长效局麻药高位硬膜外阻滞对呼吸功能的影响  

Effects of upper thoracic epidural blockade with long action local anesthetics on respiratory function

作　　者：周子戎 汪春英[1] 黄贞玲[2] 郑颖[1] 张爱萍[1] 陈轶菁[1] 杭燕南[2] 

机构地区：[1]上海市黄浦区中心医院麻醉科,200002 [2]上海交通大学附属仁济医院麻醉科

出　　处：《江苏医药》2008年第5期451-453,共3页Jiangsu Medical Journal

摘　　要：目的探讨长效局麻药高位硬膜外阻滞（TEA）对呼吸功能的影响。方法选择ASAⅠ或Ⅱ级择期乳腺单纯切除和部分切除术病人200例,随机分为四组,每组50例,分别用0.375%布比卡因（B组）,0.375%左旋布比卡因（LB组）,0.5%罗哌卡因（R组）和1.0%利多卡因＋0.1%丁卡因（LD组）。每组随机抽10例在硬膜外注药前、注药后10、15、20、30、45、60min监测呼吸功能,包括呼吸频率（RR）、呼出气潮气量（VTE）、吸气流速（PIFR）、吸气峰流率（PIFR）、呼吸功（WOBp）、吸气/总呼吸时间比（Ti/TTOT）,以及手握力和感觉、运动阻滞情况。结果四组注药后60min时的感觉阻滞平面均在C2～6。四种局麻药TEA对呼吸功能均有不同程度的抑制,按其抑制程度次序为B组〉LB组〉LD组〉R组,以0.5%罗哌卡因TEA呼吸抑制最轻。结论四种局麻药液实施高位硬膜外阻滞对呼吸功能均有不同程度的影响,0.5%罗哌卡因对呼吸功能影响相对较轻,适合用于TEA。Objective To study the effects of upper thoracic epidural blockade with long action local anesthetics on respiratory function. Methods A total of 200 patients, ASA status Ⅰor Ⅱ, Undergoing selective mastectomy were randomly divided into four groups with 50 cases each. Upper thoracic epidural blockade was performed with 0.375% bupivacaine （group B）, 0.375%levobupivacaine （group LB）, 0.5% ropivacaine （group R）,or 1% lidocaine 0.1% dicaine mixture （group LD）. Respiratory function was monitored in 10 patients selected randomly from each group before and at 10,15,20,30,45 and 60min after epidural injection.Results The sensory blockade range （C2-6） was similar in the four groups at 60min after epidural injection. The depressive effects of respiratory functions including expiratory tidal volume （VTE）, respiratory rate（RR）, peak inspiratory flow rate（PIFR）, work of breathing（WOBp）,inspiratory time /total expiratory time ratio（Ti/TTOT） was in an order of group B 〉 group LB 〉 group LD 〉 group R. Conclusion Three local anesthetics of 0.375% levobupivacaine, 0.375% bupivacaine and 0.5% ropivacaine have depressive effect on respiratory function,of which 0.5% ropivacaine has the least influence with more safety used for upper thoracic epidural blockade.

关 键 词：硬膜外阻滞 局麻药 呼吸功能 

分 类 号：R971[医药卫生—药品]