可乐定硬膜外腔预注的镇静效应及其对脑电双频谱指数的影响

Sedation and bispectral index effects of single epidural clonidine shot

目的观察可乐定硬膜外腔预注对左旋布比卡因硬膜外麻醉患者的镇静效应及其对脑电双频谱指数(BIS)的影响。方法45例ASAⅠ～Ⅱ级经腹全子宫切除手术患者,根据硬膜外腔预注可乐定剂量的不同,随机分为3组:C2组(n=15)2μg/kg,C4组(n=15)4μg/kg和C0组对照(n=15)。L2～3硬膜外腔穿刺置管,可乐定注射15min后以0.5%左旋布比卡因行硬膜外阻滞麻醉。结果各组麻醉效果良好,阻滞平面T6(T3～6),术中左旋布比卡因用量组间无显著差异,C0组1例需要辅助镇静药物。可乐定给药5～15min后,BIS明显降低,C4组降低比C2组更显著;警觉/镇静评分为C4组<C2组<C0组(P<0.05或0.01)。C0组使用阿托品和麻黄素患者比率(13.3%和6.7%)较低(P<0.05)。结论硬膜外腔可乐定预注具有剂量相关的镇静和BIS降低效应,且可引起循环系统抑制。

Objective To investigate the sedation and bispectral index effects of single epidural clonidine shot in levobupivacaine anesthesia. Methods Forty-five ASA class Ⅰ～Ⅱ gynecologic patients were randomly assigned into three groups with 0, or 2, or 4 (μg/kg) of epidural clonidine. There were 15 patients in each group. Epidural anesthesia was performed at the L_(2～3) interspaces with 0.5% levobupivacaine after single epidural clonidine shot. Results Anesthesia was clinically satisfied in all with average sensory reached T_6(T_(3～6)). The dose of levobupivacaine was similar among 3 groups. One case in control group needed additional intraoperative sedation. 5～15 min affter clonidine injection bispectral index begain to drop significantly. In group with 4 (μg/kg) of clonidine, decreasein bispectral index was more prominent than that in group with 2 (μg/kg) of clonidine(P<0.05 or 0.01). The scores of OAA/S significantly dropped in group with 2 (μg/kg) of clonidine, and was more significant in group with 4 (μg/kg) of clonidine(P<0.05 or 0.01). The frequency of atropine and ephedrine use was lower in control group(P<0.05). Conclusion Single epidural clonidine shot can induce dose-related sedative effects and reduce bispectral index, but can inhibit hemodynamics.