Roberts-Thomson I C, Jonsson J R, Frewin D B
Department of Gastroenterology, Queen Elizabeth Hospital, Woodville South, Australia.
Clin Auton Res. 1994 Aug;4(4):185-8. doi: 10.1007/BF01826184.
Anomalous responses to morphine are common in patients with unexplained pain in the upper abdomen after cholecystectomy and may be linked to activation of the sympathetic nervous system. The hypothesis that sympathetic suppression would attenuate anomalous responses to morphine was tested by a randomized, cross-over trial using a standard challenge with morphine, with and without pretreatment with clonidine (300 micrograms orally, 1 h prior to the administration of morphine). In 13 of the 15 patients who completed the study, pre-treatment with clonidine decreased plasma concentrations of noradrenaline, dopamine and adrenaline by 56, 15 and 25% respectively. This was associated with a significant reduction in morphine-induced pain (p = 0.02) and nausea (p = 0.04) and attenuated increases in plasma aspartate aminotransferase (AST) activity (p = 0.03). Clonidine attenuates anomalous responses to morphine, perhaps through effects on sympathetic nervous activity or plasma concentrations of catecholamines.
胆囊切除术后上腹部不明原因疼痛的患者对吗啡的异常反应很常见，这可能与交感神经系统的激活有关。通过一项随机交叉试验来检验交感神经抑制会减弱对吗啡异常反应的假设，该试验使用标准剂量的吗啡进行激发试验，分别在给予吗啡前1小时口服可乐定（300微克）或不进行预处理。在完成研究的15名患者中的13名中，可乐定预处理分别使去甲肾上腺素、多巴胺和肾上腺素的血浆浓度降低了56%、15%和25%。这与吗啡诱导的疼痛显著减轻（p = 0.02）和恶心（p = 0.04）以及血浆天冬氨酸转氨酶（AST）活性升高减弱（p = 0.03）相关。可乐定可能通过影响交感神经活动或儿茶酚胺的血浆浓度来减弱对吗啡的异常反应。
