三种不同局麻药腰麻最大运动阻滞效应的比较  

Estimation of the maximum motor blocking potency ratio for intrathecal ropivacaine,levobupivacaine and bupivacaine

作　　者：黄绍强[1] 王婷婷[1] 李宁[1] 耿桂启[1] 胡建英[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海市200011

出　　处：《临床麻醉学杂志》2010年第8期670-673,共4页Journal of Clinical Anesthesiology

摘　　要：目的采用序贯试验评估罗哌卡因、左旋布比卡因和布比卡因鞘内注射后达到Bro-mage3级的半数有效剂量(ED50),比较三种局麻药腰麻的运动阻滞效应。方法腰-硬联合麻醉(CSEA)下择期行妇科手术患者99例,随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,分别鞘内注射0.5%等比重罗哌卡因、左旋布比卡因或布比卡因,起始剂量均为7mg,剂量变化梯度为1mg,鞘内注药后25min内双下肢改良Bromage达到3级为有效。结果罗哌卡因组腰麻产生最大运动阻滞的ED50为9.62mg,95%可信区间(CI)为9.16～10.09mg;左旋布比卡因组的ED50为9.55mg,95%CI为9.01～10.11mg;布比卡因组的ED50为6.08mg,95%CI为5.39～6.80mg。罗哌卡因最大运动阻滞相对效价比是布比卡因的0.63倍(95%CI0.56～0.73)。结论罗哌卡因和左旋布比卡因腰麻的运动阻滞效应明显低于布比卡因,而罗哌卡因与左旋布比卡因无明显差异。Objective To determine the median effective dose （ED50） for maximum motor block of intrathecal bupivacaine, levobupivacaine and ropivacaine, and to define their motor-blocking potency ratio. Methods In this prospective, randomised, double blind, parallel group, up-down sequential allocation study, we enrolled 99 patients undergoing selective gynecological surgery with combined spinal-epidural anesthesia（CSEA） and randomized them to one of three groups to receive intrathecal 0.5%（wt/vol） bupivacaine,levobupivacaine and ropivacaine,respectively. The initial dose was 7 mg and the testing interval was set at 1 rag. Efficacy was determined by the occurrence of modified Bromage 3 in both lower limbs within 25 rain after spinal injection. Results Intratheeal EDs0 for maximum motor block was 9.62 mg for ropivacaine （95% CI 9.16-10.09）, 9.55 mg for levobupivacaine（95% CI 9.01-10.11）,6.08 mg for bupivacaine （95% CI 5.39-6.80） （P〈0.01 vs. ropivacaine）. The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.63 （95% CI 0. 56 0. 73）. There was no significant difference between levobupivacaine and ropivacaine. Conclusion Intrathecal bupivacaine is more potent than levobupivacaine and ropivacaine for motor block, which is not significantly different between levobupivacaine and ropivacaine.

关 键 词：脊髓麻醉 罗哌卡因 左旋布比卡因 布比卡因 运动阻滞 

分 类 号：R614[医药卫生—麻醉学]