剖宫产孕妇硬膜外给局麻药的药代动力学

为了解孕妇硬膜外给局麻药的药代动力学，选择２０名实施剖宫产手术的健康临产妇，随机分成硬膜外腔给予了哌卡因组（Ｂ１组）和给予利多卡因组（Ｌ组）。另外， ６例非妊娠患者硬膜外腔给予了哌卡因（Ｂ２组）。Ｂ１和Ｂ２组均给予０．７５％丁哌卡因１～１．５ｍｇ·ｋｇ－１，Ｌ组给予２％利多卡因４～４．５ｍｇ·ｋｇ－１。采用高效液相色谱（ＨＰＬＣ）测定硬膜外给药后血浆药物浓度。结果表明三组病例血药浓度均在安全范围内。Ｂ１组的血药浓度达高峰时间（Ｔｐｅａｋ）和脐静脉与母体血药浓度比（ＵＶ／ＭＶ）值均小于Ｌ组，表明丁哌卡因在硬膜外腔的吸收比利多卡因快，且透过胎盘屏障的药量小于利多卡因，新生儿Ａｐｇａｒ评分在娩出后５分钟均为１０分。Ｂ１组的药代动力学参数与Ｂ２组基本相似。结论：剖宫产手术硬膜外腔给予临床剂量的局麻药是安全的。

Pharmacokinetics of epidural local anesthetics in parturient women undergoing cesareau sections.

To evaluate the variations in pharmacokinetics of epidural local anesthetics in pregnant women, twenty healthy parturient women,scheduled to undergo cesarean sections,were randomly allocated to receiving epidural 0. 75'% bupivacaine 1. 2mg.kg-1 (B1 group)or 2%lidocaine 4. 5mg .kg-1 (L group)respectively,and six non-pregnant female patients were elected to receive epidural 0. 75 % bupivacaine 1. 5mg .kg-1 (B2 group). High performance liquid chromatography(HPLC) was used to measure the plasma concentrations of local anesthetics following epidural administration. The results showed that the plasma concentrations were all within safty ranges in these three groups. Tpeak and UV/MV value in B1 group were less than those in L groap,indicating that the absorption following epidural bupivacaine was more rapid and its placental transfer dosage was lower as compared with those of lidocaine. Neonatal Apgar scores were equally ten at five minutes after delivery. The pharmacokinetic parameters in B1 group were all basically similar to those in B2 group. it's concluded that the clinical routine dosages of epidural local anesthetics for cesarean section are safe.