肝功能异常患者罗哌卡因硬膜外阻滞复合全麻的药效学和安全性  

Pharmacodynamics and safety of ropivacaine used for combined general - epidurai anesthesia in pa- tients with hepatic dysfunction

作　　者：冉菊红[1] 马民玉[1] 刘兰萍[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,郑州450052

出　　处：《中原医刊》2007年第1期3-5,共3页Central Plains Medical Journal

基　　金：河南省科技攻关资助项目（0211043900）

摘　　要：目的 探讨罗哌卡因硬膜外阻滞复合全麻用于肝功能异常患者的药效学和安全性。方法 选择择期上腹部手术病人40例，其中20例有阻塞性黄疸的肝功能异常病人，AsAⅢ级，为肝功能异常组（Ⅰ组），另20例肝功能正常病人，ASAⅠ～Ⅱ级，为对照组（Ⅱ组），所有患者均采用硬膜外阻滞复合全身麻醉，第8～9胸椎硬膜外穿刺成功后，2min内注入0．75％RP溶液（含肾上腺素5μg／m1）2mg／kg，30min后分别静注γ-羟丁酸钠、瑞芬太尼和阿曲库铵诱导插管并维持，并持续吸入N2O：O2（1：1）。观察硬膜外注药后30min内的感觉、运动阻滞效果；所有患者入手术室均连续测定并记录注药前、后10、20、30、60、90、120和180min时的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）和心电图（ECG）；同时记录麻醉期间的不良反应发生情况。结果 两组感觉和运动阻滞特征相似，组间比较差异无统计学意义（P〉0．05）。Ⅰ组注药后各时点SBP、DBP、MAP均下降，与注药前比较差异有统计学意义（P〈0．05或P〈0．01）；Ⅱ组注药后10～90min内各时点SBP、DBP、MAP均下降，与注药前比较差异有统计学意义（P〈0．05或P〈0．01），两组注药120min后各时点SBP、DBP、MAP均趋向回升，Ⅱ组回升明显，与Ⅰ组比较差异有统计学意义（P〈0．05或P〈0．01）。HR：两组注药后均减慢，Ⅰ组或Ⅱ组分别在注药30min或90min后各时点减慢明显，与注药前比较差异均有统计学意义（P〈0．05）。Ⅰ组低血压发生率较高，麻黄素用量较大，与Ⅱ组比较差异有统计学意义（P〈0．05）。结论 0．75％罗哌卡因胸段硬膜外阻滞，肝功能正常和异常患者在注药后30min内，感觉和运动阻滞效果无明显差别；肝功能异常患者麻醉期间血流动力学稳定性较差，低血压发生率较高，故麻醉Objective To investigate the pharmacedynamics and safety of ropivacaine used for combined epidural - general anesthesia in patients with hepatic dysfunction. Methods Fourty patients scheduled to undergo upper abdominal surgery under the combined epidural - general anesthesia were divided into two groups Ⅰ hepatic dysfunction group （ group Ⅰ） included 20 patients with obstructive jaundice and control group （ group Ⅱ ） included 20 patients with normal hepatic function. Epidural block was performed at the T8-9 interspace, all patients received 0. 75% ropivacaine 2mg/kg plus adrenaline 5μg/ml epidurally in 2min. After 30min, general anesthesia was induced with sodium hydroxybutyrate,remifentanil and atracurium, the trachea was intu- bated and maintained with inhalation of N2O：O2 （ 1：1 ） ,a continuous iv infusion of remifentanil and intermittent iv boluses of atracurium. The index for sensory and motor blockade within 30min after injection 6f both groups were compared, SBP, DBP, MAP, HR, SpO2 and ECG were monitored and recorded continuously during anesthesia at before injection, 10,20,30,60,90,120,180min after injection of RP, The adverse reactions were recorded during anesthesia. Results There were no significant differences in indexes for sensory and motor blockes within 30 min after injection between two groups. SBP, DBP andMAP at each time - points after injection decreased markedly in group Ⅰ , which was significantly different from the baseline （ P 〈 0. 05 or P 〈 0. 01 ）. At each time - points within 10 - 90min after injection SBP, DBP and MAP decreased markedly in group Ⅱ ,which was significantly different from the baseline （ P 〈 0. 05 or P 〈 0. 01 ）, SBP, DBP, MAP at each time - points after 120 min increase a bit in group Ⅱ, there was no significant difference compared with the baseline（ P 〉0. 05 ）. Compared with group Ⅰ,SBP,MAP and DBP after 120min increase significantly in group Ⅱ（P 〈0.05 orP 〈0.01）.The incidence of hypotension was higher and ep

关 键 词：酰胺类 肝功能不全 硬膜外阻滞 复合全身麻醉 药效学 安全性 

分 类 号：R614.42[医药卫生—麻醉学]