硬膜外腔可乐定预先给药对患者舒芬太尼复合左旋布比卡因镇痛效应的作用  

Effects of epidurai clonidine pretreatment in epidural patient-controlled analgesia using sufentanil combined with levobupivacaine

作　　者：阮祥才[1] 许立新[1] 佘守章[1] 苏健[1] 谢晓青[1] 

机构地区：[1]广州医学院附属广州市第一人民医院麻醉科,510180

出　　处：《中华医学杂志》2008年第9期583-586,共4页National Medical Journal of China

摘　　要：目的观察硬膜外腔可乐定预先给药，对舒芬太尼复合左旋布比卡因术后患者自控硬膜外镇痛的作用。方法60例符合美国麻醉医师协会（ASA）Ⅰ-Ⅱ级、经腹全子宫切除手术患者，根据硬膜外腔可乐定的剂量随机分为：C2组（n=20）2μg／kg，C4组（n=20）4μg／kg和对照的C0组（n=20）。腰2—3椎间隙穿刺、置管，可乐定注射后以0．5％左旋布比卡因行硬膜外阻滞，术后硬膜外镇痛药液为0．4μg／ml舒芬太尼＋2mg／ml左旋布比卡因。结果全部患者麻醉效果满意，C4组使用阿托品比例较对照组增高（30％vs．5％）。镇痛满意率高：术后24h可乐定预先给药患者静止时视觉模拟评分（VAS）≤3比例明显增高（88％和93％vs．75％），该差异的主要来源为术后4h时点；C4组术后24h咳嗽时VAS≤3比例，较对照组升高（79％vs．48％），差异主要源自于术后4h和8h两个时点；C2组术后24h咳嗽时VAS≤3比例低于C4组（61％VS．79％）。可乐定预先注射患者术后24h镇痛药液较对照组分别下降11．8％和22．8％，其中0—4h和4-8h的用药量以C0组最高、C4组最低，除了4—8h内C2组和C4组间差异无统计学意义之外，其他差异均具有统计学意义。C4组镇静程度较对照组增高；术后24h呕吐率C4组为0，C2组是10％，对照组有40％。结论2—4μg／kg可乐定硬膜外腔预先给药，可改善舒芬太尼复合左旋布比卡因术后早期镇痛效果、减少不良反应发生率。Objective To investigate the clinical effects of epidural clonidine pretreatment in epidural patient-controlled analgesia （PCA） using sufentanil combined with levobupivacaine. Methods Sixty patients undergoing abdominal hysterectomy of ASA status Ⅰ～Ⅱ were randomly divided into 3 equal groups： C2 group was pretreated with epidural clonidine 2 μg/kg at the L2-3 interspace, 15 min later, epidural anesthesia was performed with 0. 5% levobupivacaine, and then 0. 4 μg/ml combined with levobupivacaine 2 mg/ml was given for postoperative epidural patient-controlled analgesia. C4 group was pretreat4ed with epidural clonidine 4 μg/kg, and C0 group was pretreated with normal saline. The analgesic effect, PCA drug dosage, adverse reaction, and visual analog scale （VAS） score were recorded. Results Anesthesia was clinically satisfactory in all patients. The rate of atropine use of the C4 group was 30%, significantly higher than those of the C2 group （ 15% ） and Co group （5 % , both P 〈 0.05 ）. The rate of VAS ≤3 at rest 24 h postoperatively of the C2 and C4 groups were 88% and 93% respectively, both significantly higher than that of the Co group （75% , P 〈0.01 and P 〈0.01 ）. The rate of VAS≤3 while coughing 24 h postoperatively of the C2 and C4 groups were 61% and 79% respectively, both significantly higher than that of the Co group （48%）. The dosages of PCA drug of the C2 and C4 groups were significantly lower than that of the Co group by 11.8% and 22.8% respectively （ both P 〈 0.05 ）. The dosage of PCA drug 0 - 4 h after operation of the C2 was significantly higher than that of the C4 group. The sedative degree of the C4 group was higher than that of the Co group. The rate of postoperative vomiting of the Co group was 40%, significantly higher than that of the C4 group （ 10%, P 〈 0. 05 ）. Conclusion Epidural clonidine 2 -4μg/kg pretreatment improves the clinical effects of epidural PCA using sufentanil combined with levobupivacaine.

关 键 词：镇痛 硬膜外 药理学 临床 可乐定 舒芬太尼 

分 类 号：R686[医药卫生—骨科学]