硬膜外罗哌卡因和左旋布比卡因运动阻滞效能的比较  

Relative Motor Blocking Potencies of Epidural Ropivacaine and Levobupivacaine

作　　者：孙来保[1] 刘松[1] 王卓青[2] 魏明[1] 汪卫兵[1] 黄文起[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广东广州510080 [2]中山大学附属第一医院科研科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2008年第4期477-481,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2002154)

摘　　要：【目的】在分娩第一产程时测定左旋布比卡因和罗哌卡因的最小运动阻滞浓度(EC50)并对其运动阻滞效能进行比较。【方法】60例产妇随机分为两组,每组30例,在宫口开至2～5cm时行硬膜外穿刺置管注入左旋布比卡因或罗哌卡因溶液10mL。注药前和注药后30min进行Bromage运动评分,运动阻滞的标准为注药后30min任何一侧下肢出现Bromage评分<4分。各组产妇硬膜外起始用药浓度均设定0.5%,按照序贯法来调整每组下一例产妇用药的浓度。记录临床效果及不良反应。【结果】所有产妇均顺利产婴,母婴安全,无明显不良反应。硬膜外罗哌卡因运动阻滞EC50为0.674%;左旋布比卡因运动阻滞EC50为0.562%。罗哌卡因运动阻滞的效能为左旋布比卡因的0.83,95%的置信区间为0.80～0.87。【结论】硬膜外罗哌卡因的运动阻滞效能小于左旋布比卡因,仅为左旋布比卡因运动阻滞效能的83%。[Objective] To determine the motor block minimum local analgesic concentrations （EC50） of levobupivacaine and ropivacaine, and compare the relative potency of these drugs used in epidural space. [Methods] Sixty parturients with 2 - 5 cm cervical dilatation were randomized to receive either ropivacaine or levobupivacaine. Drugs were administered as a 10 mL epidural bolus （5 mL/min）. The first woman received 0.5%, Up-down sequential allocation was used to determine subsequent concentration： to increase the concentration one level if the previous woman did not respond and to reduce the concentration one level if the previous woman did respond. Effective motor block was defined as a Bromage score 〈 4 within 30 min. Efficacy was assessed using visual analog pain scores, and safety was assessed by recording maternal and fetal/neonate vital signs and adverse events. [ Results ] The motor block minimum local analgesic concentrations （EC50） of ropivacaine was 0.674% and for levobupivacaine （EC50） was 0.562% with a ropivacaine/levobupivacaine potency ratio of 0.83 （95% CI, 0.80-0.87）. [Conclusion] Ropivacaine was significantly less potent for motor block, at 83% that of levobupivacaine.

关 键 词：分娩镇痛 硬膜外 酰胺类 药效动力学 运动阻滞 

分 类 号：R614[医药卫生—麻醉学]