左旋布比卡因用于小儿腹股沟疝手术超声引导下腹横肌平面阻滞的半数有效剂量研究  

Research of median effective dose of levobupivacaine for ultrasound - guided transversus abdominis plane block in pediatric hernia surgery

作　　者：蒋毅 吴博 Jiang Yi, Wu Bo.(1Department of Anesthesiology,the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang 325000, China ;2 Center of Laboratory Animal, Wenzhou Medical University, Wenzhou, Zhejiang 325035 ,China)

机构地区：[1]温州市中西医结合医院麻醉科,浙江省温州325000 [2]温州医科大学实验动物中心,浙江省温州325035

出　　处：《中国基层医药》2018年第6期688-691,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市公益性科技计划项目（Y20150241）

摘　　要：目的探讨左旋布比卡因用于小儿腹股沟疝手术超声引导下腹横肌平面（TAP）阻滞的半数有效剂量（ED50）。方法选取择期行单侧腹股沟疝手术的患儿30例为研究对象，给予基础麻醉后行超声引导下TAP阻滞，左旋布比卡因起始剂量为0．5mg／kg，其后各患儿所用药物剂量根据前面患儿的反应按Dixon序贯法确定，以心率（HR）或平均动脉血压（MAP）超过基础值的20％作为阻滞失败的评价指标，剂量变化梯度为0．1mg／kg。采用Dixon序贯法和logistic回归分析计算左旋布比卡因的ED50及其95％可信区间。结果采用Dixon序贯法计算左旋布比卡因用于TAP阻滞的ED50及其95％可信区间为0．24（0．22—0．27）mg／kg，采用logistic回归分析进行概率单位转换计算的ED50及其95％可信区间为0．17（0．08～0．24）mg／kg，且术后无TAP穿刺相关的不良反应发生。结论超声引导下TAP阻滞可减少局部麻醉药的用量和不良反应的发生，左旋布比卡因用于小儿腹股沟疝手术超声引导下TAP阻滞的ED50为0．24mg／kg。Objective To investigate the median effective dose of levobupivacaine for ultrasound - guided transversus abdominis plane （ TAP ） block in pediatric hernia surgery. Methods Thirty consecutive children scheduled for pediatric hernia surgery were treated by basic anesthesia and ultrasound - guided TAP block. The levnbupivacaine dose for a particular patient was determined by the response of the previous patient to a higher or smaller dose （step size of 0. 1 mg/kg） using Dixon ＇s up-and-down sequential method, starting at levobupivacaine 0. 5mg/kg, Block failure was defined as a 20% increase in heart rate（HR） or mean arterial pressure（MAP） from baseline. The ED50 and 95% confidence interval（CI） of levobupivacaine were calculated by the Dixon＇s up-and-down method and logistic regression analysis. Results The ED50 and 95% CI of levobupivacaine for TAP block obtained by Dixong up-and-down sequential method were 0.24（0.22 ~ 0.27 ）mg/kg, the EDS0 and 95% CI of levobupivacaine obtained through the probit test were 0.17 （0.08 - 0.24） mg/kg. Adverse effects related to TAP block were not found in all children who underwent hernion-haphy. Conclusion Ultrasound - guided TAP block can reduce local analgesic dosis and adverse effects, the ED50 of levobupivaeaine for ultrasound - guided TAP block in pediatric hernia surgery is 0.24mg/kg.

关 键 词：疝 腹股沟 左旋布比卡因 麻醉药 局部 超声检查 儿童 

分 类 号：R726.1[医药卫生—儿科]