关键词：左旋布比卡因；罗哌卡因；布比卡因；病人自控；硬膜外镇痛；剖宫产术

    摘要：目的 比较左旋布比卡因与罗哌卡因及布比卡因复合吗啡用于剖宫产术后硬膜外镇痛的效果和副作用。 方法 采用随机双盲法，将90例择期行剖宫产术的足月、单胎、年龄25~38岁、体质量59~87 kg孕妇均分为3组：左旋布比卡因组(L组)、罗哌卡因组(R组)和布比卡因组(B组)。术后分别采用0.125%左旋布比卡因、0.125%罗哌卡因或0.125%布比卡因复合小剂量吗啡(20 μg/ml)行病人自控硬膜外镇痛。观察各组术后48 h内镇痛效果、运动阻滞程度以及恶心呕吐、皮肤瘙痒等副作用的发生率。 结果 3组产妇术后视觉模拟评分、镇痛治疗总体印象评分、改良Bromage评分比较差异均无显著性(P>0.05)。3组产妇对病人自控硬膜外镇痛的满意率有显著性差异(L组93.3%，R组70%，B组96.6%，P<0.05)。3组不良反应发生率及排气时间无显著性差异(P>0.05)。 结论 0.125%左旋布比卡因混合吗啡用于产科术后硬膜外镇痛可获得满意的镇痛效果，且无明显毒副作用。

    Comparison of levobupivacaine, ropivacaine and racemic bupivacaine in patient-controlled epidural analgesia after cesarean section

    zhang Yong-fu, LAO Jian-xin, LIU Wen-xing, LI Yu, LAI Guo-zhong

    Department of Anesthesiology, Women and Children’s Hospital of Guangzhou, Guangzhou 510180, China

    Abstract: Objective To ­compare efficacy and side effects of patient-controlled epidural analgesia (PCEA) with levobupivacaine, ropivacaine and racemic bupivacaine after cesarean section. Methods In this prospective, randomized double-blind study, 90 ASAⅠ-Ⅱfull-term nulliparous women (aged 25-38 years with body mass of 59-87 kg) undergoing elective cesarean section under spinal-epidural anesthesia were allocated into 3 groups. PCEA was administrated with 0.125% levobupivacaine and 20 μg/ml morphine (group L, n=30), 0.125% ropivacaine and 20 μg/ml morphine (group R, n=30), and 0.125% bupivacaine and 20 μg/ml morphine (group B, n=30), respectively. The visual analog scale (VAS) score, satisfaction rate, patients’ overall impression of treatment, modified Bromage Motor Scale score, and incidence of side effects were recorded at regular intervals after operation. Results The three groups were comparable with respect to the efficacy of analgesia, patients’ overall impression of treatment, motor blockade and side effects. There was significant difference in patients’ satisfaction ratebetween group R (70%) and the other two groups (93.3% in group L and 96.6% in group B, P<0.05). Conclusion PCEA with 0.125% levobupivacaine and morphine 20 μg/ml produces better analgesic effect with little side effects after cesarean section. ......