左旋布比卡因行腰硬联合麻醉于下肢骨科手术麻醉研究.docVIP

左旋布比卡因行腰硬联合麻醉于下肢骨科手术麻醉研究 　　摘 要 目的：探讨左旋布比卡因行腰-硬联合麻醉用于下肢骨科手术的麻醉效果和安全性。方法：下肢骨科手术80例，随机等分为两组，患侧向下侧卧，L3～4腰硬联合阻滞。对照组用0.75%布比卡因（B）2ml（15mg），加10%葡萄糖注射液1ml后单次注射，注速1ml/15秒，注药后保持原位15分钟后仰卧。实验组用0.75%左旋布比卡因（LB），其他与对照组完全相同。结果：①两组比较，阻滞特征的6项指标中除运动阻滞持效时间LB组较短有显著性差异（P＜0.05）外，其余指标无显著性差异（P＞0.05）。②两组的阻滞前后平均动脉压和心率的变化均无显著性差异（P＞0.05）。③两组的单侧阻滞率均为100%，且单侧阻滞均完善。结论：LB和B单侧腰麻的阻滞特征除运动阻滞持效时间LB较短外基本一致，对循环的干扰均较轻，二者应可任选。使用左旋布比卡因行腰-硬联合麻醉于下肢骨科手术是安全有效的。 　　关键词 腰-硬联合麻醉 左旋布比卡因 下肢骨科手术 　　AbstrctObjective:To observe the efficacy and safety of combined spinal-epidural anesthesia（CSEA） with levobupivacaine on the operation of lower extremities.Methods:80 patients scheduled for lower limb fracture surgerywere randomly divided into 2 groups,In one group the patients were asked to lie on the compromised side for slow injection of Hyperbaric bupivacaine solution（0.75%15mg,diluted to 3ml with 10% glucoseinjection）at the rate of 1 ml/15 s through a 27-gauge needle.The patients maintained their position for 15 分钟 before shifting to a supine position.In the other group levobupivacaine was used instead.Results:Statistical study showed that the block characteristics were of no significant difference between the 2 groups （P＞0.05）except that the duration of motor block was shorter in levobupivacaine group than in bupivacaine group（P＜0.05）.Blood pressure or heart rate showed no significant difference between the two groups during operation.Conclusion:The block characteristics of hypobaric unilateral spinal block with levobupivacaine or bupivacaine are similar and their effect on circulatory function is slight.Levobupivacaine provides an option in case bupivacaine is not available 　　Keywordscombined spinal-epidural;levobupivacaine;the operation of lower extremities 　　左旋布比卡因比布比卡因心脏毒性更小，很多国外学者最近几年开始关注它并不断对左旋布比卡因腰麻进行临床应用和研究［1，2］。左旋布比卡因腰麻在下肢骨科手术的效果怎样？本文用反映阻滞特征的六项指标（痛觉和运动阻滞起效时间及持效时间，阻滞平面固定时间和其持效时间）对左旋布比卡因与布比卡因下肢骨科手术在应用效果和安全方面进行对比和研究。 　　资料与方法 　　一般资料：下肢手术80例，男34例，女26例；年龄16～42岁。由专人操作、监测和术后定时随访。 　　方法：术前40～60分钟口服咪唑安定0.07～0.15m