摘要
目的 研究曲马多与芬太尼静脉镇痛对阻塞性睡眠呼吸暂停综合征 (OSAS)病人术后睡眠结构的影响。方法 选择择期全麻手术的OSAS病人 4 5例随机分为三组 ,每组 15例。组Ⅰ为曲马多组 ,组Ⅱ为芬太尼组 ,组Ⅲ为空白对照组。麻醉清醒后行PCIA。以多导睡眠图 (PSG)记录当夜睡眠 ,对结果进行分析。并记录不同时刻的VAS评分。试验采用双盲操作。结果 在所记录的 4 80民min内 ,曲马多组的慢波睡眠时间及总睡眠时间分别为 (13 0 6± 7 5 6 )min和 (197 4± 84 4 8)min ;芬太尼组的慢波睡眠时间及总睡眠时间分别为 (9 2± 7 2 6 )min和 (14 8 33± 72 73)min ;对照组的慢波睡眠时间及总睡眠时间分别为 (6 33± 4 6 8)min和 (12 4 13± 6 1 38)min。曲马多组明显长于对照组。曲马多组镇痛 6小时及手术次日晨起的VAS评分分别为 5 4± 1 9,2 6± 1 2 ;芬太尼组分别为 3 6± 1 2 ,2 0± 1 9,对照组分别为 7 8± 2 0 ,5 1± 1 4。两试验组优于对照组。结论 曲马多与芬太尼均能提供有效镇痛。曲马多可能有延长术后当夜慢波睡眠及总睡眠时间的作用 ,使术后睡眠结构趋于合理。芬太尼无此作用。
Objective The purpose of this study was to determine and compare the effect of patient controlled analgesia(PCA) with tramadol and fentanyl on postoperative sleep pattern in patients with severe obstructive sleep apnea syndrome(OSAS) Methods Forty five ASA Ⅱ patients with severe OSAS undergoing uvula palate pharyngoplasty(UPPP) were randomly divided into 3 groups of 15 patients each according to the postoperative PCA the patients received: 1) tramadol group; 2) fentanyl group and 3) control group The patients were premedicated with intramuscular atropine 0 01mg·kg -1 .The patients were adequately sedated (Ramsay Ⅱ Ⅲ) with midazolam 0 03 mg·kg -1 and fentanyl 2μg·kg -1 Awake intubation was performed under topical anesthesia Anesthesia was then induced with propofol 1 5 2 0 mg·kg -1 and maintained with inhalation of 1 0% 1 5% isoflurane and 60% N 2O and intermittent intravenous boluses of vecuronium PCA was started when the patients were awake Tramadol 500mg (tramadol group) and fentanyl 500μg (fentanyl group) were diluted to 100ml(tramadol 5mg·ml -1 , fentanyl 5μg·ml -1 ) A loading does of 10ml was given followed by continuous intravenous infusion at a rate of 3ml·h -1 PCA bolus does was 1 5ml and lock out time 10 min Polysomnography(PSG) was continuously monitored and recorded the first night after operation from 10 pm to 6 am next morning According to Rechtschaffen standard sleep was divided into 6 stages: stage Ⅰ, stage Ⅱ, slow wave sleep(SWS)(stageⅢ+Ⅳ), stageV (rapid eye movement REM) and stage Ⅳ(awake) Results During the 480 min of PSP monitoring, SWS was (13 06±7 56) min in tramadol group, (9 2±7 26) min in fentanyl group and (6 33±4 68)min in control group and the total sleep time (TST) was (197 4±84 48) min in tramadol group, (148 33±72 73)min in fentanyl group and (124 13±61 38)min in control group SWS and TST were significantly longer in tramadol group than those in control group(P<0 05) VAS was significantly lower in the two experimental groups than that in control group(P<0 05).Conclusions Both tramadol and fentanyl can provide satisfactory analgesia for patients after UPPP Tramadol can prolong SWS and TST in the first night after operation but fentanyl cannot
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第10期611-613,共3页
Chinese Journal of Anesthesiology
