罗哌卡因单独或复合肾上腺素上胸段硬膜外阻滞的麻醉效果和药动学  

Efficacy and pharmacokinetics of ropivacaine with and without adrenaline used for upper thoracic epidural anesthesia

作　　者：马民玉[1] 张斯[1] 刘兰萍[1] 马君志[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,河南郑州450052

出　　处：《中国新药与临床杂志》2005年第9期740-743,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：河南省科技攻关资助项目(0211043900)

摘　　要：目的:探讨罗哌卡因单独或复合肾上腺素上胸段硬膜外阻滞的麻醉效果和药动学特征.方法:20例美国麻醉医师协会病情估计分级(ASA)Ⅰ～Ⅱ级行乳腺肿瘤手术病人,随机分为罗哌卡因单用组(RP组)及其与肾上腺素合用组(RP+AD组)每组10例;均选择T3-4穿刺并置管,在2 min内RP组注入0.5%罗哌卡因1.3 mg·kg-1,RP+AD组注入加入1:200 000肾上腺素(5 mg·L-1)的0.5%罗哌卡因1.3 mg·kg-1.比较注药后2组感觉和运动阻滞特征,以高效液相色谱法测血浆罗哌卡因浓度,比较2组药动学参数.结果:2组麻醉效果均评定为优,2组感觉和运动阻滞指标,t1/2α,t1/2β,tmax,Cl和Vd比较差异均无显著意义(P＞0.05),RP+AD组在10～360 min期间对应时刻的血浆RP浓度值低于RP组,差异有显著或非常显著意义(P＜0.05或P＜0.01),cmax和AUC0～t均低于RP组,差异有显著意义(P＜0.05).结论:0.5%罗哌卡因上胸段硬膜外麻醉安全、有效,加1:200000肾上腺素对0.5%罗哌卡因麻醉效果无明显影响,但可降低罗哌卡因血药浓度,有利于减少全身毒性的风险.AIM ：To investigate the anesthetic efficacy and pharmacokinetics of ropivacaine with and without adrenaline used for upper thoracic epidural anesthesia （UTEA）. METHODS： Twenty female patients （ASA Ⅰ-Ⅱ） undergoing breast surgery were allocated into two groups： group RP （ropivacaine group, n = 10） and group RP ＋ AD （ropivacaine with adrenaline group,n = 10）. UTEA was performed at the T3-4 interspace by using epidural catherter. Patients of group RP and RP ＋ AD received 0.5 % ropivacaine 1.3 mg · kg^-1 and 0.5 % ropivacaine 1.3 mg · kg^-1 plus adrenaline 5 mg · L^-1 epidurally in 2 min, respectively. The indexes for sensory and rooter blockades of both groups were compared, the total plasma concentration of ropivacaine was determined by high perform- ance liquid chromatography. RESULTS： The anesthetic efficacies in both groups were satisfactory. There were no significant differences in indexes of sensoryand moter blockas, t1/2α,t1/2β,tmax, Cl and Vd between both groups . The plasma concentration of ropivacaine in group RP ＋ AD was lower than that in group RP at 10-360 min relation time-point （P 〈 0. 05 or P 〈 0.01）. The cmax and AUC0-t of group RP ＋ AD were lower than those of group RP （P 〈 0.01 ）. CONCLUSION： 0.5 % ropivacaine for UTEA is safe and effective. Addition of adrenaline shows no significant improvement but can significantly decrease the systemic plasma concentration and cmax of ropivacaine, and thus reduce the toxicity from absorption of ropivacaine.

关 键 词：罗哌卡因 肾上腺素 药动学 麻醉 硬膜外 麻醉效果 

分 类 号：R969.1[医药卫生—药理学] R971.2[医药卫生—药学]