可乐定减少硬膜外分娩镇痛中突破性疼痛的临床观察

The effect of clonidine on breakthrough pain relief in parturients using epidural analgesia for labor analgesia

目的：观察可乐定联合罗哌卡因及芬太尼减少硬膜外分娩镇痛中突破性疼痛的临床疗效。方法100例拟行无痛分娩的初产妇，随机分为可乐定组（ n=50）和对照组（ n=50）。可乐定组和对照组硬膜外腔分别注射0.1%罗哌卡因，2μg/ml芬太尼及5μg/ml的可乐定混合液和0.1%罗哌卡因及2μg/ml芬太尼混合液10~15 ml作为负荷剂量，维持镇痛药物两组均为0.1%罗哌卡因及2μg/ml芬太尼混合液，背景剂量6 ml，病人自控单次给药剂量（ PCEA）6 ml，锁定时间15 min，比较两组突破性疼痛的数量、产程时间、罗哌卡因用量和分娩方式。结果两组产程时间和分娩方式差异无统计学意义（ P 〉0.05）。对照组产妇发生突破性疼痛的例数高于可乐定组，两组比较差异有统计学意义（ P〈0.05）。对照组患者罗哌卡因用量大于可乐定组，两组比较差异有统计学意义（ P 〈0.05）。结论可乐定联合罗哌卡因及芬太尼用于硬膜外分娩镇痛可减少产妇的突破性疼痛，并降低罗哌卡因的用量。

Objective To observe the efficacy of clonidine in relieving breakthrough pain in labour using epidural analgesia with ropiva-caine and fentanyl. Methods One hundred nulliparous women who requested for epidural analgesia were randomly divided into clonidine group （n=50）andcontrolgroup（n=50）. Parturientsinclonidinegroupwereadministered10~15mladmixtureof0.1% epiduralropivacaineand2μg/ml fentanyl and 5 μg/ml clonidine,while control group received 10~15 ml admixture of 0. 1% epidural ropivacaine and 2 μg/ml fentanyl as initial loading dose. Analgesia was maintained using patient-controlled epidural analgesia（PCEA）using a 6 ml of admixture of 0. 1% epidural ropivacaine and 2μg/ml fentanyl and a lockout of 15 min with a continuous background infusion of 6 ml/h. The number of breakthrough pain,du-ration of labour,ropivacaine consumption and mode of delivery were compared between two groups. Results The number of breakthrough pain in clonidine group were significantly higher than control group（ P 〈0. 05）. The ropivacaine consumption in control group were significantly higher than clonidine group（ P 〈0. 05）. Conclusion Clonidine can reduce the number of breakthrough pain and ropivacaine consumption in nullipa-rous women using epidural analgesia for labour analgesia.