CAJ | 학술논문

目的探讨经尿道前列腺电切术老年患者鞘内注射不同局麻药的药效学.方法择期拟在脊椎-硬膜外联合阻滞下行经尿道前列腺电切术的老年患者90例,ASA分级Ⅰ～Ⅲ级,年龄69～82岁,体重指数＜30 kg/m2,随机分为3组(n=30):左旋布比卡因组(L组)、罗哌卡因组(R组)和布比卡因组(B组)分别于蛛网膜下腔注射0.5%左旋布比卡因、0.5%罗哌卡因、0.5%布比卡因.采用序贯法进行试验,初始剂量分别为7、10、6 mg,相邻剂量比均为0.9.阻滞有效,则下一例采用低一级剂量;阻滞无效,则下一例采用高一级剂量.阻滞有效的标准为:蛛网膜下腔注药后20 min内感觉阻滞平面达T10.计算3种局麻药半数有效剂量(ED50)及其95%可信区间(95%CI).结果经尿道前列腺电切术老年患者鞘内注射左旋布比卡因、罗哌卡因和布比卡因阻滞的ED50及其95%CI分别为6.781(6.561～7.024)mg、9.135(8.670～9.616)mg和5.170(5.012～5.333)mg.左旋布比卡因、罗哌卡因和布比卡因的效价比为0.76∶0.57∶1.00.结论经尿道前列腺电切术老年患者鞘内注射左旋布比卡因、罗哌卡因和布比卡因阻滞的效价比为0.76∶0.57∶1.00.
목적 탐토경뇨도전렬선전절술노년환자초내주사불동국마약적약효학.방법 택기의재척추-경막외연합조체하행경뇨도전렬선전절술적노년환자90례,ASA분급Ⅰ～Ⅲ급,년령69～82세,체중지수＜30 kg/m2,수궤분위3조(n=30):좌선포비잡인조(L조)、라고잡인조(R조)화포비잡인조(B조)분별우주망막하강주사0.5%좌선포비잡인、0.5%라고잡인、0.5%포비잡인.채용서관법진행시험,초시제량분별위7、10、6 mg,상린제량비균위0.9.조체유효,칙하일례채용저일급제량;조체무효,칙하일례채용고일급제량.조체유효적표준위:주망막하강주약후20 min내감각조체평면체T10.계산3충국마약반수유효제량(ED50)급기95%가신구간(95%CI).결과 경뇨도전렬선전절술노년환자초내주사좌선포비잡인、라고잡인화포비잡인조체적ED50급기95%CI분별위6.781(6.561～7.024)mg、9.135(8.670～9.616)mg화5.170(5.012～5.333)mg.좌선포비잡인、라고잡인화포비잡인적효개비위0.76∶0.57∶1.00.결론 경뇨도전렬선전절술노년환자초내주사좌선포비잡인、라고잡인화포비잡인조체적효개비위0.76∶0.57∶1.00.
Objective To investigate the pharmacodynamics of different local anesthetics administered intrathecally for elderly patients undergoing transurethral resection of the prostate (TURP). Methods Ninety ASA Ⅰ - Ⅲ elderly patients, aged 69-82 yr, with body mass index less than 30 kg/m2 , undergoing TURP under combined spinal-epidural anesthesia, were randomly divided into 3 groups ( n = 30 each): levobupivacaine group (group L), ropivacaine group (group R) and bupivacaine group (group B). Group L, R and B received intrathecai (IT) 0.5 % levobupivacaine, 0.5 % ropivacaine and 0.5 % bupivacaine respectively. The initial dose was 7,10 and 6 mg in group L, R and B respectively. The ratio of two successive doses was 0.9. If the upper sensory block reached T10 within the 20 min after IT injection, the IT analgesia was considered to be effective. The median effective dose (EDs0) and 95 % confidence interval (95 % CI) were calculated by Dixon. Results The ED50 and 95% CI of levobupivacaine, ropivacaine and bupivacaine were 6.781 (95% CI 6.561-7.024) mg, 9.135 (95%CI8.670-9.616) mg and 5.170 (95% CI 5.012-5.333) ng respectively. The relative potency ratio between levobupivacaine, ropivacaine and bupivacaine is 0.76∶0.57∶1.00. Conclusion The relative potency ratio be tween levobupivacaine, ropivacaine and bupivacaine is 0.76∶0.57∶1.00.