硬膜外阻滞时罗哌卡因和布比卡因的药代动力学  

Hemodynamics and stress response changes during laparoscopic cholecystectomy under general anesthesia or combination of general and epidural anesthesia

作　　者：解大建[1] 吴新民[1] 许幸[1] 胡晓华 

机构地区：[1]北京医科大学第一医院麻醉科,100034

出　　处：《中华麻醉学杂志》1999年第8期459-460,共2页Chinese Journal of Anesthesiology

摘　　要：目的　研究国人在硬膜外阻滞时罗哌卡因和布比卡因的药代动力学特征。方法　选择１４ 例手术病人、随机分为两组。硬膜外阻滞时，分别注入罗哌卡因２．０ｍ ｇ／ｋｇ 或布比卡因２．０ｍ ｇ／ｋｇ。用气相色谱法测定血浆药物浓度。结果　罗哌卡因和布比卡因的药－时曲线均符合二室开放模型。ｔ１／２ｋａ分别为０．２２ 小时和０．１４ 小时，Ｔｐｅａｋ 分别为０．５１ 小时和０．４７ 小时，Ｃａｍ ｘ 分别为１．０６ｍ ｇ·Ｌ－ １和１．４４ｍ ｇ·Ｌ－ １ 。另外发现，其主要药代动力学参数，ＡＵＣ分别为２．６ｍ ｇ·Ｌ－ １·ｈ－ １ 和５．２ｍ ｇ·Ｌ－ １·ｈ－ １ ，ｔ１／２ β分别为１．７ 小时和２．８ 小时，ＣＬ分别为７５７ｍ ｌ·ｍ ｉｎ－ １ 和３８２ｍ ｌ·ｍ ｉｎ－ １，两组间均具有显著差异（Ｐ＜ ０．０５）。结论　罗哌卡因比布比卡因较少发生中枢神经系统及心血管的蓄积，主要是由于罗哌卡因在体内消除代谢能力较强所致。Objective To observe the hemodynamic and concentration of plasma catecholamines changes during laparoscopic cholecystectomy (LC) under general anesthesia or combined with epidural anesthesia Methods Twenty patients,scheduled for LC,were randomly divided into general anesthesia group (A group,n=11) and general anesthesia combined with epidural anesthesia group (B group,n=9) The hemodynamic changes after peritoneal insufflation of CO 2 were measured with Swan Ganz catheterization,and the plasma concentration of epinepherine (E) and nonepinepherine (NE) were measured before and after CO 2 being insufflated into peritoneal cavity with high performance liquid chromatography electrochemical method Results (1) Both concentraitons of NE and E were increased significantly after peritoneal insufflation in A group (P<0 05),while no obvious changes in B group (P>0 05) (2)HR,MAP,CVP,SVR and CI were increased significantly while SV had no obvious change after peritoneal insufflation in A group; in B group, all parameters had no significant changes except CVP was significantly increased Conclusion The combination of general and epidural anesthesia can suppress the stress response and stablize the hemodynamics during LC

关 键 词：罗哌卡因 布比卡因 硬膜外麻醉 药代动力学 

分 类 号：R614.42[医药卫生—麻醉学] R971.2[医药卫生—外科学]