摘要
目的：探讨布比卡因与国产罗哌卡因用于腋路臂丛阻滞对心脏的毒性作用。方法选择择期上肢手术患者60例，A-SAI～Ⅱ级.随机分为罗哌卡因组（R组）及布比卡因组（B组）各30例，分别于麻醉前、麻醉后30 min,麻醉后2 h抽取静脉血3 mL,测定血清心肌肌钙蛋白cTnI及心肌酶学的变化。结果 R组在麻醉前的cTnI 、CK-MB 、CK值分别为（0.062±0.018）ug/L、（6.340±1.723）U/L、（44.000±12.000）U/L，B组在麻醉前的cTnI、CK-MB、CK值分别为（0.073±0.034）ug/L、（6.876±2.357）U/L、（48.000±14.000）U/L。比较两组间差异无统计学意义（P＞0.05）。R组在麻醉后30 min的cTnI 、CK-MB 、CK值分别为（3.482±1.892）ug/L、（32.684±9.842）U/L、（314.00±47.000）U/L，B组在麻醉后30 min的cTnI 、CK-MB 、CK值分别为（6.842±2.147） ug/L、（46.960±8.792）U/L、（429.00±50.000）U/L。比较两组间差异有统计学意义（P＜0.05）。R组在麻醉后2 h的cTnI、CK-MB、CK值分别为（5.546±0.032）ug/L、（38.724±8.686）U/L、（378.00±45.000）U/L，B组在麻醉后2 h的cTnI 、CK-MB 、CK值分别为（9.278±0.065）ug/L、（57.789±9.240）U/L、（466.00±47.000）U/L。比较两组间差异有统计学意义（P＜0.05）。麻醉前比较过两组患者相应指标差异无统计学意义（P＞0.05），麻醉后两组患者相应指标均较麻醉前有所提高，B组较R组相应指标增高显著，比较两组间差异有统计学意义（P〈0.05）。结论罗哌卡因及布比卡因臂丛阻滞后均出现cTnI及心肌酶增高，两药均有抑制心肌影响，但国产罗哌卡因对心脏毒性小于布比卡因，可安全用于臂丛腋路阻滞。
Objective To compare the toxicity between bupivacaine and homemade ropivacaine applied to axillary brachial plexus block on the heart. Methods 60 patients with ASAI~Ⅱ grade underwent selective upper limb operation were selected and divided into the ropivacaine group（（R group） and the bupivacaine group（B group） with 30 patients in each. Blood samples were taken from veins of the patients for determine the serum cardiac troponin （cTnI） and myocardial enzymes before anesthesia, 30min and 2 hours after the anesthesia. Results Before anesthesia, the cTnI, CK-MB, CK value of group R was （0.062 ±0.018） ug / L, （6.340 ±1.723） U/L, （44.000±12.000） U/L, respectively, and that of group B was （0.073±0.034） ug/L, （6.876±2.357） U/L, （48.000±14.000） U/L, re-spectively. The differences between the two groups were not statistically significant （P〉0.05）. 30min after the anesthesia, the cTnI, CK-MB, CK value of group R was （3.482±1.892） ug/L, （32.684±9.842） U/L, （314.00±47.000） U/L, and that of group B was （6.84 ± 2.147） ug/L, （46.960±8.792） U/L, （429.00±50.000） U/L, respectively. The differences between the two groups were statistically sig-nificant （P〈0.05）. 2h after the anesthesia, the cTnI, CK-MB, CK value of group R was （5.546 ±0.032） ug/L, （38.724 ± 8.686） U/L, （378.00 ± 45.000） U/L, respectively, and that of group B was （9.278±0.065） ug/L, （57.789±9.240） U/L, （466.00 ± 47.000） U/L, re-spectively. The differences between the two groups were statistically significant （P〈0.05）. Before anesthesia the differences in the corresponding indexes between the two groups were not statistically significant （P〉0.05）, after anesthesia, the values of the corre-sponding indexes of both groups increased as compared with those before anesthesia, and the increase in group B was more obvi-ous, the differences between the groups were statistically significant （P〈0.05）. Conclusion Increase of cTnI and cardiac enzymes occurs after application of ropivacaine and bupivacaine for axillary brachial plexus block, both the drugs can inhibit the myocardi-um, but homemade ropivacaine has less toxicity, so it can be used for axillary brachial plexus block safely.
出处
《中外医疗》
2014年第33期1-3,共3页
China & Foreign Medical Treatment
基金
深圳市宝安区科技计划社会公益科研资助项目(237号)
深圳市宝安区2011年区级课题立项(20110673)
关键词
罗哌卡因
布比卡因
心肌肌钙蛋白
心肌酶
臂丛腋路阻滞
Ropivacaine
Bupivacaine
Cardiac troponin
Cardiac enzymes
Axillary brachial plexus block
