可乐定对吗啡硬膜外病人自控镇痛效果的影响

Effects of clonidine on morphine epidural patient controlled analgesia

目的观察可乐定对硬膜外吗啡病人自控镇痛临床效果的影响。方法54例ASAⅠ～Ⅱ级硬膜外麻醉下全宫切除术病人,随机分为三组,镇痛液分别为:C0组(n=18):吗啡0.1mg/ml,C1组(n=18):吗啡0.1mg/ml+可乐定1μg/ml,C2组(n=18):吗啡0.1mg/ml+可乐定2μg/ml。PCA泵设置均相同。术后疼痛视觉模拟评分3分时启动PCA,监测镇痛的第4、8、16、24小时视觉模拟评分、警觉/镇静评分、血压、心率、总用药量等资料。结果所有病人麻醉效果满意,组间布比卡因用量、术后平均动脉压和心率变化均无统计学差异。三组病人24小时吗啡/可乐定的用量为C0组(3.3±0.6)mg/0μg、C1组(3.3±0.6)mg/(33.4±8.5)μg和C2组(3.3±0.6)mg/(65.5±11.6)μg,吗啡剂量组间无统计学差异(P>0.05)。疼痛视觉模拟评分≤3比例C0组(86.7%)显著性低于C1组(95.0%)和C2组(98.7%),警觉/镇静评分≤4级比例N0组最低,C2组最高,镇痛期间呕吐的发生率分别为C0组16.7%、C1组22.2%和C2组16.7%,组间差异均具有统计学意义(P<0.05)。结论硬膜外腔1～2μg/ml可乐定可改善吗啡术后镇痛效果,并具有与其剂量有关的镇静和降低呕吐发生率的作用。

Objective To investigate effects of clonidine on morphine epidural patient controlled analgesia after bupivacaine epidural anesthesia, Methods Fifty-four ASh, class Ⅰ-Ⅱ gynecologic patients were randomly assigned into three groups with eighteen patients per group. Analgesics was 0.1mg/ml morphine in control group, and additional 1μg/ml clonidine was added in C1 group, and additional 2μg/ml clonidine was added in C2 group. All epidural anesthesia were performed at the L2-3 interspaces with 0.5% bupivacaine. Postoperative patient controlled analgesia ran for 24 hours after visual analog pain score reached 3. Results All anesthesia are clinically satisfied. Dose of bupivacaine, and changes of mean arterial pressure and heart rate are similar among groups. Dose of morphine in 24 hours analgesia is similar among groups. Ratio of visual analog pain score ≤3 in control group is 86.7 percent, and in C1 group is 95.0 percent, and in C2 group is 98.7 percent, scores of OAA/S drop significantly in C1 group, and more significantly in C2 group （P〈0.05）. The frequency of vomiting is lowest in con- trol group, and is highest in C2 group （P〈0.05）. Conclusion 1-2μg/ml clonidine added to morphine can improve epidural patient control analgesia effects, induce dose-related sedative effects, and reduce postoperative vomiting.