布比卡因、左旋布比卡因和罗哌卡因在硬膜外分娩镇痛中效能的比较

摘要

目的比较布比卡因、左旋布比卡因和罗哌卡因低浓度在硬膜外分娩镇痛中的效能。方法选取450例足月初产妇，按随机数字表法分为布比卡因组、左旋布比卡因组和罗哌卡因组，每组各150例。给予0.050%、0.075%、0.100%、0.125%和0.150%浓度的各组局麻药复合舒芬太尼0.5滋g/ml实施患者硬膜外自控分娩镇痛（PCEA）（各浓度30例）。镇痛负荷量8 ml，背景量5 ml/h，PCEA量5 ml，锁定时间15 min。观察镇痛效果及记录产科相关情况。结果布比卡因、左旋布比卡因、罗哌卡因硬膜外分娩镇痛50%及95%有效浓度分别为0.043%和0.198%、0.055%和0.254%、0.058%和0.269%。镇痛效能相对中位数潜力（95%CI）分别为布比卡因/左旋布比卡因：0.7808（0.4601~1.1655），布比卡因/罗哌卡因：0.7378（0.4241～1.0980），左旋布比卡因/罗哌卡因：0.9449（0.6064~1.4251）。logistc回归分析显示镇痛效果与局麻药浓度明显相关（OR=1.451，P＜0.05），与局麻药种类无相关性（OR=0.576，P＞0.05）。结论硬膜外分娩镇痛时，3种局麻药镇痛效能相似，镇痛效果主要取决于药物浓度。%Objective To compare the epidural analgesic potencies of bupivacaine, levobupivacaine and ropivacaine in patient-control ed labor analgesia. Methods Four hundred and fifty term nul iparous women were randomly assigned to re-ceive patient-control ed epidural labor analgesia with bupivacaine, levobupivacaine or ropivacaine combined with 0.5μg/ml sufentanil (n=150 in each group), and each group were divided into 5 subgroups with concentrations of 0.050%, 0.075%, 0.100%, 0.125% and 0.150%, respectively (n=30 in each subgroup). The initial bolus of the anesthetic solution was 8 ml, fol-lowed by continuous background infusion of 5 ml/h, bolus dose of 5 ml and a lockout of 15 min. The results of analgesia and obstetrics were recorded. Results No demographic and obstetric data differences were found among three groups(P>0.05). The 50% and 95% effective concentrations for epidural labor analgesia were 0.043% and 0.198% (bupivacaine), 0.055% and 0.254%(levobupivacaine), 0.058%and 0.269%(ropivacaine), respectively. The relative median potencies (95% CI) of three lo-cal anesthetics were bupivacaine/levobupivacaine: 0.7808 (0.4601~1.1655), bupivacaine/ropivacaine: 0.7378(0.4241~1.0980), and levobupivacaine/ropivacaine: 0.9449 (0.6064~1.4251). Logistic regression analysis showed that the analgesic effect was significantly related to the concentration of local anesthetics (OR=1.451, P<0.05), with a poor relation to the type of local anesthetic(OR=0.576, P>0.05). Conclusion The relative analgesic potencies of bupivacaine, levobupivacaine and ropivacaine are similar under epidural labor analgesia at low concentration. The analgesic effect mainly depends on the concentration of lo-cal anesthetics.