术前口服可乐定对脊柱手术患者全麻苏醒的影响

The effects of oral clonidine for premedication of anesthetic recovery on the spinal operation patients

目的：观察脊柱手术患者术前口服可乐定对全麻苏醒的影响。方法：将64例ASAⅠ-Ⅱ级，18~60岁，择期行椎管减压、脊柱融合手术的患者随机分为术前口服可乐定组（200 μg）和安慰剂组（维生素C 600 mg）。麻醉诱导采用芬太尼2 μg/kg、异丙酚1~2 mg/kg及维库溴铵0.1 mg/kg。气管插管后机械通气，调整吸入异氟烷浓度维持BIS 40~50，间断给予维库溴铵维持肌松。调整呼吸参数维持ETCO2 35~40 mmHg。记录患者一般资料，芬太尼、异丙酚用量、麻醉时间、拔管时间、低血压或高血压发生率。结果：可乐定组患者芬太尼用量少于安慰剂组（2.11±0.87 vs. 3.68±0.93，P〈0.05）,拔管时间早于安慰剂组（9.88±6.12vs. 13.62±9.74，P〈0.05），异丙酚用量、低血压及心动过缓发生率组之间没有统计学意义（P〉0.05）。结论：脊柱手术的患者，术前给于可乐定能减轻麻醉所需麻醉药的用量，加快麻醉后复苏，并且不增加低血压和心动过缓的发生率。

Objective：To observe the effects of oral clonidine premedication on the general anesthesia and recovery in patients undergoing spinal surgery. Methods： Sixty-four ASA level I - Ⅱ patients （ 18-60 years old） undergoing major spine surgery were ran- domly allocated to two groups. One group received oral clonidine （200 p.g） and the other received placebo （ Vitamin C 600 mg） for premedication. Standard anesthesia protocols were followed for induction Fentanyl 2 μg/kg,Propofol 1 - 2 mg/kg and Vecuronium Bro- mide 0. 1 mg/kg. The mechanical ventilation was performed after the tracheal intubation. And the concentration of isoflurance was adjus- ted and maintained at the level of BIS 40 - 50. The Veeuronium Bromide was given inconsistently in order to keep the muscular relaxa- tion. The reference data of breathing is adjusted at the level of ETCO2 35 ~ 40 mmHg. Heart rate,blood pressure, and end-tidal concen- trations of isoflurane were monitored. Hypotensive episodes were treated with bolus doses of ephedrine or phenylephrine. Results： The demographic data,duration of anesthesia, propofol requirement were not significant between the two groups. The total dose of fentanyl （2. 11 ± 0.87 vs. 3.68 ± 0.93 ） and the recovery time （9.88 ± 6.12vs. 13.62 ± 9.74） were decreased in clonidine group. There was no statistical difference in the change of hemodynamic parameters, the incidence of hypotension or bradycardia between the two groups. Conclusion：Clonidine for premedication can reduce the requirement of opoids, facilitate the recovery from inhaled isoflurane anesthe- sia,and does not increase the incidence of hypotension or bradycardia.