinal anesthesia for abdominal operation

目的观察罗哌卡因与布比卡因连续蛛网膜下腔阻滞用于腹部手术的安全性和可行性。方法择期行腹部手术患者60例，取L2-3间隙行连续蛛网膜下腔麻醉，用药为罗哌卡因与布比卡因，根据药物浓度不同随机分为三组：Ⅰ组0.5%布比卡因、Ⅱ组0.5%罗哌卡因、Ⅲ组0.75%罗哌卡因，每组20例，经蛛网膜下腔导管给药，初次剂量均为3 ml，根据需要追加药量0.5-1 ml，使麻醉平面达T4水平，此为基础剂量，记录基础剂量后最高痛觉消失平面节段、感觉阻滞起效时间、最高锐痛觉阻滞平面下降一节段时间、镇痛效果及肌松程度，记录各组给药后不同时点平均动脉压、心率、血氧饱和度值。结果Ⅱ组和Ⅲ组与Ⅰ组相比：除最高痛觉消失平面无显著性差异外，其余各项指标均差异显著，Ⅱ组和Ⅲ组感觉阻滞起效时间较慢（P〈0.05），而最高锐痛觉阻滞平面下降一节段时间明显增快（P〈0.01）；镇痛和肌松效果方面，Ⅰ组和Ⅲ组相当，但显著优于Ⅱ组（P〈0.01）。结论0.75%罗哌卡因行连续蛛网膜下腔麻醉，其镇痛及肌松效果与0.5%布比卡因相当，但对循环抑制轻，并发症少，可用于腹部手术。

Objective To investigate the feasibility and safety of isobaric bupivaeaine and ropivaeaine in continuous spinal anesthesia for abdominal surgery. Methods 60 paitents （ASA Ⅰ-Ⅱ ） for abdominal surgery were randomly divided into 3 groups, 20 patients were included in each group. Group Ⅰ ： 0.5% bupivacaine solutions, Group Ⅱ ： 0. 5% ropivacaine solutions, Group Ⅲ ： 0.75% ropivaeaine solutions. First intrathecal injection bupivacaine or ropivacaine 3ml and adding 0. 5- 1 ml to achieve T4 plane of analgesia. The following variables were measured： the highest analgesic level, time to reach complete plane of analgesia, analgesia effects, and extent of muscle blockade. Mean arterial pressure, heart rate, oxygen saturation were recorded. Resluts There was no statistical difference among the basic conditions （P〉0.05）. Compare group Ⅱ and Ⅲ with group Ⅰ , all the observed indexes including the onset time and duration of motor blockade showed significant difference, except the anesthetic level was similar. The anesthesia effects of group Ⅰ and group Ⅲ were significantly better than group Ⅱ , but the mean arterial pressure （MAP） in group Ⅰ decreased obviously after the intrathecal injection than the other groups （P〈0. 05）. Conclusion The 0. 75% isobaric ropivacaine used during continuous spinal anesthesia in the abdominal surgery produces a suitable and a more controllable anesthesia, but there need advanced study and more clinical data in the true sea rescue and surgery.