布比卡因与左布比卡因用于SA对TURP手术患者QT间期影响的比较

Comparison between effects of bupivacaine and levobupivacaine for spinal anesthesia on QT dispersion in patients undergoing TURP surgery

目的探讨蛛网膜下腔阻滞(SA)中应用布比卡因与左布比卡因对经尿道前列腺电切术(TURP)手术患者QT间期的影响。方法选择2018年12月—2022年10月分别行布比卡因和左布比卡因SA麻醉行TURP手术的56例患者,测量并记录患者术前、麻醉后10分钟、手术开始后10分钟和手术结束后10分钟的QT间期值,同时记录二组麻醉前(T0)、SA后1(T1)、5(T2)和10(T3)min、切口后1(T4)、5(T5)、10(T6)min和术后10 min(T7)时间点的SBP、DBP、MAP、HR、SO2值(指脉氧饱和度),以及阻滞平面水平和持续时间,分析布比卡因与左布比卡因对QTc、QTd和QTcd的影响。结果左布比卡因组在麻醉后10分钟,HR值明显高于基础值(P<0.05)。布比卡因组在麻醉后10分钟和手术开始后10分钟的QT间期校正值(QTc)均大于左布比卡因组(P<0.05)。布比卡因组中分别在麻醉后10分钟、手术开始后10分钟和手术结束后10分钟的QTd值与QTcd值均显著大于左布比卡因组(P<0.05)。结论左布比卡因相较于布比卡因具有更好的血流动力学稳定性,布比卡因对患者QTd值与QTcd值影响更大。对于有心脏疾患的患者,左布比卡因可能是布比卡因较好的替代品。

Objective To investigate the effects of bupivacaine and levobupivacaine for spinal anesthesia on QT dispersion in patients undergoing TURP surgery.Methods Fifty-six patients who received bupivacaine and levobupivacaine SA anesthesia for TURP were selected from December 2018 to October 2022.The QT values were taken preoperatively and during the 1oth of the spinal block,the loth of the surgical incision,and the 10th postoperative minute.Additionally,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),oxygen saturation(SO,),and heart rate(HR)values,in addition to motor block levels and durations,were recorded for each patient.The effects of bupivacaine and levobupivacaine on QTc,QTd and QTcd were analyzed by statistical methods.Results HR values measured at 10 min after spinal block were significantly higher than the baseline values in the levobupivacaine group(P<0.05).The corrected QT interval(QTc)values increased significantly at 10 minutes after spinal block and at 10 min postoperative-ly in the bupivacaine group(P<0.05).QTd and QTcd measurements were taken at the 10th minute of spinal anesthesia,the 1oth minute of the incision,and the 1oth minute postoperatively.When compared to the levobupivacaine group,a statistically significant increase was found in the bupivacaine group(P<0.05).Con-clusion Levobupivacaine allows greater hemodynamic stability,while bupivacaine affects QTc and QTd measurement times more.As such,we believe that levobupivacaine may be a better alternative to bupivacaine during clinical practice,particularly in patients with cardiac problems.