盐酸左旋布比卡因复合液用于硬膜外持续泵注术后镇痛的临床研究  

Clinical study of continuous epidural analgesia with fentanyl-levobupivacaine mixture for the treatment of postoperative pain in gynecology operation

作　　者：李熹[1] 徐湘盛[1] 许峰[1] 刘功俭[2] 

机构地区：[1]解放军第123医院麻醉科,安徽蚌埠233015 [2]徐州医学院附属医院麻醉科,江苏徐州221002

出　　处：《淮海医药》2006年第3期173-175,共3页Journal of Huaihai Medicine

摘　　要：目的观察国产盐酸左旋布比卡因注射液用于硬膜外持续泵注术后镇痛的效果,探讨其用于硬膜外镇痛的可行性和最佳浓度,评价其安全性.方法选择ASA Ⅰ～Ⅱ级、妇产科手术患者96例,随机分为4组：Ⅰ组：0.125%左旋布比卡因组,Ⅱ组0.15%左旋布比卡因组,Ⅲ组：0.2%左旋布比卡因组,Ⅳ组：0.125%布比卡因组.观察术毕即刻、术后4 h、8 h、12 h、24 h、48 h各时间点的VAS评分、MBS评分以及MAP、SpO2、HR、RR变化、不良反应发生情况,注射局麻药前和术后24 h抽血测定AST、LDH、BDH、CK的变化.结果VAS评分Ⅰ、Ⅱ、Ⅳ组相比差异无显著性,而Ⅲ组与Ⅰ、Ⅱ、Ⅳ比较差异有显著性（P＜0.05）,MBS评分Ⅲ组高于Ⅰ、Ⅱ、Ⅳ组,但差异无显著性（P＞0.05）,各组术后24 h AST、LDH、BDH、CK均有增高,与术前比较差异有显著性（P＜0.05）,组间比较除CK、BHD外均无差异（P＞0.05）,Ⅳ组术后BDH变化高于Ⅰ、Ⅱ、Ⅲ组（P＜0.05）.各组术后24 h CK,与术前相比差异有非常显著性（P＜0.01）.结论采用浓度为0.125%～0.2%的左旋布比卡因复合4μg/ml的芬太尼,以4 ml/h的速度持续榆注能提供良好的术后镇痛效果,0.2%的左旋布比卡因组运动神经恢复时间较长,盐酸布比卡因组安全性高于盐酸左旋布比卡因组.Objective To investigate the clinical effect of different dense of levobupivacaine used during continuous epidural analgesia. Methods 96 ASA Ⅰ～Ⅱ patients undergoing gynecology operation under epidural analgesia were randomly divided into four groups, 24 cases in each group. After operation, in our departmental study, 3 different concentrations of levobupivacaine （Group Ⅰ： 0.125% Group Ⅱ： 0.15% and Group Ⅲ： 0.2%） and 0.125% bupivacaine （Group Ⅳ） combined with fentanyl （4 μg/ml） were administered in continuous epidural post-operative infusion to investigate quality of analgesla,motor block and side-effects. The incidence of nausea and vomiting, VAS, MAP, SpO2, HR and RR were respectively measured at the time of 0, 4, 8, 12, 24 and 48th hour after PCA. Blood samles were obtained and myocardial zymograms （AST, LDH, BDH, CK）were measured before operation and at 24th hour after operation. Results No statistically significant difference was noted in age, height, weight, duration of the operation between the groups. Postoperative analgesia was satisfactiory in all four groups. VAS showed no statistical difference among groups Ⅰ, Ⅱ, Ⅳ, and was significantly lower in group Ⅲ than in groups Ⅰ, Ⅱ, Ⅳ （P 〈 0.05）. There were no significant differences in the changes of MAP, HR, RR and SpO2 among the four groups. Postoperative CK was significantly different from that in preoperation （P 〈 0.01）. Conclusion Background epidural infusion of 0.125%～0.2% levobupivaeaine with 4μg/ml fentanyl is satisfactory for postoperative analgesia. Levobupivacaine is less eardiotoxie than bupivacaine.

关 键 词：布比卡因 左旋布比卡因 自控镇痛 硬膜外腔 心肌酶 

分 类 号：R614.42[医药卫生—麻醉学] R713[医药卫生—外科学]