CAJ | 학술논문

目的评价0.5%速卡(左旋布比卡因)用于硬膜外麻醉剖宫产手术的临床效果,在母体中血药浓度及经胎盘转运的情况,并以0.5%布比卡因作对照.方法选择行剖宫产手术足月单胎孕妇43例,硬膜外麻醉时随机分别接受0.5%速卡(速卡组)或0.5%布比卡因(布比卡因组)25 mL,观察感觉阻滞、运动阻滞、镇痛和腹壁肌松质量、心电图(ECG)变化、新生儿Apgar、NACS评分和脐静脉血气及不良反应.并用高效液相色谱法测定了母体和胎儿的血浆药物浓度.结果两组孕妇感觉和运动阻滞的起效时间和持续时间、最高阻滞平面、低血压的发生率及ECG变化、新生儿Apgar、NACS评分和血气均无统计学差异,观察中无严重不良反应.两组母体血浆药物浓度在30 min左右达高峰,脐静脉/母体静脉血药浓度比(UV/MV)无统计学差异.结论0.5%速卡适用于产科硬膜外麻醉,麻醉效能与同等浓度和剂量的布比卡因相同,其镇痛和麻醉效果可以满足临床手术需要;对母体副作用少,对新生儿无不良反应;同时药代动力学参数及经胎盘的转运比率两组相似.
목적평개0.5%속잡(좌선포비잡인)용우경막외마취부궁산수술적림상효과,재모체중혈약농도급경태반전운적정황,병이0.5%포비잡인작대조.방법선택행부궁산수술족월단태잉부43례,경막외마취시수궤분별접수0.5%속잡(속잡조)혹0.5%포비잡인(포비잡인조)25 mL,관찰감각조체、운동조체、진통화복벽기송질량、심전도(ECG)변화、신생인Apgar、NACS평분화제정맥혈기급불량반응.병용고효액상색보법측정료모체화태인적혈장약물농도.결과량조잉부감각화운동조체적기효시간화지속시간、최고조체평면、저혈압적발생솔급ECG변화、신생인Apgar、NACS평분화혈기균무통계학차이,관찰중무엄중불량반응.량조모체혈장약물농도재30 min좌우체고봉,제정맥/모체정맥혈약농도비(UV/MV)무통계학차이.결론0.5%속잡괄용우산과경막외마취,마취효능여동등농도화제량적포비잡인상동,기진통화마취효과가이만족림상수술수요;대모체부작용소,대신생인무불량반응;동시약대동역학삼수급경태반적전운비솔량조상사.
[Objective] To compare the efficacy of 0.5% levobupivacaine with 0.5% bupivacaine in epiduralspace and study their pharmacokinetics and transfer across placents. [Methods] Forty-three healthy obstetric pa-tients undergoing elective cesarean section with epidural anesthesia were selected. Patients were randomized to receive 25 mL of either0.5% levobupivacaine (group Levobupivacaine) or 0.5% bupivacaine (group Bupivacaine) in adouble-blind fashion. The efficacy endpoint measurement included onset, offset, and quality of anesthesia. Neonatalblood gas analyses, Apgar score determinations, and neurobhavioral examinations were perfomed. Venous samples forpharmacokinetic studies and seriallectrocardiograms were obtained in 10 patients in each group. [Results] Levelsof sensory block, motor block, muscle relaxation, and overall quality of anesthesia did not differ between groups. Thefrequency of hypotension was 75.0% in the levobupivacaine group and 90.0% for the bupivacaine group (P =0.051).No significant difference in observed aximum oncentration of drug after dosing or area under the plasma drugconcentration versus time curve was seen. [Conclusions] The use of epidural 0.5% levobupivacaine for cesareansection results in equally efficacious anesthesia compared with 0.5% bupivacaine. Pharmacokinetic parameters weresimilar in the two groups with a good foreground for clinical pplication.