注射用速卡用于产科手术阻滞的临床研究(英文)  

Clinical effect and placental transfer of epidural levobupivacaine vs bupivacaine for cesarean section

作　　者：高成杰[1] 宁吉顺[1] 隋波[1] 李训美[1] 

机构地区：[1]济南军区总医院麻醉科,山东济南250031

出　　处：《中国现代医学杂志》2005年第5期656-660,共5页China Journal of Modern Medicine

摘　　要：目的评价0.5%速卡(左旋布比卡因)用于硬膜外麻醉剖宫产手术的临床效果,在母体中血药浓度及经胎盘转运的情况,并以0.5%布比卡因作对照。方法选择行剖宫产手术足月单胎孕妇43例,硬膜外麻醉时随机分别接受0.5%速卡(速卡组)或0.5%布比卡因(布比卡因组)25mL,观察感觉阻滞、运动阻滞、镇痛和腹壁肌松质量、心电图(ECG)变化、新生儿Apgar、NACS评分和脐静脉血气及不良反应。并用高效液相色谱法测定了母体和胎儿的血浆药物浓度。结果两组孕妇感觉和运动阻滞的起效时间和持续时间、最高阻滞平面、低血压的发生率及ECG变化、新生儿Apgar、NACS评分和血气均无统计学差异,观察中无严重不良反应。两组母体血浆药物浓度在30min左右达高峰,脐静脉/母体静脉血药浓度比(UV/MV)无统计学差异。结论0.5%速卡适用于产科硬膜外麻醉,麻醉效能与同等浓度和剂量的布比卡因相同,其镇痛和麻醉效果可以满足临床手术需要;对母体副作用少,对新生儿无不良反应;同时药代动力学参数及经胎盘的转运比率两组相似。To compare the efficacy of 0.5% levobupivacaine with 0.5% bupivacaine in epidural space and study their pharmacokinetics and transfer across placents. Forty-three healthy obstetric patients undergoing elective cesarean section with epidural anesthesia were selected. Patients were randomized to receive 25 mL of either 0.5% levobupivacaine (group Levobupivacaine) or 0.5% bupivacaine (group Bupivacaine) in a double-blind fashion. The efficacy endpoint measurement included onset, offset, and quality of anesthesia. Neonatal blood gas analyses, Apgar score determinations, and neurobhavioral examinations were perfomed. Venous samples for pharmacokinetic studies and serial electrocardiograms were obtained in 10 patients in each group. Levels of sensory block, motor block, muscle relaxation, and overall quality of anesthesia did not differ between groups. The frequency of hypotension was 75.0% in the levobupivacaine group and 90.0% for the bupivacaine group (P =0.051). No significant difference in observed maximum concentration of drug after dosing or area under the plasma drug concentration versus time curve was seen. [Conclusions] The use of epidural 0.5% levobupivacaine for cesarean section results in equally efficacious anesthesia compared with 0.5% bupivacaine. Pharmacokinetic parameters were similar in the two groups with a good foreground for clinical application.

关 键 词：速卡 产科麻醉 药代动力学 

分 类 号：R614[医药卫生—麻醉学]