合用吗啡可乐定术后镇痛对促肾上腺皮质激素的影响

THE EFFECT OF POSTOPERATIVE ANALGESIA AFTER CO ADMINISTRATION OF MORPHINE AND CLONIDINE ON PLASMA ACTH

目的观察吗啡可乐定持续硬膜外腔给药对上腹部手术病人术后镇痛作用及对血浆促肾上腺皮质激素（ＡＣＴＨ）的影响。方法１２例全麻下上腹部手术病人，苏醒后随机分成两组，持续硬膜外腔注射吗啡镇痛组（Ｍ，ｎ＝６）与吗啡可乐定合用组（Ｃ，ｎ＝６）。测定硬膜外给药至次日８时的疼痛视觉模拟评分（ＶＡＳ）值。抽静脉血测定术前任一天９时和术后第一天９时血浆ＡＣＴＨ浓度。结果两组硬膜外给药至次日８时平静时的ＶＡＳ值均小于２０ｍｍ；次日８时咳嗽时的ＶＡＳ值两组均增高，且Ｍ组高于Ｃ组（Ｐ＜０．０５）。术后第１天９时血浆ＡＣＴＨ浓度均较术前水平提高，两组间无明显差异（Ｐ＞０．０５）。结论吗啡与可乐定合用持续硬膜外腔注射术后镇痛效果优于单用吗啡；两药合用不增强对术后ＡＣＴＨ分泌的抑制作用。

Objective This study was conducted to evaluate the effect of postoperative analgesia and enfluence on plasma ACTH afere co administration of morphine and clonidine by continuous epidural infusion in patients recovering fromupper abdominal surgery.Method 12 ASA physical status Ⅰ patients were locatedrandomly to receive either a continuous epidural infusion of morphine and clonidine(group C,n=6,the dose of mrphine 0.1 mg.kg -1 and colnidine 300 μg;1/3 of morphine and 75 μg clonidine added isotonic saline solution to 2 ml for bolus injection and then the left of morphine and clonidineadded isotonic saline solution to 25 ml,2 ml.h -1 for epidural continusous infusion) or morphine alone (group M,n=6).Analgesia was assessed by visual analogue scale (VAS)over the study period.Venous blood sample were abtained at 9 am any day before operation and the first day after operation for radioimmunoassy determination of plasma concentration of adrenocorticotrophic hormone(ACTH).Results The VAS scores were lower in group C during the entire observation period than in group M.The plasma concentration of ACTH at 9 am in the first day after surgery was increased (group M,P<0.01;group C,P<0.05) and no significant difference between the two groups.Conclusion The combination of morphine and clonidine continuous epidural infusion produce more effective postoperative analgesia than epidural morphine alone in patients undergoing upper abdominal surgery and do not enhance the inhibitory effects on postoperative ACTH secretion.