丙泊酚和七氟醚对术后睡眠质量的影响

Comparison of the effects of propofol and sevoflurane on postoperative sleep quality

目的观察丙泊酚或七氟醚对全麻术后睡眠质量及褪黑素分泌的影响。方法选择行妇科腹腔镜手术的患者120例,年龄18~49岁,BMI 18.5~25 kg/m^2,ASAⅠ或Ⅱ级,采取随机数字表法分为两组(n=60):丙泊酚组(P组)和七氟醚组(S组)。两组采用相同药物麻醉诱导;P组麻醉维持采用丙泊酚靶控输入4~12 mg·kg^-1·h^-1,间断静注舒芬太尼0.2μg/kg、顺阿曲库铵0.1 mg/kg,维持BIS 40~60;S组麻醉维持采用七氟醚吸入MAC 1.0~1.3,间断静注舒芬太尼0.2μg/kg、顺阿曲库铵0.1 mg/kg,维持BIS 40~60。观察术前1 d及术后1、3、7、30 d患者的匹兹堡睡眠质量指数(PSQI)及晨尿硫酸褪黑素浓度。结果与术前比较,术后1、3 d P组PSQI明显升高,术后1d S组PSQI明显升高(P<0.05)。术后3 d S组的PSQI明显低于P组(P<0.05)。与术前比较,术后1、3 d P组褪黑素浓度明显降低(P<0.05);术后1d S组褪黑素浓度明显降低(P<0.05)。术后3 d S组褪黑素浓度明显高于P组(P<0.05)。结论丙泊酚和七氟醚对全麻术后睡眠质量都有明显影响,但七氟醚对睡眠质量的影响较丙泊酚短暂。

Objective To observe effect of propofol or sevoflurane on sleep quality and melatonin secretion after general anesthesia. Methods A total of 120 cases of gynecologic laparoscopic surgery with age 18-49 years old, BMI 18.5-25 kg/m2, falling into ASA physical status Ⅰor Ⅱ, were randomly divided into two groups: propofol group( group P) and sevoflurane group(group S) via random number table. Induction of anesthesia were the same. Group P maintained the anesthesia via target control input of propofol which dose was 4-12 mg·kg-1·h-1 and during the surgery intermittent intravenous injection of sufentanyl 0.2 μg/kg, cisatracurium 0.1 mg/kg, were conducted to keep the BIS index 40-60. Group S inhaled sevoflurane(MAC 1.0-1.3), giving intermittent intravenous sufentanyl 0.2 μg/kg, cisatracurium 0.1 mg/kg, to maintain the BIS index 40-60. The Pittsburgh sleep quality index(PSQI) and the concentration of melatonin in morning urine were observed preoperative and postoperative 1, 3, 7 and 30 days. Results Intra-group comparison: group P showed significant increases in PSQI on the 1 st and 3 rd days postoperative compared with preoperative(P < 0.05), at the same time, melatonin concentrations decreased significantly(P < 0.05). Group S showed a marked increase in PSQI on the 1 st day postoperation compared with preoperation(P < 0.05), and the corresponding melatonin concentrations decreased significantly(P < 0.05). Inter-group comparison: PSQI was significantly higher in group P on the 1 st and 3 rd days after operation than that in group S, and melatonin concentrations was obviously lower in group S(P < 0.05). Conclusion Propofol and sevoflurane have a significant effect on the quality of sleep after general anesthesia, but the time of effect of sevoflurane on the quality of sleep is shorter than that of propofol.