摘要
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.
出处
《潍坊医学院学报》
1997年第3期167-169,共3页
Acta Academiae Medicinae Weifang
关键词
术后镇痛
硬膜外麻醉
吗啡
可乐定
ACTH
analgesia postoperative
anesthetic technique epidural
morphine
clonidine
stress adrenocorticotrophic hormone