左旋布比卡因与布比卡因高位胸段硬膜外阻滞的麻醉和术后镇痛效果及对肺功能的影响  

Effects of anesthesia and postoperative analgesia and influence on lung function of levobupivacaine and bupivacaine in high thoracic epidural analgesia

作　　者：陆惠元[1] 范晓琳[1] 赵辉[2] 刘加洪[3] 戴晓凤[1] 曹倩倩[1] 

机构地区：[1]青岛大学医学院第二附属医院青岛市中心医院麻醉科,青岛266042 [2]青岛大学医学院第二附属医院青岛市中心医院乳腺科,青岛266042 [3]青岛大学医学院第二附属医院青岛市中心医院肺病研究所,青岛266042

出　　处：《中国临床保健杂志》2015年第6期618-621,共4页Chinese Journal of Clinical Healthcare

摘　　要：目的 比较左旋布比卡因与布比卡因高位胸段硬膜外阻滞（TEA）乳腺肿瘤外科手术麻醉效果及对肺功能的影响。方法 60例女性美国麻醉医师协会（ASA）分级Ⅱ-Ⅲ级择期乳腺手术患者,采用随机数字表法分成左旋布比卡因组和布比卡因组各30例。取T3-4或T2-3硬膜外穿刺成功注入左旋布比卡因或布比卡因局部麻醉药液,手术结束硬膜外自控镇痛（PCEA）。监测记录局部麻醉药用量,感觉阻滞、镇痛效果、血压、心率、肺功能和不良反应。结果 左旋布比卡因组阻滞范围较广,视觉模拟评分法（VAS）优于布比卡因组（P〉0.05）。硬膜外注药30 min布比卡因组血压（BP）显著下降（P〈0.01）。并且两组患者在麻醉30 min时潮气量（VT）,用力肺活量（FVC）,一秒钟用力呼气容积（FEV1）,一秒钟用力呼气容积占用力肺活量百分比（FEV1/FVC）30 min也降低（P〈0.05）,手术结束和术后VT、FEV1和FEV1/FVC却升高（P〉0.05）。术后VAS评分〈2分,组内比较差异无统计学意义（P〉0.05）。结论 0.25%左旋布比卡因和0.25%布比卡因在TEA有相似的麻醉效果,左旋布比卡因感觉阻滞优于布比卡因并显示有较低的心血管抑制作用,其麻醉和硬膜外术后镇痛可使呼吸道阻力降低以及对术中和术后肺功能皆有改善作用。Objective Compare the anesthetic effect and pulmonary function of high thoracic epidural anesthesia （TEA） in breast neoplasms operation between levobupivacaine and bupivacaine. Methods Sixty ASA lI -III female patients with selected breast surgery were randomly divided into L and B groups, where 30 patients in each group. In all patients ,T3.4or T2.3was selected as epidural space. The patients would receive sequential local anesthetic as the initial volume of L or B group. The anesthesia was maintained with epidural administration. The patient-controlled epidural analgesia （PCEA） was initiated at the end of operation. Local anesthetic dosage, effect of sensory block, analgesia,hemodynamic,lung function and adverse reaction were recorded and compared. Result The area of block and VAS was better in levobupivaeaine group than that in bupivacaine （ P 〉 0. 05 ）. BP in B group was decreased significantly （P 〈 0.01 ） and TV, FVC, FEVl , FEV1/FVC decreased significantly at 30 minutes after epidural infusion （ P 〈 0.05）. TV, FEV1 and FEV1/FVC were increased at the end and post of operation （ P 〉 0.05）. Postoperative VAS score 〈 2, there was no statistically significant difference comparing the within group （ P 〉 0.05 ）. Conclusion The 0.25% levebupivacaine have a similar anesthesia effect with 0.25% bupivacaine in TEA. Levobupivacaine sensory block is better than bupivacaine, and show lower cardiovascular inhibition. The＇ anesthesia and postoperative PCEA reduces the airway resistance and improve lung function.

关 键 词：镇痛 硬膜外 外科手术/乳腺肿瘤 布比卡因 

分 类 号：R614.42[医药卫生—麻醉学]