胸段硬膜外腔注射可乐定对上腹部手术术后膈肌功能的影响

目的　观察胸段硬膜外腔注射可乐定对上腹部手术 (UAS)术后膈肌功能的作用。方法　在连续硬膜外神经阻滞麻醉下行剖腹胆囊切除术病人 2 0例 ,均分为可乐定 (A)组与生理盐水(B)组。术后 2小时A组经硬膜外导管注入可乐定 4μg/kg ,B组注入生理盐水。记录注药前、注药后30分钟、2小时有无反常呼吸运动以及RR、VT。结果　A组注射可乐定 30分钟后膈肌功能改善 :反常呼吸运动消失 ,RR减慢 (由 2 0 0± 1 8降到 15 2± 1 7,P <0 0 0 1)、VT 增加 (由 2 19 8± 2 6 8ml/m2 增到 2 91 0± 2 5 5ml/m2 ,P <0 0 0 1) ,连续观察 2小时 ,膈肌功能仍优于注药前。B组注射生理盐水后上述指标无明显变化。结论　胸段硬膜外腔注射可乐定可改善UAS术后膈肌功能

Effects of thoracic epidural clonidine on diaphragmatic function after upper abdominal surgery

Objective To assess the effects of thoracic epidural clonidine on diapbragrnatic functuin after upper abdominal surgery(UAS). Methods Twenty patients umdergoing enoryycysrecromy unae-eno racic epidural anesthesia were divided into two groups equally: clonidine group(group A)and saline group (group B). Two hours after surgery, clonidine 4μg/kg in 8mi saline was infused through epidural catheter in group A and 8ml saline in group B. Respiratory pattern, tidal volume and respiratory rate were measured before injection,at30min and2h after injeetion. Results All patients in group A exhibited diaphragmatic function imorivenent afterthoracic epidural clonidine manifested by parado xic abdominal movement disappeared, decrease in respiratory rate(from20 ± 1.8to 15.2 + 1.7, P ＜ 0.001 )and increase in tidal volume (from219.8 ±26.8ml/m2 to 291± 25.5ml/m2, P ＜ 0.001 ) at 30min after clonidine. The improvement persisted for 2 hours. 8ml saline in group B had no effect on these parameters. Conclusion Thoracic epidural clonidine produces an improvement irn diaphragmatic function after UAS.