左旋布比卡因与布比卡因在腰硬联合麻醉中的应用比较

摘要

[Objective]To compare the effect of levobupivacaine vs bupivacaine in combined spinal epidural anesthesia for gynaecological patients. [Methods]Sixty ASΛⅠ ～ Ⅱ patients aged 20～60 years old undergo lng elective gynecological surgery under combined spinal epidural anesthesia were randomized into 2 groups with 30 in each. In group L received intrathecal injection of 15mug 0.5％ levobupivacaine and lml 10 ％ glucose hyperbaric solution. Group B received injection of 15ml 0. 5％ bupivacaine into subarachnoid space and lml 10％ glucose hyperbaric solution. The onset time of sensory and motor block, degree of motor block, the height of sensory block and the quality of anesthesia were observed. [Results] There was no significant differ ence in the onset time of sensory and motor block, the height of sensory block and the quality of anesthesia be tween the two groups( P ＞0.05). There was no significant difference in the onset of motor block, and the pa tients with the 2～3 scores of motor block in group L were less than those in group B( P ＜0.05). The onset time of sensory and the degree of motor block in group L were shorter than those in group B( P ＜0.05) , but there was no significant difference in the quality of anesthesia between two groups. Compared with group L,the systemic blood pressure(SBP) at 30min after anesthesia in group B decreased markedly( P ＜0.05), but there was no obvious change in heart rate(HR) and digital blood pressure(DBP). [Conclusion] The 0. 5％levobupivacaine in combined spinal epidural anesthesia has satisfactory anesthesia effect, rapid recovery of mo tot block after surgery and less influence on the hemodynamics of the patients, so it is the good substitute for bupivacaine in clinics.%[目的]比较左旋布比卡因与布比卡因用于腰硬联合麻醉下行妇科手术的临床效果.[方法]拟在腰硬联合麻醉下行妇科手术患者60例,ASA Ⅰ～Ⅱ级,年龄20～60岁,随机分成两组(n=30).L组蛛网膜下腔注射0. 5%左旋布比卡因15 mg+10%葡萄糖1 mL配成重比重液,B组蛛网膜下腔注射0.5%布比卡因15 mg+10%葡萄糖1 mL配成重比重液,观察两组感觉阻滞起效时间、运动阻滞起效时间、最高感觉阻滞平面上界、感觉阻滞开始消退时间、运动阻滞程度及麻醉质量评分.[结果]两组患者的感觉阻滞起效时间、运动阻滞起效时间、最高感觉阻滞平面上界、感觉阻滞开始消退时间均无显著性差异(P>0.05).运动阻滞程度2～3分者,L组低于B组(P<0.05).L组感觉阻滞开始时间和运动阻滞程度短于B组(P<0.05),两组患者麻醉质量评分差异无显著性.B组在麻醉后30 min时收缩压(SBP)较L组有明显降低(P<0.05),而心率(HR)和舒张压(DBP)无明显改变.[结论]0.5%左旋布比卡因用于腰硬联合阻滞麻醉时具有满意的麻醉效果且手术后运动阻滞恢复更快,对患者血流动力学影响更小,是临床上布比卡因的良好替代品.