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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。
Objective To observe the changes of pharmacokinetics and pharmacodynamics of ropivacaine epidural anesthesia in renal transplant recipients. Methods Eight cases of renal allograft (R group) were selected. The age-matched kidney function was normal, and 8 cases underwent lower abdomen or lower limb surgery (group C). The epidural block of 0.75% ropivacaine was applied to determine the degree of sensory block and motor block. The plasma concentration of ropivacaine was determined by HPLC and the plasma concentration of α1-acid glycoprotein was determined. Results The upper limit of sensory block in group R was (20.00 ± 4.63) min, which was significantly faster than that in control group (32.14 ± 8.09 min) (P <0.05). The duration of anesthesia was prolonged (60.00 ± 27.69) min, (43.10 ± 27.64) min, P <0.05. The plasma α1-acid glycoprotein concentration in group R was significantly higher than that in group C ([(125.49 ± 46.84) mg / dl] (69.69 ± 20.39 mg / dl)] (P <0.05). The concentration-time curve AUC of ropivacaine in R group (496.46 ± 237.84) was significantly higher than that in C group (304.09 ± 100.77) (P <0.05). However, there was no significant difference in Tmax, Tβ1 / 2 and Cmax between two groups. Conclusion Epidural 0.75% ropivacaine provides good anesthesia for renal transplantation. Renal failure has different effects on the pharmacodynamics and pharmacokinetics of ropivacaine.