【摘要】 目的 观察肾移植术患者罗哌卡因硬膜外麻醉时药代动力学和药效学的变化。方法选择肾移植术病人8例（R组）;年龄体重相匹配的肾功能正常,行下腹部或下肢手术病人8例（C组）。应用0.75％罗哌卡因行硬膜外阻滞,测定感觉阻滞、运动阻滞程度;以高效液相法测定罗哌卡因血浆浓度,测定血浆α1-酸性糖蛋白浓度。结果　R组感觉阻滞上界固定时间为（20.00±4.63）min,比对照组[（32.14±8.09）min]明显快（P<0.05）;麻醉持续时间明显延长,分别为（60.00±27.69）min,（43.10±27.64）min,P<0.05。R组血浆α1-酸性糖蛋白浓度[（125.49±46.84）mg/dl]明显高于C组[（69.69±20.39）mg/dl）]（P<0.05）。R组罗哌卡因血药浓度-时间曲线 AUC（496.46±237.84）明显高于C组（304.09±100.77）（P<0.05）。而运动阻滞时间、Tmax、Tβ1/2、Cmax两组无显著性差异。结论 硬膜外0.75％罗哌卡因可为肾移植术提供良好的麻醉。肾衰对罗哌卡因药效学和药代动力学有不同程度的影响。更多还原

【Abstract】 Objective To investigate the pharmacodynamics and pharmacokinetics of ropivacaine for epidural anesthesia in renal transplantion. Methods Eight patients undergoing renal transplantation (group R) and eight patients with normal renal function (group C) were included in this study. Nine patients were male and seven female. Age ranged from 27-52 years and body weight from 46-89 kg. Radial artery was cannulated under local anesthesia for blood pressure monitoring and blood sampling. An epidural catheter was placed at L1-2. An epidural bolus of 0.75% ropivacaine 16 ml was given. The level of sensory block was tested every 3 min within 30min after epidural ropivacaine and then every 15 min.The degree of motor block was assessed using Bromage score every minute (0 = the patient can move his/her lower limb freely, 3 = the patient can not flex his/her hip, knee and ankle) . Arterial blood samples were taken before, during and after surgery for determination of plasma concentration of Alphal acid glycoprotein (α1-AGP) using an ultrafiltration technique. Results Demographic data including gender, age and body weight were comparable between the two groups. The onset time of sensory block in group R (20.00±4.63)min was significantly shorter than that in group C (32.14±8.09) min, while duration of sensory block in group R (60.00±27.69) min was significantly tonger than that in group C (43.13 ± 27.64) min. Plasma concentration of α1-AGP in group R was significantly higher than that in group C ( P < 0.05 ) . AUC in group R was significantly greater than that in group C (P<0.05). The duration of motor block, Tmax, Tβ1/2 and Cmax were not significantly different between the two groups.Conclusions Epidural 0.75% ropivacaine provides satisfactory analgesia for renal transplantation. The pharmacodynamics and pharmacokinetics are affected to some extent in patients undergoing renal transplantation due to physiological changes including higher plasma α1-AGP in renal failure patients.更多还原