下腹部手术患者氯普鲁卡因、罗哌卡因、布比卡因、利多卡因低位硬膜外阻滞的效应比较  

Compare the efficacy of chlorprocaine,ropivacaine,bupivacaine and lidocaine for lower epidural anesthesia in lower abdominal surgery

作　　者：齐伟[1] 吴志恒[1] 张明华[1] 朱铁梁[1] 

机构地区：[1]武警医学院附属医院药剂科,天津300162

出　　处：《武警医学院学报》2007年第3期276-278,共3页Acta Academiae Medicinae CPAPF

摘　　要：【目的】比较3％氯普鲁卡因与0．75％罗哌卡因，0．75％布比卡因，2％利多卡因用于低位硬膜外阻滞的麻醉效果。【方法】选择择期下腹部手术患者80例（ASAⅠ-Ⅱ级），随机分为4组，3％氯普鲁卡因组20例，0．75％罗哌卡因组20例，0．75％布比卡因组20例，2％利多卡因20例。侧卧位下取L1—2或L2—3行硬膜外穿刺，向头端置管3cm，分别注入首次量3％氯普鲁卡因、0．75％罗哌卡因组、0．75布比卡因、2％利多卡因L组3ml，试验量5min后再分别注入对应药物各12ml。分别观察心率、血压、呼吸次数和氧饱和度及麻醉起效时间、痛觉消失时间、疼痛恢复时间、硬膜外阻滞范围、运动阻滞最大程度（Bromage评分）和运动阻滞恢复时间。【结果】0．75％布比卡因麻醉起效时间、痛觉消失时间、疼痛恢复时间、运动阻滞恢复时间明显长于3％氯普鲁卡因、0．75％罗哌卡因和2％利多卡因（P〈0．05），3％氯普鲁卡因的起效时间最短，与0．75％罗哌卡因和2％利多卡因比较有显著性差异（P〈0．05）。3％氯普鲁卡因和2％利多卡因在疼痛恢复和运动阻滞恢复上时间最短，0．75％罗哌卡因的运动阻滞程度在4组中最为轻微。4组间阻滞范围比较差异无显著性（P〉0．05）。【结论】4组镇痛效果均良好。氯普鲁卡因起效迅速，阻滞完善，维持时间稍短，更适合临床中、短手术；布比卡因维持时间长，适用长时间手术；利多卡因组与氯普鲁卡因组相似，痛觉恢复时间和运动阻滞恢复时间快：罗哌卡因感觉阻滞完善，止痛效果好，维持时间适中，下肢运动阻滞弱且恢复迅速，对循环影响小，利于术后患者运动功能的恢复。[Objective] To compare the analgesic efficacy and safety of epidural anesthesia of 3% chlorprocaine, 0.75% ropivacaine, 0.75%bupivacaine and 2% lidocaine for lower epidural anesthesia. [Methods] Eighty ASA Ⅰ - Ⅱ patients undergoing lower abdominal operation under epidural anesthesia were randomly divided into four groups： chlorprocaine group （20 cases）, ropivacaine group （20 cases）, bupivacaine group （20 cases） and hdocaine group （20 cases）. Epidural space L1-2 or L2-3 was selected in all cases, and the catheter was put upward 3 - 4 cm. The initial dose was 3 ml for each anesthetic. Five min after a 3 ml test dose injected into epidural space, another 12 ml local anesthetic was given in each group. The vital signs （HR, BP, RR, SPO2） and the efficacy of each drug （onset time of pain free, duration time, and blockage level） were recorded. [Results] 0.75%bupivacaine had a significiant longer time on onset, anesthesia effect, recoverv from anesthesia and motor block than 3% chlororocaine, 0.75% rooivacaine and 2%hdocaine （P 〈0.05）. 3% chlorprocaine had the shortest onset time and had a significiant difference from 0.75% ropivacaine and 2% lidocaine （P 〈 0.05）. Both 3 % chlorprocaine and 2 % Lidocaine had the shortest time on recovery from anesthesia effect and motor blockade. 0.75 % ropivacaine had the slightest effect on motor blockade amons these four groups. There were no significiant differences among these four groups on blockade level （P 〉 0.05）. [Collusions] Each of these four groups could produce a satisfactory anesthesia effect. Chlorprocaine hydrochloride is faster in onset, is well in blockade. So it is more suitable for middle operation and short operation. Bupivacaine has a prolonged duration time. So it is better for long operation. Lidoeaine has a similar effect with chlorprocaine; both of them have a shorter recovery time from anesthetie effect and motor blockade. Ropivacaine hydrochloride is well in sensory block and anesthetie effect. And it has a midd

关 键 词：氯普鲁卡因 布比卡因 罗哌卡因 利多卡因 硬膜外麻醉 

分 类 号：R614.4[医药卫生—麻醉学]