【作者】 胡建英；

【导师】 梁伟民； 黄绍强；

【作者基本信息】 复旦大学 ， 麻醉学， 2009， 硕士

【摘要】 目的:比较布比卡因、左旋布比卡因和罗哌卡因脊麻下满足剖宫产手术的效价。方法:选取96名拟在腰硬联合麻醉下行剖宫产手术的单胎健康产妇,随机分成三组（n=32）:分别于蛛网膜下腔注射等比重0.5%的布比卡因（布比卡因组）;等比重0.5%的左旋布比卡因（左旋布比卡因组）;等比重0.5%的罗哌卡因（罗哌卡因组）。采用序贯法进行试验,每组第1例病人的起始剂量为9mg,剂量间隔为1mg。设定注药后15分钟内感觉阻滞平面到T7或以上,术中无牵拉痛,注药后45分钟内硬膜外不需要追加局麻药为有效。若上一例有效,则下一例采用低一级剂量;若无效,则下一例采用高一级剂量。采用概率单位回归法计算三药满足剖宫产手术的半数有效剂量(ED₅₀)及其95%可信区间（95%CI）。记录感觉阻滞平面和运动阻滞程度。结果:三组病人的一般情况无明显差异。布比卡因的ED₅₀和ED₉₅及其95%CI分别为6.15（5.48-6.68）mg和7.62（6.91-11.82）mg。左旋布比卡因的ED₅₀和ED₉₅及其95%CI为8.06（7.46-8.62）mg和9.59（8.86-13.42）mg。罗哌卡因分别为10.55（9.73-11.49）mg和12.80（11.66-21.42）mg。左旋布比卡因与布比卡因满足剖宫产手术的效价比及其95%CI为0.76（0.68-0.87）,罗哌卡因与布比卡因的效价比为0.58（0.51-0.67）,罗哌卡因与左旋布比卡因的效价比为0.76（0.68-0.86）。结论:三种不同的局麻药蛛网膜下腔阻滞均能满足剖宫产手术。三者的效价比为布比卡因:左旋布比卡因:罗哌卡因为1:0.76:0.58。更多还原

【Abstract】 Objective: This study was aimed to compare relative potency of three local anesthetics, such as bupivacaine, levobupivacaine and ropivacaine, if injected intrathecally in patients undergoing cesarean section.Methods: Ninety six parturients with singleton term pregnancies undergoing cesarean section with combined spinal-epidural anesthesia were enrolled in this study. The median effective dose (ED₅₀) was determined by up-down sequential allocation.The patients were randomly divided into three groups and received intrathecally injection of 0.5% bupivacaine、0.5%levobupivacaine and 0.5% ropivacaine respectively. If an upper sensory lever was achieved to T7 or above and no need for additional dosage in the next 45 min, the I.T. was considered effective. The degree of sensory and motor block was recorded.Results: There were no differences in demographic and obstetric characteristics between the patients receiving the three local anesthetics. There were significant differences in ED₅₀ values for spinal bupivacaine、levobupivacaine and ropivacaine: the ED₅₀ and ED₉₅ for bupivacaine were 6.15 （95%CI 5.48-6.68） mg and 7.62 （95%CI 6.91-11.82） mg; the ED₅₀and ED95 respectively of levobupivacaine were 8.06 （95%CI 7.46-8.62） mg and9.59 （95%CI 8.86-13.42） mg; for ropivacaine ED₅₀ and ED₉₅ were 10.55（95%CI 9.73-11.49） mg and 12.80 （95%CI 11.66-21.42） mg. The potency ratioat ED₅₀ for levopivacaine and bupivacaine was 0.76 （95%CI 0.68-0.87）; forropivacaine and bupivacaine was 0.58 （0.51-0.67） and for ropivacaine andlevobupivacaine was 0.76 （0.68-0.86）.Conclusions: The study confirms that three local anesthetics can be usesuccessfully for cesarean section. The relative potency ratio of bupivacaine:levobupivacaine: ropivacaine was 1:0.76:0.58.更多还原