超声心动图评价相同剂量左旋布比卡因与罗哌卡因对血流动力学的影响

Effect of haemodynamics of middle-aged and senile patients in subarachnoid block with levobupivacanine and ropivacaine

目的探讨相同剂量左旋布比卡因与罗哌卡因在蛛网膜下腔阻滞中分别对中老年患者的血流动力学的影响。方法30例择期下肢或下腹部手术患者(ASAⅠ～Ⅱ级,年龄>40岁),分为两组,每组15例,分别接受左旋布比卡因15mg及罗哌卡因15mg蛛网膜下腔阻滞。监测患者心电图(ECG)、血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),并应用sonosite彩色超声诊断仪,采用单平面simpson′s法[11],即取心尖二腔或四腔观,勾画心内膜,按simpson′s规则,将左室按长轴方向分为若干个小圆柱体,这些圆柱体的体积之和为左室容积,公式为:V=∑A.△h,计算每搏输出量(SV)、心输出(CO)等血流动力学参数,记录时点分别为:注药前(TO)、注药后6min(T1)、12min(T2)和18min(T3),同时记录感觉阻滞平面、双下肢运动阻滞情况。结果给罗哌卡因中老年组T1、T2、T3时点为TO相比,HR左室舒张末期容积(VD)、左室收缩末期容积(LVS)、SV、CO均下降明显(P<0.05),左旋布比卡因中老年组,LVD、LVS、SV、CO有不同程度的下降(P>0.05),HR无明显变化。组间比较,罗哌卡因中老年组变化更为显著(P<0.05)。结论相同剂量左旋布比卡因与罗哌卡因对中老年人的血流动力学的影响较小。

Objective To estimate the effect of haemodynamics of middle-aged and senile patients in subarachnoid biock with levobupivacaine and ropivacaine in same dosage. Methods Thirty patients （ASA Ⅰ - Ⅱ, age 〉 40 years） undergoing elective surgery on the lower limbs or lower abdomen were divided into two group medially. Spinal block was performed with 15mg levobupivacaine and 15mg rompvacaine. Electrocardiogram, blood pressurt, heart rate, arterial pulse and saturation of blood oxygen were applied to every patient. The color Doppler uhrasonograph named sonosite was used to calculate the hemodynamic parameters such as cardiac output （CO）, stroke volume （SV） . These parameters were recorded before spinal blocking （TO） , 6 min （T1）, 12 min （T2） and 18 min （T3） after blocking The level of sensory block and Bromage score were recorded at the same time. According to regulation of uniplanar simpson＇s （formula： V = ∑A · △h）, on the section of two or four chambers on the apex of heart, the endocardium was drawed and the left artrium were devided into some small cylinders on the long direction. Results COmpared the corresponding parameters at T1, T2, T3 with T0, in the group of Levobupivacaine, HR, VD, SV and EF significantly decreased （P 〉0. 05） . In the control group of ropivacine, LVD, LVS, SV, CO also significantly decreased （P 〈 0. 05 ） . There were no apparent difference on HR during the study period and significant difference was found between the groups. Conclusion The effect of levobupivacaine and ropivacaine on the haemodynamics of middle-aged and senile patients were relatively little in same dosage.