中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
1期
115-118
,共4页
陆惠元%赵辉%冷翠波%刘加洪%戴晓凤%曹倩倩
陸惠元%趙輝%冷翠波%劉加洪%戴曉鳳%曹倩倩
륙혜원%조휘%랭취파%류가홍%대효봉%조천천
高位胸段硬膜外麻醉%左旋布比卡因%布比卡因
高位胸段硬膜外痳醉%左鏇佈比卡因%佈比卡因
고위흉단경막외마취%좌선포비잡인%포비잡인
High thoracic epidural anesthesia%Levobupivacaine%Bupivacaine%Pulmonary Function%Breast Surgery
目的 比较左旋布比卡因和布比卡因高位胸段硬膜外阻滞乳腺手术的麻醉效果和对肺通气功能的影响.方法 32例有合并慢性阻塞性肺疾病(COPD)和哮喘、女性、美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级择期乳腺手术患者,完全随机分为左旋布比卡因组和布比卡因组,每组16例.取T2～4硬膜外注入左旋布比卡因组或布比卡因组局麻药初量,术中酌情追加用药.对局部麻醉药用量,感觉阻滞、镇痛效果、血流动力学、肺通气功能和不良反应进行比较.结果 左旋布比卡因组感觉阻滞起效时间(12±5)min,达最高平面平均时间(26 ±8)min,感觉阻滞最高平面为C4,布比卡因组:感觉阻滞起效时间(12±6)min,达最高平面平均时间(24±8)min,感觉阻滞最高平面为C5.左旋布比卡因组术中视觉模拟评分＞2分者3例,布比卡因组7例,左旋布比卡因组术中静脉注射芬太尼者2例,布比卡因组7例,左旋布比卡因组硬膜外追加局部麻醉药者2例,布比卡因组6例.布比卡因组麻醉后20 min,左旋布比卡因组麻醉后30 min血压、心率低于麻醉0 min(麻醉前)时.左旋布比卡因组2例静脉注射麻黄碱,布比卡因组7例静脉注射麻黄碱;术中硬膜外静脉注射阿托品,左旋布比卡因组7例,平均(0.52 ±0.15)mg,布比卡因组12例,平均(0.66±0.24)mg,2组患者注射麻黄碱、注射阿托品,使用阿托品的平均剂量差异亦无统计学意义(P＞0.05).术前2d平卧位和硬膜外麻醉后30min用力肺活量(FVC)、第1秒钟用力呼气容积(FEV1)均明显低于术前2d坐位,左旋布比卡因组(2.01 ±0.41)、(1.69 ±0.43)L比(2.38 ±0.48)L,(62±6)％、(57±5)％比(66±6)％;布比卡因组(2.02±0.43)、(1.71 ±0.42)L比(2.37 ±0.46)L,(62±6)％、(58±6)％比(67±6)％;差异均有统计学意义(P＜0.05).术后2h FVC、FEV1与术前2d平卧位比较,差异无统计学意义(P＞0.05).硬膜外麻醉30 min与术后2 h FEV1/FVC均明显高于术前2d平卧位[左旋布比卡因组为(72 ±7)、(72 ±6)比(67 ±7),布比卡因组为(71 ±6)、(71 ±5)比(67±5)].结论 左旋布比卡因和布比卡因在高位胸段硬膜外阻滞乳腺手术有相似的麻醉效果和对肺通气功能影响,左旋布比卡因感觉阻滞优于布比卡因并显示有较低的心血管抑制作用,其麻醉使呼吸道阻力降低并对FEV1/FVC有明显改善作用,因此左旋布比卡因与布比卡因高位胸段硬膜外阻滞可用于有合并COPD和哮喘患者.
