可乐定用于膝关节置换术后自控硬膜外镇痛的效果

目的：观察不同浓度可乐定用于膝关节置换术后自控硬膜外镇痛（PCEA）的效果。方法：60例ASA I~Ⅱ级择期行膝关节置换手术的患者,均采用全麻复合硬膜外阻滞麻醉。术后均行PCEA,随机分为3组（每组20例）。镇痛药液配方：A组用吗啡2mg和罗哌卡因150mg;B组用可乐定100μg、吗啡2mg和罗哌卡因150mg;C组用可乐定200μg、吗啡2mg和罗哌卡因150mg。监测术前和术后血压（BP）、心率（HR）和进行疼痛视觉模拟评分（VAS）、Pemesay镇静评分,记录24h镇痛泵总按压次数、实进次数、镇痛药总用量。结果：术后24h VAS评分：A组高于B组（P〈0.01）,B组高于C组（P〈0.05）。B组和C组24h总按压次数、实进次数、镇痛药总用量均显著低于A组（P〈0.01）,且C组低于B组（P〈0.01）。A、B、C组镇静评分别为2.5±0.4分、2.9±0.7分、3.9±0.7分,（P〈0.05）。与术前相比,A、B两组术后BP、HR、差异无统计学意义（P〉0.05）,而C组术后BP、HR均降低。结论：可乐定用于膝关节置换术后PCEA不仅能发挥良好镇痛作用,而且能降低术后血压,有利于患者术后关节功能的恢复。

Clinical Observation of Clonidine in Patient Controlled Epidural Analgesia after the Replacement for Knee Joint

Objective：To observe the effects of clonidine in patients controlled epidural analgesia（PCEA） after the replacement for knee joint.Methods： Sixty patients scheduled for replacement for knee joint were randomly divided into three groups.All patients received the combination of general and epidural anesthesia.Patients in Group A received the analgesia formula of 2mg morphine and 150mg Ropivacaine.Patients in Group B received 2mg morphine,150mg Ropivacaine and 100μg clonidine.Patients in Group C received 2mg morphine,150mg Ropivacaine and 200μg clonidine.Blood pressure（BP）,heart rate（HR） and visual analogue scale（VAS） were recorded before and after operation,the Remesay score,24 h hold times,really enter times and the analgesic total amount used.Results： The VAS score after operation in Group A were higher than those in Group B（P0.01） and Group C（P0.05）.The 24 h hold times,really enter times and the analgesic total amount used in Group B and C were lower than those in Group A（P0.01）.The Remesay score in Group A,Group B and Group C were 2.5±0.4,2.9±0.7 and 3.9±0.7,respectively.The Remesay score in Group C were lower than those in Group B and Group C（P0.05）.The BPs and HRs before and after operation in Group A and B had no difference.The BPs and HRs after operation were lower that those before operation in Group C.Conclusions： The PCEA technique used in the knee joint replacement is not only surely to play the key role in analgesia,but also able to reduce the blood pressure after operation.It is helpful for postoperative joint function restoration.