罗比卡因与布比卡因高位硬膜外阻滞对肺功能影响的比较

The effects of high thoracic epidural anesthesia with 0.375% ropivacaine or 0.25% bupivacaine on pulmonary function

目的 探讨 0 375 %罗比卡因与 0 2 5 %布比卡因高胸段硬膜外麻醉对肺功能的影响。方法 选择在胸段硬膜外麻醉下行乳腺切除术的ASAⅠ～Ⅱ级患者 31例 ,随机分成 0 375 %罗比卡因 (罗 )组和 0 2 5 %布比卡因 (布 )组。麻醉前、后定时测定血压 (BP)、心率 (HR)、血氧饱和度 (SpO2 )、呼吸频率 (RR)、潮气量 (VT)、肺活量 (VC)、用力肺活量 (FVC)、一秒钟用力肺活量 (FEV1)、感觉被阻滞范围以及其他不良反应。结果 硬膜外阻滞 2 0分钟后 ,两组感觉阻滞范围相似 (C4～T8)。两组均显著影响肺功能 :罗组和布组的VC分别从 2 7L降至 1 3L和从 2 6L降至 1 1L ;FVC分别从2 2L降至 1 2L和从 2 1L降至 1 1L ;FEV1分别从 1 7L降至 1 1L和从 1 7L降至 1 1L(P <0 0 1)。VT 值分别从 0 6 2L降至 0 4 3L和 0 4 1L ,RR从 15次 /分上升至 18次 /分 ,HR从 86次 /分降至 6 8次 /分 ,SpO2 下降幅度在 2 %之内 ,BP相似 ,组间无差异。结论 0 375 %罗比卡因与 0 2 5 %布比卡因均可获得满意的麻醉效果 ,两组都明显影响肺功能。但两组SpO2 、BP均较稳定 ,无明显不良反应发生。

Objective To compare the effects of 0 375% ropivacaine with 0 25% bupivacaine on pulmonary function during thoracic epidural anesthesia (TEA).Methods 31 patients ASA status Ⅰ Ⅱ scheduled for breast surgery under TEA were randomized to receive either 0 375% ropivacaine (group R)or 0 25% bupivacaine(group B).Before and after the adimnistration of 0 375% ropivacaine or 0 25% bupivacaine,the blood pressure(BP),heart rate(HR),hemoglubin oxygen saturation (SpO 2),respiratory rate(RR),tidal volume(V T),vital capacity (VC),forced vital capacity (FVC),forced expiratory volume at the 1 st s (FEV 1),sensory blockade and the side effects were recorded.Results The sensory blockade range(C 4～T 8) was similar in the two groups at 20min after TEA.Both 0 375% ropivacaine and 0 25% bupivacaine resulted in a similar depression of pulmonary function.The VC values of group R and group B decreased from 2 7L to 1 3L and 2 6L to 1 1L,FVC values from 2 2L to 1 2L and 2 1L to 1 1L,FEV 1 values from 1 7L to 1 1L and 1 7L to 1 1L( P≤ 0 01),respectively,the tidal volume decreased from 0 62L to 0 43L and 0 41L in group R and group B respectively,the RR increased from 15 to 18 breaths/min,the HR decreasd from 86 to 68 beats/min.The SpO 2 decreased by 2%,the BP was similar in both groups.Conclusions Both 0 375% ropivacaine and 0 25% bupivacaine provide better sensory blockade and produce a similar depression in pulmonaary function.