目的 比較左鏇佈比卡因和佈比卡因高位胸段硬膜外阻滯乳腺手術的痳醉效果和對肺通氣功能的影響.方法 32例有閤併慢性阻塞性肺疾病(COPD)和哮喘、女性、美國痳醉醫師協會(ASA)分級Ⅱ～Ⅲ級擇期乳腺手術患者,完全隨機分為左鏇佈比卡因組和佈比卡因組,每組16例.取T2～4硬膜外註入左鏇佈比卡因組或佈比卡因組跼痳藥初量,術中酌情追加用藥.對跼部痳醉藥用量,感覺阻滯、鎮痛效果、血流動力學、肺通氣功能和不良反應進行比較.結果 左鏇佈比卡因組感覺阻滯起效時間(12±5)min,達最高平麵平均時間(26 ±8)min,感覺阻滯最高平麵為C4,佈比卡因組:感覺阻滯起效時間(12±6)min,達最高平麵平均時間(24±8)min,感覺阻滯最高平麵為C5.左鏇佈比卡因組術中視覺模擬評分＞2分者3例,佈比卡因組7例,左鏇佈比卡因組術中靜脈註射芬太尼者2例,佈比卡因組7例,左鏇佈比卡因組硬膜外追加跼部痳醉藥者2例,佈比卡因組6例.佈比卡因組痳醉後20 min,左鏇佈比卡因組痳醉後30 min血壓、心率低于痳醉0 min(痳醉前)時.左鏇佈比卡因組2例靜脈註射痳黃堿,佈比卡因組7例靜脈註射痳黃堿;術中硬膜外靜脈註射阿託品,左鏇佈比卡因組7例,平均(0.52 ±0.15)mg,佈比卡因組12例,平均(0.66±0.24)mg,2組患者註射痳黃堿、註射阿託品,使用阿託品的平均劑量差異亦無統計學意義(P＞0.05).術前2d平臥位和硬膜外痳醉後30min用力肺活量(FVC)、第1秒鐘用力呼氣容積(FEV1)均明顯低于術前2d坐位,左鏇佈比卡因組(2.01 ±0.41)、(1.69 ±0.43)L比(2.38 ±0.48)L,(62±6)％、(57±5)％比(66±6)％;佈比卡因組(2.02±0.43)、(1.71 ±0.42)L比(2.37 ±0.46)L,(62±6)％、(58±6)％比(67±6)％;差異均有統計學意義(P＜0.05).術後2h FVC、FEV1與術前2d平臥位比較,差異無統計學意義(P＞0.05).硬膜外痳醉30 min與術後2 h FEV1/FVC均明顯高于術前2d平臥位[左鏇佈比卡因組為(72 ±7)、(72 ±6)比(67 ±7),佈比卡因組為(71 ±6)、(71 ±5)比(67±5)].結論 左鏇佈比卡因和佈比卡因在高位胸段硬膜外阻滯乳腺手術有相似的痳醉效果和對肺通氣功能影響,左鏇佈比卡因感覺阻滯優于佈比卡因併顯示有較低的心血管抑製作用,其痳醉使呼吸道阻力降低併對FEV1/FVC有明顯改善作用,因此左鏇佈比卡因與佈比卡因高位胸段硬膜外阻滯可用于有閤併COPD和哮喘患者.
목적 비교좌선포비잡인화포비잡인고위흉단경막외조체유선수술적마취효과화대폐통기공능적영향.방법 32례유합병만성조새성폐질병(COPD)화효천、녀성、미국마취의사협회(ASA)분급Ⅱ～Ⅲ급택기유선수술환자,완전수궤분위좌선포비잡인조화포비잡인조,매조16례.취T2～4경막외주입좌선포비잡인조혹포비잡인조국마약초량,술중작정추가용약.대국부마취약용량,감각조체、진통효과、혈류동역학、폐통기공능화불량반응진행비교.결과 좌선포비잡인조감각조체기효시간(12±5)min,체최고평면평균시간(26 ±8)min,감각조체최고평면위C4,포비잡인조:감각조체기효시간(12±6)min,체최고평면평균시간(24±8)min,감각조체최고평면위C5.좌선포비잡인조술중시각모의평분＞2분자3례,포비잡인조7례,좌선포비잡인조술중정맥주사분태니자2례,포비잡인조7례,좌선포비잡인조경막외추가국부마취약자2례,포비잡인조6례.포비잡인조마취후20 min,좌선포비잡인조마취후30 min혈압、심솔저우마취0 min(마취전)시.좌선포비잡인조2례정맥주사마황감,포비잡인조7례정맥주사마황감;술중경막외정맥주사아탁품,좌선포비잡인조7례,평균(0.52 ±0.15)mg,포비잡인조12례,평균(0.66±0.24)mg,2조환자주사마황감、주사아탁품,사용아탁품적평균제량차이역무통계학의의(P＞0.05).술전2d평와위화경막외마취후30min용력폐활량(FVC)、제1초종용력호기용적(FEV1)균명현저우술전2d좌위,좌선포비잡인조(2.01 ±0.41)、(1.69 ±0.43)L비(2.38 ±0.48)L,(62±6)％、(57±5)％비(66±6)％;포비잡인조(2.02±0.43)、(1.71 ±0.42)L비(2.37 ±0.46)L,(62±6)％、(58±6)％비(67±6)％;차이균유통계학의의(P＜0.05).술후2h FVC、FEV1여술전2d평와위비교,차이무통계학의의(P＞0.05).경막외마취30 min여술후2 h FEV1/FVC균명현고우술전2d평와위[좌선포비잡인조위(72 ±7)、(72 ±6)비(67 ±7),포비잡인조위(71 ±6)、(71 ±5)비(67±5)].결론 좌선포비잡인화포비잡인재고위흉단경막외조체유선수술유상사적마취효과화대폐통기공능영향,좌선포비잡인감각조체우우포비잡인병현시유교저적심혈관억제작용,기마취사호흡도조력강저병대FEV1/FVC유명현개선작용,인차좌선포비잡인여포비잡인고위흉단경막외조체가용우유합병COPD화효천환자.
