罗哌卡因、左旋布比卡因复合芬太尼用于剖宫产术后镇痛半数有效浓度的研究

EC_(50) of ropivacaine,levobupivacain combined with fentanyl on efficacy of cesarean section postoperative analgesia

目的探讨罗哌卡因、左旋布比卡因复合芬太尼用于剖宫产术后镇痛半数有效浓度。方法选择要求剖宫产术后镇痛的初产妇80例,ASAⅠ～Ⅱ,随机分为罗哌卡因(R)组和左旋布比卡因(L)组。每组第1例产妇分别使用0.125%罗哌卡因、左旋布比卡因复合芬太尼(2μg/mL)100mL混合液镇痛,应用序贯法以0.025%的浓度梯度升降调整局麻药浓度,记录硬膜外自控镇痛(PCEA)开启时(0h)、开启后4、24、48h的血压(BP)、脉搏氧饱和度(SpO2)、心率(HR)、VAS评分、下肢运动阻滞程度、不良反应发生率及总体满意度,计算罗哌卡因、左旋布比卡因术后镇痛的半数有效浓度(EC50)及其95%可信区间。结果两组产妇镇痛效果、感觉阻滞平面、Bromage评分、不良反应发生率及总体满意度比较差异无统计学意义(P>0.05);4hR组的EC50及95%CI为0.151%(0.109%～0.183%),L组的EC50及95%CI为0.126%(0.098%～0.154%),相对效价比R∶L为0.83。结论 R、L与芬太尼混合用于剖宫产术后硬膜外镇痛的EC50及95%CI分别为0.151%(0.109%～0.183%)、0.126%(0.098%～0.154%),R的效能小于左旋布比卡因。

Objective To investigate the EC50 of ropivacaine and levobupivacaine combined with fentanyl on efficacy of cesarean section postoperative analgesia. Methods 80 primiparas with ASA Ⅰ-Ⅱ , who requested postoperative analgesia, were randomly allocated to either ropivacaine （group R）or levobupivacaine （group L）both with fentanyl 0.2 ug/ml respecially. The first primipara in each group were accepted 0. 125% ropivacaine and levobupivacaine 100ml solutions with epidural analgesia. Concentration of local anaesthetics was ajusted with up-down sequential allocation by concentration gradient 0. 025% according to total analgesia effect. The scales of blood pressure, pulse oxygen saturation, heart rates, VAS, lower limb motor block, the incidence of side- effect and total satisfaction degree were recorded when patient controlled epidural analgesia（PECA） opened （0 h）, after being opened 4, 24 and 48 h. EC50 and 95% confidence interval （CI） of ropivaeaine and levobupivacaine were calculated according to formula. Results Analgesic effect, upper sensory level, scores for VAS and Bromage, the incidence of side effect and total satisfaction degree were significant differences in both groups（P〉 0.05）. EC50 and 95 % confidence interval（CI） of ropivacaine were 0. 151 % （0. 109%--0. 183%）and for levobupivaeaine 0. 126% （0. 098%--0. 154%）. The potency ratio at EC50 for ropivacaine：bupiva- caine was 0.83. Conclusion Ropivacaine and levobupivacaine combined with 2mg/ml of fentanyl are used for postoperative epidural analgesia of cesarean section. EC50 and 95%Clof both are 0. 151%（0.109%--0. 183%）and 0. 126%（0.098%--0. 154%）respecially. The relative potency in ropivacaine is less than that in levobupivacaine.