性别差异对肛肠手术罗哌卡因骶管阻滞半数有效浓度的影响

中国临床药理学与治疗学 ›› 2015, Vol. 20 ›› Issue (2): 188-193.

性别差异对肛肠手术罗哌卡因骶管阻滞半数有效浓度的影响

董如建¹, 何锐², 李玉红²

¹浙江省临海市中医院麻醉科,临海 317000,浙江;
²绍兴市人民医院麻醉科和医学研究中心,绍兴 312000,浙江

收稿日期:2014-10-29 修回日期:2015-01-26 出版日期:2015-02-26 发布日期:2015-03-20
通讯作者: 李玉红,女,博士,主任医师,研究方向:临床麻醉药理和液体治疗。Tel: 13758147990 E-mail: yuh_li@qq.com
作者简介:董如建,男,主治医师,学士,研究方向:临床麻醉药理学。Tel: 13586126196 E-mail: 1210735677@qq.com
基金资助:
浙江省科技厅钱江人才计划(2012R10033);浙江省卫生厅课题(2014KYB277)

Difference of EC₅₀ values of ropivacaine in male and female patients for caudal anesthesia in anorectal surgery

DONG Ru-jian¹, HE Rui², LI Yu-hong²

¹Department of Anesthesiology, Linhai Chinese Medical Hospital, Linhai 317000, Zhejiang, China;
²Department of Anesthesiology and Research Center, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang,China

Received:2014-10-29 Revised:2015-01-26 Online:2015-02-26 Published:2015-03-20

摘要/Abstract

摘要： 目的: 研究性别差异对罗哌卡因骶管麻醉应用于肛肠手术半数有效浓度(EC₅₀)的影响。方法: 本研究是双盲设计,前瞻性研究,选择ASA I级,择期在骶管麻醉下行肛肠手术患者70例,按性别分为男性组和女性组,每组35例。两组第一例患者罗哌卡因浓度均为 0.2%(20 mL),相邻浓度之差为 0.025%,以对切皮无痛作为有效指标。罗哌卡因给药浓度的增加或减少根据前一个患者的反应决定。应用Dixon法和概率回归分析(Probit)法计算骶管麻醉罗哌卡因EC₅₀。结果: Dixon计算得男性组和女性组罗哌卡因骶管麻醉应用于肛肠手术的EC₅₀分别为 0.296%(95% CI:0.286%-0.307%)和 0.389%(95% CI: 0.372%-0.407%);Probit法计算得EC₅₀值分别 0.295%(95% CI:0.173%-0.325%)和 0.382%(95% CI: 0.352%-0.405%);EC₉₉值分别为 0.364%(95% CI: 0.330%-1.313%)和 0.422%(95% CI: 0.400%-0.646%),女性组EC₅₀显著高于男性组(P<0.01)。结论: 罗哌卡因骶管麻醉应用于肛肠手术时,女性患者的EC₅₀较男性增加31%,提示应根据性别调整罗哌卡因的浓度实施骶管麻醉。

关键词: 骶管麻醉, 性别, 罗哌卡因, 序贯法

Abstract: AIM: To investigate the effect of sex on the median effective concentration (EC₅₀) of ropivacaine for caudal anesthesia.METHODS: In this double-blind, prospective study, we enrolled 70 ASA physical status I patients (35 male and 35 female) who were scheduled for anorectal surgery under caudal anesthesia, and classified them into two study groups (Group M and Group F) on the basis of their gender difference. Each participant received a single injection of 20 mL ropivacaine through a caudal catheter. Using Dixon's up-and-down sequential allocation, the first participant received 0.2% and subsequent concentrations were determined by the analgesic response of the previous patients to the initial skin incision. The concentration change was 0.025%. The up-and-down sequences were analyzed using the Dixon and Probit methods to quantify the caudal analgesic block effective concentrations in 50% of patients.RESULTS: From Dixon method, The EC₅₀ values of ropivacaine for caudal analgesia were 0.296%(95% CI, 0.286%-0.307%) in male patients and 0.389% (95% CI, 0.372%-0.407%) in female patients. From Probit analysis, the EC₅₀ values ropivacaine in Group M and Group F were 0.295%(95% CI, 0.173%-0.325%), 0.382% (95% CI, 0.352%-0.405%) respectively and EC₉₉ was 0.364% (95% CI, 0.330%-1.313%), 0.422% (95% CI, 0.400%-0.646%) respectively. EC₅₀ values of ropivacaine was significantly higher in Group F as compare with Group M (P<0.01).CONCLUSION: We concluded that the ropivacaine EC₅₀ values for caudal anesthesia in female patients is 31% higher as compare to the male patients. The present findings provide suitable suggestion to anesthesiologists about ropivacaine concentration adjustment for caudal anesthesia based on gender difference.

Key words: caudal anesthesia, sex differences, ropivacaine, sequential allocation

中图分类号:

R614

董如建, 何锐, 李玉红. 性别差异对肛肠手术罗哌卡因骶管阻滞半数有效浓度的影响[J]. 中国临床药理学与治疗学, 2015, 20(2): 188-193.

DONG Ru-jian, HE Rui, LI Yu-hong. Difference of EC₅₀ values of ropivacaine in male and female patients for caudal anesthesia in anorectal surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(2): 188-193.

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