CAJ | 학술논문

目的：探讨布比卡因与国产罗哌卡因用于腋路臂丛阻滞对心脏的毒性作用。方法选择择期上肢手术患者60例，A-SAI～Ⅱ级.随机分为罗哌卡因组（R组）及布比卡因组（B组）各30例，分别于麻醉前、麻醉后30 min,麻醉后2 h抽取静脉血3 mL,测定血清心肌肌钙蛋白cTnI及心肌酶学的变化。结果 R组在麻醉前的cTnI 、CK-MB 、CK值分别为（0.062±0.018）ug/L、（6.340±1.723）U/L、（44.000±12.000）U/L，B组在麻醉前的cTnI、CK-MB、CK值分别为（0.073±0.034）ug/L、（6.876±2.357）U/L、（48.000±14.000）U/L。比较两组间差异无统计学意义（P＞0.05）。R组在麻醉后30 min的cTnI 、CK-MB 、CK值分别为（3.482±1.892）ug/L、（32.684±9.842）U/L、（314.00±47.000）U/L，B组在麻醉后30 min的cTnI 、CK-MB 、CK值分别为（6.842±2.147） ug/L、（46.960±8.792）U/L、（429.00±50.000）U/L。比较两组间差异有统计学意义（P＜0.05）。R组在麻醉后2 h的cTnI、CK-MB、CK值分别为（5.546±0.032）ug/L、（38.724±8.686）U/L、（378.00±45.000）U/L，B组在麻醉后2 h的cTnI 、CK-MB 、CK值分别为（9.278±0.065）ug/L、（57.789±9.240）U/L、（466.00±47.000）U/L。比较两组间差异有统计学意义（P＜0.05）。麻醉前比较过两组患者相应指标差异无统计学意义（P＞0.05），麻醉后两组患者相应指标均较麻醉前有所提高，B组较R组相应指标增高显著，比较两组间差异有统计学意义（P<0.05）。结论罗哌卡因及布比卡因臂丛阻滞后均出现cTnI及心肌酶增高，两药均有抑制心肌影响，但国产罗哌卡因对心脏毒性小于布比卡因，可安全用于臂丛腋路阻滞。
목적：탐토포비잡인여국산라고잡인용우액로비총조체대심장적독성작용。방법선택택기상지수술환자60례，A-SAI～Ⅱ급.수궤분위라고잡인조（R조）급포비잡인조（B조）각30례，분별우마취전、마취후30 min,마취후2 h추취정맥혈3 mL,측정혈청심기기개단백cTnI급심기매학적변화。결과 R조재마취전적cTnI 、CK-MB 、CK치분별위（0.062±0.018）ug/L、（6.340±1.723）U/L、（44.000±12.000）U/L，B조재마취전적cTnI、CK-MB、CK치분별위（0.073±0.034）ug/L、（6.876±2.357）U/L、（48.000±14.000）U/L。비교량조간차이무통계학의의（P＞0.05）。R조재마취후30 min적cTnI 、CK-MB 、CK치분별위（3.482±1.892）ug/L、（32.684±9.842）U/L、（314.00±47.000）U/L，B조재마취후30 min적cTnI 、CK-MB 、CK치분별위（6.842±2.147） ug/L、（46.960±8.792）U/L、（429.00±50.000）U/L。비교량조간차이유통계학의의（P＜0.05）。R조재마취후2 h적cTnI、CK-MB、CK치분별위（5.546±0.032）ug/L、（38.724±8.686）U/L、（378.00±45.000）U/L，B조재마취후2 h적cTnI 、CK-MB 、CK치분별위（9.278±0.065）ug/L、（57.789±9.240）U/L、（466.00±47.000）U/L。비교량조간차이유통계학의의（P＜0.05）。마취전비교과량조환자상응지표차이무통계학의의（P＞0.05），마취후량조환자상응지표균교마취전유소제고，B조교R조상응지표증고현저，비교량조간차이유통계학의의（P<0.05）。결론라고잡인급포비잡인비총조체후균출현cTnI급심기매증고，량약균유억제심기영향，단국산라고잡인대심장독성소우포비잡인，가안전용우비총액로조체。
Objective To compare the toxicity between bupivacaine and homemade ropivacaine applied to axillary brachial plexus block on the heart. Methods 60 patients with ASAI~Ⅱ grade underwent selective upper limb operation were selected and divided into the ropivacaine group((R group) and the bupivacaine group(B group) with 30 patients in each. Blood samples were taken from veins of the patients for determine the serum cardiac troponin (cTnI) and myocardial enzymes before anesthesia, 30min and 2 hours after the anesthesia. Results Before anesthesia, the cTnI, CK-MB, CK value of group R was (0.062 ±0.018) ug / L, (6.340 ±1.723) U/L, (44.000±12.000) U/L, respectively, and that of group B was (0.073±0.034) ug/L, (6.876±2.357) U/L, (48.000±14.000) U/L, re-spectively. The differences between the two groups were not statistically significant (P>0.05). 30min after the anesthesia, the cTnI, CK-MB, CK value of group R was (3.482±1.892) ug/L, (32.684±9.842) U/L, (314.00±47.000) U/L, and that of group B was (6.84 ± 2.147) ug/L, (46.960±8.792) U/L, (429.00±50.000) U/L, respectively. The differences between the two groups were statistically sig-nificant (P<0.05). 2h after the anesthesia, the cTnI, CK-MB, CK value of group R was (5.546 ±0.032) ug/L, (38.724 ± 8.686) U/L, (378.00 ± 45.000) U/L, respectively, and that of group B was (9.278±0.065) ug/L, (57.789±9.240) U/L, (466.00 ± 47.000) U/L, re-spectively. The differences between the two groups were statistically significant (P<0.05). Before anesthesia the differences in the corresponding indexes between the two groups were not statistically significant (P>0.05), after anesthesia, the values of the corre-sponding indexes of both groups increased as compared with those before anesthesia, and the increase in group B was more obvi-ous, the differences between the groups were statistically significant (P<0.05). Conclusion Increase of cTnI and cardiac enzymes occurs after application of ropivacaine and bupivacaine for axillary brachial plexus block, both the drugs can inhibit the myocardi-um, but homemade ropivacaine has less toxicity, so it can be used for axillary brachial plexus block safely.