肾功能异常患者左旋布比卡因臂丛神经阻滞的药效学及药代动力学

Pharmacodynamics and pharmacokinetics of levobupivacaine for brachial plexus block in patients with renal dysfunction

目的观察左旋布比卡因用于肾功能异常患者臂丛神经阻滞时的药效学及药代动力学。方法将60例择期上肢手术患者分为两纽：I纽（30例，肾功能正常纽）和Ⅱ组（30例，肾功能异常组）。分别给予0．375％左旋布比卡因行肌间沟入路臂丛神经阻滞，观察并记录感觉阻滞的起效时间、完善时间和维持时间。Ⅱ组随机抽取10例患者，高效液相色谱法测定肌间沟注药后10—720min左旋布比卡因的血药浓度，3P97软件计算药代动力学参数。结果两组患者感觉阻滞起效时间和完善时间相当（P〉0．05），但Ⅱ组维持时间长于Ⅰ（P〈0．05）。Ⅱ组患者左旋布比卡因主要药代动力学参数达峰时间、峰值浓度和消除半衰期分别为（0．45±0．26）h、（0．90±0．13）mg／L和（4．98±0．45）h。结论肾功能异常对左旋布比卡因臂丛神经阻滞的药代动力学无影响，对术后镇痛维持时间有一定影响。

Objective To investigate the clinical pharmaeodynamics and pharmaeokinetics of levobupivaeaine for brachial plexus block in patients with renal dysfunction. Methods Sixty patients, underwent selective upper shoulder surgery were divided into two groups：group I （30 cases, patients with normal renal function） and group Ⅱ （30 cases,patients with renal dysfunction）. All patients were injected with levobupivacaine 0. 375% for interscalene brachial plexus block. The onset time, perfect time and recovery time of sensory block were observed and recorded. Ten patients were selected randomly to determine the plasma concentration of levobupivaeaine 10 - 720 rain after interscalene iniection, and3P97 software package was used to calculate the pharmacokinetic parameters. Results Both groups had the similar onset time and perfect time of sensory block （ P 〉 0. 05）, but group Ⅱ had a more longer recovery time than group I （P 〈 0. 05）. The main pharmacokinetic parameters such as Tmax Cmax and t1/2β in Group U were （0. 45 ±0. 26）h,（0. 90 ±0. 13） mg/L and （4. 98 ±0. 45）h,respective- ly. Conclusions Renal dysfunction does not affect the pharmacokinetics of levobupivacaine for brachial plexus block, while it has an impact on the duration of postoperative analgesia.