左旋布比卡因对不同体重产妇剖宫产术脊麻ED_(50)的研究  

ED_(50) of Levobupivacaine during spinal anesthesia in women of different weight undergoing cesarean section

作　　者：李树武 金振疆 李晓峰 屠雪峰 范明威 

机构地区：[1]辽河油田妇婴医院麻醉科,辽宁盘锦124000

出　　处：《海南医学》2011年第22期17-20,共4页Hainan Medical Journal

摘　　要：目的确定0.5%左旋布比卡因等比重溶液在肥胖产妇与非肥胖产妇脊麻中产生运动阻滞的半数有效量(ED50),确定两类产妇运动阻滞的效价比。方法随机选择ASAI^II级择期剖宫产产妇50例,术中行腰硬联合麻醉(CSEA),按体重指数(BMI)不同分为两组,每组产妇25例,肥胖组,BMI>30kg/m2,正常组,BMI≤30kg/m2。脊麻给药剂量的选择用上下序贯法,首次剂量为0.5%左旋布比卡因6mg,下一次剂量视前一患者反应而定,1mg为药量增减梯度。根据脊麻给药后5min阻滞情况决定下例患者给药剂量,以Bromage和HMFS评分判定下肢运动阻滞是否有效,用Dixon和Massey公式和概率单位回归(Probit Regression)方法计算分析两组患者运动神经阻滞的ED50。结果用Dixon和Massey计算得出,0.5%左旋布比卡因在肥胖组和正常组产妇脊麻中产生运动神经阻滞的ED50分别为3.123mg(95%CI:2.738,3.563)和3.558mg(95%CI:3.325,3.872),ED50的效价比为0.878(95%CI:0.614,1.023);Probit回归分析得出肥胖组和正常组产妇ED50分别为3.010mg(95%CI:1.992,3.532)和3.441mg(95%CI:2.487,3.996),ED50的效价比为0.875(95%CI:0.540,1.023),左旋布比卡因对肥胖产妇的运动阻滞效应增强,与正常组相比,差异有统计学意义(P<0.05)。结论 0.5%左旋布比卡因在肥胖产妇脊麻中,产生运动阻滞的效价强度大于正常体重产妇。Objective To determine the median effective dose （ED50） of 0.5% Levobupivacaine during spinal anesthesia in women with maternal obesity and those without maternal obesity. Methods Fifty patients of ASA Ⅰ-Ⅱ scheduled for intraoperative epidural anesthesia （CSEA） during cesarean section （CS） was randomly selected. The patients were divided into two groups according to body mass index （BMI）： the obesity group （n=25, BMI30 kg/m2） and the normal group （n=25, BMI≤30 kg/m2）. Based on up-and-down sequential method, the first patient was given 6 mg 0.5% levobupivacaine, and the dose of next patient was given depending on the response of the first patient 5 minutes later, with 1 mg as the gradient for increase or decrease. Bromage and HMFS were used to determine the efficacy of lower limb motor block. Dixon and Massey formula as well as Probit regression were applied to analyze the ED50 of the two groups. Results Calculated by Dixon and Massey, the ED50 in the obesity group and the normal group were 3.123 mg （95% CI： 2.738, 3.563 mg） and 3.558 mg （95% CI： 3.325, 3.872）, respectively, with the ratio of 0.878 （95% CI： 0.614, 1.023）. Probit regression analysis revealed that ED50 in the obesity group and the normal group were 3.010 mg （95% CI： 1.992, 3.532） and 3.441 mg （95% CI： 2.487, 3.996）, respectively, with the ratio of 0.875 （95% CI： 0.540, 1.023）. The effect of motor block by levobupivacaine was significantly more pronounced in the obesity group than the normal group （P〈0.05）. Conclusion Levobupivacaine is more effective for motor block in women with maternal obesity than those without obesity.

关 键 词：左旋布比卡因 脊髓 麻醉 局麻药 半数有效量 运动阻滞 肥胖 

分 类 号：R719.8[医药卫生—妇产科学]