CAJ | 학술논문

目的探讨患者硬膜外注射不同浓度左旋布比卡因的药代动力学.方法择期行结肠癌根治术、经腹或腹会阴直肠癌根治术患者20例,ASA Ⅰ或Ⅱ级,年龄35～59岁,随机分为0.75%左旋布比卡因组(Ⅰ组)和0.5%左旋布比卡因组(Ⅱ组),每组10例.麻醉方法为腰段硬膜外阻滞联合全麻.经L1,2硬膜外穿刺成功后,分别经2 min注入0.75%或0.5%左旋布比卡因2 mg/kg.硬膜外注药结束后30 min内记录感觉和运动阻滞效果,记录不良反应发生情况.于注药后即刻、注药后10、20、30、45、60、90、120、210、300、420、540、660和840 min时取中心静脉血3 ml,采用高效液相色谱法测定血浆左旋布比卡因浓度,绘制血浆左旋布比卡因浓度-时间曲线,计算2组药代动力学参数.结果 2组血浆左旋布比卡因浓度-时间曲线均符合二房室开放模型;2组药代动力学参数比较差异均无统计学意义(P＞0.05).结论 0.75%和0.5%左旋布比卡因2mg/kg腰段硬膜外阻滞安全性高,血浆药物浓度-时间曲线均符合二房室开放模型,两者药代动力学特性无差异.
목적 탐토환자경막외주사불동농도좌선포비잡인적약대동역학.방법 택기행결장암근치술、경복혹복회음직장암근치술환자20례,ASA Ⅰ혹Ⅱ급,년령35～59세,수궤분위0.75%좌선포비잡인조(Ⅰ조)화0.5%좌선포비잡인조(Ⅱ조),매조10례.마취방법위요단경막외조체연합전마.경L1,2경막외천자성공후,분별경2 min주입0.75%혹0.5%좌선포비잡인2 mg/kg.경막외주약결속후30 min내기록감각화운동조체효과,기록불량반응발생정황.우주약후즉각、주약후10、20、30、45、60、90、120、210、300、420、540、660화840 min시취중심정맥혈3 ml,채용고효액상색보법측정혈장좌선포비잡인농도,회제혈장좌선포비잡인농도-시간곡선,계산2조약대동역학삼수.결과 2조혈장좌선포비잡인농도-시간곡선균부합이방실개방모형;2조약대동역학삼수비교차이균무통계학의의(P＞0.05).결론 0.75%화0.5%좌선포비잡인2mg/kg요단경막외조체안전성고,혈장약물농도-시간곡선균부합이방실개방모형,량자약대동역학특성무차이.
Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes aged 35-59 yr scheduled for elective rectum or colon cancer operation under general anesthesia combined with epidural block were randomly divided into 2 groups(n=10 each):group Ⅰ 0.75% levobupivacaine and group Ⅱ 0.5% levobupivacaine.Epidural block was performed at L1-2 interspace.Group Ⅰ and Ⅱ received epidural 0.75% and 0.5% levobupivacalne 2 mg/kg(containing adrenaline 5 μg/kg)injected slowly over 2 min respectively.Thirty minutes after epidural levobupivacaine,general anesthesia was induced withγ-hydroxybutyrate 60-80 mg/kg,and remifentanil 1-2 μg/kg.Tracheal intubation was facilitated with succinyl choline 1-1.5 mg/kg and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of nitrous oxide and O2(1:1)and continuous blockade were assessed after epidural levobupivacaine.Blood samples were taken from central vein at 0,10,20,30,45,60,90,120,210,300,420,540,660 and 840 min after epidural levobupivacaine for determination of plasma concentration of levobupivacaine by high performance liquid chromatography.Results The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the two groups and there was no significant difference in the pharmacokinetic profiles between the two groups.The onset time of sensory and motor block was shorter and the duration of the two blocks was longer with 0.75% levobupivacaine as compared with 0.5% levobupivacaine.The incidences of nausea and vomiting and hypotension were low and no severe cardiovascular and neurological side-effects developed.Conclusion The pharmacokinetic parameters do not differ significantly between epidural 0.75% and 0.5% levobupivacaine when the total amount is the same.Epidural anesthesia with either 0.75% or 0.5% levobupivacaine is safe.