Objective To compare the effect of high thoracic epidural anesthesia(hTEA) with levobupivacaine and bupivacaine on pulmonary function during breast surgery.Methods Thirty two ASA Ⅱ-Ⅲ female patients with chronic obstructive pulmonary disease (COPD) and asthma undergoing breast surgery were randomly divided into L(levobupivacaine) and B(bupivacaine) groups,with 16 patients in each group.The epidural space T2-4 was selected.The patients received sequential local anesthetic until sensory blockate to C4.7 was established and the anesthesia was maintained with epidural administration.A local anesthetic dosage,effect of sensory block,analgesia,hemodynamic,lung function and adverse reaction were recorded and compared.Results The onset time of sensory block in the levobupivacaine group was (12±5) min; average time reaching the highest plane was (12 ±5) min; highest sensory block plane was C4.The onset time of sensory block in the bupivacaine group was(12 ±6)min; average time reaching the highest plane was (24 ± 8)min; highest sensory block plane was C5 ;there was no significant difference in both groups (P ＞ 0.05).There were 3 cases with intraoperative visual analog score ＞ 2 poimts in Levobupivacaine group.There were 2 cases with additional epidural local anesthetic in Levobupivacaine group.Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in both groups were significantly lower than before operation [Levobupivacaine group showed,(2.01 ± 0.41),(1.69 ± 0.43) Lvs (2.38 ± 0.48)L;(62 ± 6)％,(57 ± 5)％ vs (66 ± 6)％; bupivacaine group showed (2.02 ± 0.43),(1.71 ± 0.42) Lvs (2.37 ± 0.46)L,(62 ± 6)％,(58 ±6)％ vs (67 ± 6)％ ; the differences were statistically significant (P＜0.05)].30 min and 2 h after surgery,FEV1/ FVC in both groups was significantly higher than before operation [levobupivacaine group (72 ± 7),(72 ± 6) vs (67 ± 7),bupivacaine group (71 ± 6),(71 ± 5) vs of (67 ± 5)].After epidural infusion for30 minutes,FVC,FEV1 decreased and FEV1/FVC increased (P ＜ 0.05).FVC,FEV1 increased slightly (P ＞ 0.05) and FEV1/FVC increased (P ＜ 0.05) after operation 2 h.Conclusions Levobupivacaine and bupivacaine in high thoracic epidural anesthesia have similar effects on pulmonary function during breast surgery.The anesthesia can reduce the airway resistance and improve FEV1/FVC,therefore hTEA can be used in the patient with COPD and asthma.
