右美托咪定和可乐定硬膜外给药对硬膜外罗哌卡因麻醉效果的影响  

The influence of epidural dexmedetomidine and clonidine on ropivacaine epidural anesthesia

作　　者：裘学[1] 张兆平[1] 房宁宁[2] 顾美蓉[1] 姚敏[1] 孙国华[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,无锡214023 [2]南京医科大学附属无锡市人民医院体检中心

出　　处：《国际麻醉学与复苏杂志》2013年第4期308-310,315,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较右美托咪定（dexmedetomidine，Dex）和可乐定硬膜外给药对罗哌卡因阻滞效果的影响。方法全组75例患者美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，年龄55岁～65岁，拟行阴式子宫切除术。按随机数字表法分为硬膜外给予0．75％罗哌卡因15ml含100μgDex组（RD组）、硬膜外给予0．75％罗哌卡因15ml含100μg可乐定组（RC组）和硬膜外给予0．75％罗哌卡因15ml含生理盐水组（C组）。结果RD组麻醉平面到达T10起效时间[（8．5±2．4）min]短于RC组和C组[（10．4±3．4）min和（12．7±4．3）min]，RD组在较短的时间内[（13±4）mini达到最高阻滞平面，明显短于RC组和C组[（15±4）min和（18±4）min]；RD组完全运动阻滞时间[（18±5）min]短于RC组和C组[（21±4）min和（24±4）min；（P〈0．05和P〈0．01）]。RD组术后24h曲马多用量[（87±17）mg]也显著少于RC组和C组[（101±21）mg和（146±19）mg；（P〈0．01）]。RD组和RC组寒战发生率明显低于C组（P〈0．01），未发现1例呼吸抑制。结论硬膜外给予Dex可增强罗哌卡因硬膜外阻滞效果，与可乐定比较麻醉起效快、围术期呼吸循环稳定，减少术后镇痛药的应用。Objective The aim of this study was to evaluate the efficacy of epidural dexmedetomidine （Dex） and clonidine on ropivacaine epidural anesthesia. Methods Seventy-five patients ASA Ⅰ or Ⅱ, aged 55 y-65 y, scheduled for elective vaginal hysterectomy under epidural anesthesia with ropivacaine were randomly allocated into three groups： patients in group RD were administered 15 ml of 0.75% epidural ropivacaine and 100 μg of Dex, while group RC received admixture of 15 ml of 0.75% ropivacaine and 100 μg of clonidine, and group C received 15 ml of 0.75% ropivacaine and saline. Results The patient in group RD exhibited an earlier onset of sensory analgesia at T10 [（8.5±2.4） mini as compared to group RC and group C [（10.4±3.4） min and （12.7±4.3） mini. Dex not only provided a higher dermatomal spread but also helped in achieving the maximum sensory anaesthetic level in a shorter period [（13±4） min compared to clonidine （15±4） min and （18±4） rain]. Bromage scale 3 was achieved earlier in group RD [（18±5） mini than in group RC and group C [（21±4） min and （24±4） min, P〈0.05]. Less tramadol consumed in group RD [（87±17） mg ] than that in group RC and in group C [（101±21） min and （146±19） mg, P〈0.01 ] for postoperative analgesia of 24 h（P〈0.05）. Sedation scores in group RD and group RC were better than in group C（P〈0.05）. The incidence of shivering was lower in group RD and group RC than that in group C （P〈0.05）. Respiratory depression was not observed in each group. Conclusions Epidural Dex may reinforce the effect of epidural anaesthesia with ropivacaine and analgesia. Dex is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, stable cardio-respiratory parameters and a prolonged post-operative analgesia.

关 键 词：右美托咪定 可乐定 硬膜外麻醉 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]