Ellis J E, Drijvers G, Pedlow S, Laff S P, Sorrentino M J, Foss J F, Shah M, Busse J R, Mantha S, McKinsey J F
Department of Anesthesia and Critical Care, University of Chicago, IL 60637.
Anesth Analg. 1994 Dec;79(6):1133-40. doi: 10.1213/00000539-199412000-00019.
We studied 61 patients undergoing elective major non-cardiac surgery in a randomized, double-blind, placebo-control clinical trial to test the hypothesis that the addition of clonidine to a standardized general anesthetic could safely provide postoperative sympatholysis for patients with known or suspected coronary artery disease. Patients were allocated randomly to receive either placebo (n = 31) or clonidine (n = 30). The treatment group received premedication with a transdermal clonidine system (0.2 mg/d) the night prior to surgery, which was left in place for 72 h, and 0.3 mg oral clonidine 60-90 min before surgery. Clonidine reduced enflurane requirements, intraoperative tachycardia, and myocardial ischemia (1/28 clonidine patients vs 5/24 placebo, P = 0.05). However, clonidine decreased heart rates only during the first five postoperative hours; the incidence of postoperative myocardial ischemia (6/28 clonidine vs 5/26 placebo) did not differ between the two groups. Patients who experienced postoperative myocardial ischemia tended to have higher heart rates after surgery. Clonidine significantly reduced the plasma levels of epinephrine (P = 0.009) and norepinephrine (P = 0.026) measured on the first postoperative morning. There were no differences in the need for intravenous fluid therapy or antihypertensive therapy after surgery. The number of hours spent in an intensive care setting and the number of days spent in hospital were not different between the two groups. These results suggest that larger doses of clonidine should be investigated for their ability to decrease postoperative tachycardia and myocardial ischemia.
我们在一项随机、双盲、安慰剂对照的临床试验中研究了61例接受择期非心脏大手术的患者，以检验以下假设：在标准化全身麻醉中添加可乐定可为已知或疑似冠状动脉疾病的患者安全地提供术后交感神经阻滞作用。患者被随机分配接受安慰剂（n = 31）或可乐定（n = 30）治疗。治疗组在手术前一晚接受经皮可乐定系统（0.2 mg/d）的术前用药，该系统保留72小时，并在手术前60 - 90分钟口服0.3 mg可乐定。可乐定降低了安氟醚的需求量、术中心动过速及心肌缺血的发生率（可乐定组28例中有1例，安慰剂组24例中有5例，P = 0.05）。然而，可乐定仅在术后最初5小时内降低心率；两组术后心肌缺血的发生率（可乐定组28例中有6例，安慰剂组26例中有5例）并无差异。经历术后心肌缺血的患者术后心率往往较高。可乐定显著降低了术后第一个早晨测得的肾上腺素（P = 0.009）和去甲肾上腺素（P = 0.026）的血浆水平。术后静脉补液治疗或抗高血压治疗的需求并无差异。两组在重症监护室的停留时间及住院天数并无不同。这些结果表明，应研究更大剂量可乐定降低术后心动过速和心肌缺血的能力。
