可乐定用于连续臂丛神经阻滞患者自控镇痛的观察

目的观察罗哌卡因复合不同浓度可乐定行连续肌间沟臂丛阻滞在上肢手术后患者自控镇痛中的效应。方法选择上肢手术患者45例,随机分成罗哌卡因组（R组）,罗哌卡因复合低浓度可乐定镇痛组（K1组）以及罗哌卡因复合高浓度可乐定镇痛组（K2组）。术后三组都使用便携式患者自控镇痛泵行患者自控镇痛,泵内液体分别为0.15%罗哌卡因,0.15%罗哌卡因＋1μg/ml可乐定和0.15%罗哌卡因＋2μg/ml可乐定。分别记录术后0、6、12、24、48h视觉模拟评分法（VAS）评分和不良反应。结果K1和K2组镇痛效果均佳（VAS〈3）,组间无明显差别;R组疼痛评分在术后0h、4h时与K1组和K2组比较差异无统计学意义（P〉0.05）,在术后8h、12h、24h均较高,与前两组间相比差异有统计学意义（P〈0.05）;K1组血压降低,口干和嗜睡发生率轻于K2组,P〈0.05。结论连续肌间沟臂丛阻滞在上肢术后镇痛中是一种合理的方法,0.15%罗哌卡因＋1μg/ml可乐定可安全有效的应用于上肢术后患者自控镇痛。

Observation of continuous brachial plexus block of clonidine the for patient-controlled analgesia

Objective To observe the effects of clonidine in various doses compounded with ropivacaine in continuous brachial plexus block for patient-controlled analgesia（PCA）following upper extremity surgery.Methods 45 patients for upper-limb surgery were randomly divided into three group：group R（analgesia with Ropivacaine）,group K1（analgesia with Ropivacaine and low dose clonidine）,group K2（analgesia with Ropivacaine and high dose clonidine）.Postoperatively,all patients of three group received a portable infusion pump for patient-controlled analgesia（PCA）delivering studying solution（0.15%Ropivacaine,0.15%Ropivacaine＋1 μg/ml clonidine and 0.15%Ropivacaine＋2 μg/ml clonidine）.To every patient,pain visual analogue scale （VAS）and complications at time points of 0,4,8,12,24 h postoperatively were all recorded.Results At all time points the VAS in group K1 and group K2 were low,but there was no significant difference between them（P〉0.05）.At 0 h and 4 h after operation there were no differences between group R and group K1 or group K 2（P〉0.05）.At 8 h,12 h and 24 h after operation,the VAS in group R were higher,and there were significant difference between group R and group K1 or group K2（P〈0.05）.The incidence of low brood pressure,thirst and sleepiness in group K1 was lower than in group K2（P〈0.05）.Conclusion Continuous interscalene brachial plexus block analgesia used following upper extremity surgery was rational.0.15%ropivacaine＋1 μg/ml clonidine ropivacaine appeared effective and safe in providing patient-controlled analgesia（PCA）following upper extremity surgnery.