静脉和硬膜外患者自控镇痛对术后睡眠失调的影响

PCA PCIA & PCEA in use of pain-relief postoperative sleep disturbances

目的:研究阿片类药对术后睡眠失调的影响及机制。方法:通过问卷调查,对239例妇科腹部手术后应用静脉和硬膜外吗啡病人自控镇痛(PCA)的病人进行了自觉睡眠质量、镇静、镇痛、舒适程度和副作用的评分。结果:手术后睡眠质量下降,而且自觉睡眠质量与副作用发生率负相关,与舒适程度无关,而与镇痛、镇静程度绝对相关。静脉组的镇痛镇静程度均优于硬外组,且具显著性差异,因此静脉组的睡眠质量明显优于硬外组;而硬外组虽然其舒适程度与静脉组无显著性差异,但其镇痛镇静程度较低,副作用发生率较高,因此其睡眠质量较低。结论:静脉组比之硬外组有较强的镇静镇痛程度,较低的副反应发生率和较佳的自觉睡眠质量。

Objective:To study the influence of opioid analgesics on postoperative sleep and its mechanism.Method&Result:This study assessed the postoperative sleep quality,sedation,analgesia,comfort and side effects after239abdominal gynecological operations using morphine patient controlled intravenous analgesia(PCIA)and patient con鄄trolled epidural analgesia(PCEA).The finding showed that sleep quality was low in all patients and was negatvely related to side effects,and comfort but had a positive correlation to sedation and analgesia.PCIA was significantly better than PCEA.Conclusion:Morphine PCIA has less negative influence on the postoperative sleep quality than PCEA with its stronger sedation and analgesia and lower side effects.Author's address Dept.of Anesthesiology,Beijing Hospital,Beijing,100730