【摘要】  目的  0.5％盐酸罗哌卡因和0.596％甲磺酸罗哌卡因用于下肢手术时硬膜外麻醉效果的比较。  方法  60例下肢手术行硬膜外麻醉患者，随机分成2组，一组给予0．5％盐酸罗哌卡因15ml；另一组给予0.596％甲磺酸罗哌卡因15ml。记录麻醉时生命体征和比较两组麻醉中感觉、运动阻滞起效和维持时间，以及术前和术后的肝肾功能。  结果：  两组患者在硬膜外麻醉时感觉阻滞起效时间、感觉阻滞维持时间、运动阻滞起效时间、运动阻滞维持时间都无显著差异。两组患者各自术前和术后肝肾功能的变化无显著差异。  结论  下肢手术时硬膜外腔隙0.596％甲磺酸罗哌卡因与0.5％盐酸罗哌卡因具有相同的麻醉效果和安全性。

【关键词】  罗哌卡因；硬膜外麻醉

Comparison of the efficacy of epidural Anesthesia with 0.5% ropivacaine hydrochloride and 0.596% ropivacaine mesylate

Chen Zhifeng, Jiang Hong, Zhu Yesen. Department of Anesthesiology, Shanghai Ninth People’s Hospital, School of Medicine, JiaoTong Universiey, Shanghai 200011 CHINA

【abstract】  objective  To compare the efficacy of epidural Anesthesia with 0.5% ropivacaine hydrochloride and 0.596% ropivacaine mesylate in the operation of lower limb.  Methods  Sixty patients under epidural anesthesia in the operation of lower limb, were randomly assigned to two groups, one group received 15ml of 0.5% ropivacaine hydrochloride, the other group received 15ml of 0.596% ropivacaine mesylate. During the anesthesia, basic life monitor was recorded. The onset and duration of sensory and motor block were compared between two groups, also the function of liver and kidne免费论文网 【http://www.51lunwen.net】y were done before operation and after operation.  Results  There were no significant differences found in the onset, duration of sensory and motor block between two gourps. Also there were no significant difference found in the function of liver and kidney between before operation and after operation in each group.  Conclusion  Epidural anesthesia with 0.596% ropivacaine mesylate is similar with 0.5% ropivacaine hydrochloride in both efficacy and safety.

【Key words】  ropivacaine；epidural anesthesia

资料与方法

一般资料    60例择期进行下肢静脉曲张手术的患者，ASAI－II级，年龄30－60岁之间，无硬膜外麻醉禁忌症，无心、肝、肾功能障碍。随机分成2组，硬膜外麻醉下手术，每组30例患者。盐酸罗哌卡因组（I组）：0．5％盐酸罗哌卡因15ml。甲磺酸罗哌卡因组（II组）：0.596％甲磺酸罗哌卡因15ml。

方法    研究采用双盲方法。患者进入手术室开放经脉，500ml平衡液在硬膜外置管前输入，然后推入局麻药后30分钟后输入液体500ml。具体硬膜外麻醉操作:患者侧卧位，L3－4硬膜外腔置管。1％利多卡因5ml试验剂量后无局麻药入血管或蛛网膜下腔的症状后，0.5％盐酸罗哌卡因或0.596％甲磺酸罗哌卡因15ml在2分钟内注入硬膜外腔，术中吸氧。罗哌卡因推完为评估开始的零点计时。用针刺法评估感觉阻滞的上下平面，用改良Bromage评分法评估双下肢的运动阻滞。0＝没有运动麻痹；1＝直腿抬高困难，但脚跟能离开床；2＝不能直腿抬高，脚跟不能离开床；3＝不能屈膝；4＝不能屈踝；5＝不能动脚趾。记录T10感觉阻滞起效和维持时间以及运动阻滞起效和维持时间。监测生命体征：心电图、无创血压、脉搏氧饱和度、呼吸次数。在起先的30分钟内，每5分钟评估一次，然后每15分钟评估，直至感觉恢复。术中出现低血压:收缩压≤80mmHg，心动过缓：心率≤55次/分，心律失常：房早、室早、房颤，则认为血流动力学不稳定。术后2天内查患者肝肾功能（谷丙转氨酶ALT、血肌酐BUN、血尿素CR）。

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