患者硬膜外注射不同浓度左旋布比卡因的药代动力学  

Pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia

作　　者：马民玉[1] 王承海[1] 冉菊红[1] 阚全程[2] 马君志[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,450052 [2]郑州大学第一附属医院临床药理基地,450052

出　　处：《中华麻醉学杂志》2008年第3期238-241,共4页Chinese Journal of Anesthesiology

基　　金：河南省科技攻关资助项目（0624420030）

摘　　要：目的 探讨患者硬膜外注射不同浓度左旋布比卡因的药代动力学。方法 择期行结肠癌根治术、经腹或腹会阴直肠癌根治术患者20例，ASAⅠ或Ⅱ级，年龄35～59岁，随机分为0．75％左旋布比卡因组（Ⅰ组）和0．5％左旋布比卡因组（Ⅱ组），每组10例。麻醉方法为腰段硬膜外阻滞联合全麻。经Ⅰ1-2硬膜外穿刺成功后，分别经2min注入0．75％或0．5％左旋布比卡因2mg／kg。硬膜外注药结束后30min内记录感觉和运动阻滞效果，记录不良反应发生情况。于注药后即刻、注药后10、20、30、45、60、90、120、210、300、420、540、660和840min时取中心静脉血3ml，采用高效液相色谱法测定血浆左旋布比卡因浓度，绘制血浆左旋布比卡因浓度一时间曲线，计算2组药代动力学参数。结果 2组血浆左旋布比卡因浓度一时间曲线均符合二房室开放模型；2组药代动力学参数比较差异均无统计学意义（P〉0．05）。结论 0．75％和0．5％左旋布比卡因2mg／kg腰段硬膜外阻滞安全性高，血浆药物浓度一时问曲线均符合二房室开放模型，两者药代动力学特性无差异。Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia. Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes aged 35-59 yr scheduled for elective rectum or colon cancer operation under general anesthesia combined with epidural block were randomly divided into 2 groups （ n = 10 each） ： group Ⅰ0.75% levobupivacaine and group Ⅱ0.5% levobupivacaine. Epidural block was performed at L1-2 interspace. Group Ⅰ and Ⅱreceived epidural 0.75% and 0.5% levobupivacaine 2 mg/kg （containing adrenaline 5 μg/kg） injected slowly over 2 min respectively. Thirty minutes after epidural levobupivacaine, general anesthesia was induced withγ-hydroxybutyrate 60-80 mg/kg, and remifentanil 1-2 μg/kg. Tracheal intubation was facilitated with succinyl choline 1-1.5 mg/kg and the patients were mechanically ventilated. Anesthesia was maintained with inhalation of nitrous oxide and 02 （ 1 ： 1 ） and continuous infusion of remifentanil 0.01-0.1 μg· kg^-1· min ^-1 and intermittent iv boluses of atracurium. Sensory and motor blockade were assessed after epidural levobupivacaine. Blood samples were taken from central vein at 0, 10, 20, 30, 45, 60, 90, 120, 210, 300, 420, 540, 660 and 840 min after epidural levobupivacaine for determination of plasma concentration of levobupivacaine by high performance liquid chromatography. Results The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the two groups and there was no significant difference in the pharmacokinetic profiles between the two groups. The onset time of sensory and motor block was shorter and the duration of the two blocks was longer with 0.75% levobupivacaine as compared with 0.5% levobupivacaine. The incidences of nausea and vomiting and hypotension were low and no severe cardiovascular and neurological side-effects developed. Conclusion The phannacokinetic parameters do not differ significantly between epidural 0.75% and 0.5% levobupivacain

关 键 词：布比卡因 药代动力学 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]