摘要
目的比较0.5％、0．75％左布比卡因和0.5％、0．75％布比卡因用于低位硬外阻滞麻醉的效果和安全性，探讨左布比卡因用于低位硬膜外阻滞麻醉的有效性和优越性。方法选择ASAⅠ～Ⅱ级下肢手术接受硬膜外阻滞麻醉的病人76例，随机分为四组，A组（19例）用0．5％左布比卡因20ml，B组（19例）用0，5％布比卡因20ml，C组（19例）用0．75％左布比卡因20ml，D组（19例）用0．75％布比卡因20ml，手术部位为股都及其以下区域。硬外穿刺间隙为第3～4腰椎棘间隙，骶向置管3cm。注药后测定阻滞平面和起效时间，判定下肢运动阻滞程度，记录术后创口开始疼痛时间和下肢运动恢复时间，并记录可能的并发症。结果A组和C组各1例阻滞失败外，四组其余病例阻滞起效时间均〈12min（P〉0．05）；注药20min后C组和D组分别有12例和13例下肢完全不能举动，A组和B组无一例下肢完全不能举动（P〈0．01）；A组运动阻滞程度低于B组，而痛觉阻滞时间长于B组（P〈0．01）；A组和B组运动阻滞程度、痛觉阻滞时间及下肢运动恢复时间均低于C组和D组（P〈0．01）；C组痛觉阻滞时间明显长于D组，运动阻滞时间明显短于D组（P〈0．01），而运动阻滞程度相似（P〉0．05）。感觉阻滞优良率100％。无局麻药中毒病例及特殊并发症出现。结论0．75％左布比卡因和0．750k布比卡因用于低位硬膜外阻滞麻醉的效果相似并具有一定的术后镇痛效应，0．5％左布比母因可用于肌松程度要求低的下肢手术，0．75左布比卡因适用于任何下肢手术的硬膜外阻滞麻醉。
Objective To compare the effect and safety of 0.5% levobupivacane,0.75% levobupivacane,0.5 bupivacane and 0.75% bupivacane for lower epidural anesthesia, to discuss the efficacy and superiority of lower concentration levobupivacane for lower epidural anesthesia. Methods From Sep. 2003 to Aug. 2005,we selected 76 ASA Ⅰ～Ⅱ patients scheduled for lower extremity surgery, all patients accepted lower epidural anesthesia. They were randomly derided into 4 groups. Group A, B, C and D （ 19 eases of each group） received 0. 5% levobupivacane,0. 5% bupivacane,0. 75% levobupivacane,0. 75% bupivacane 20ml respectively. The anagesic area, onset timing of motor and sensary block, timing of incision,timing of foot and leg movement, and the complications were recorded. Results The onset timing and the analgsia on T9 to S5 of lower extremity dermatomes were less than 12 minutes except that 1 cade failed in group A and group C respectively（ P 〉 0.05 ）. The patients who could not lift his（ or her） lower limbs in group C and group D were 12 cases and 13 cases respectively, however, there was none similar case in group A and group B（ P 〈0. 01 ）. The duration of sensary and motor block had significant difference within group A,group B and group C,group D （ P 〈 0. 01 ）, the duration of sensary and motor block had significant difference within group C and group D, too （P 〈 0. 01 ）. Sensary block were well in all groups apart from 2 cases after 20min. There appeared no toxic responseor and complication. Conclusion The anesthetic effect and analgesia postoperation of 0.75% levobupivaeane and 0.75% bupivacane for lower epidural anesthesia are similar 0.5% levobupivacane seems more suitable for lower extremity surgery asking for lower musle relaxand. 0.75% levobupivacane is suitable for lower epidural anesthesia on all lower extremtiy surgery.
出处
《临床医学》
CAS
2006年第12期19-22,共4页
Clinical Medicine
