Knill R L, Moote C A, Skinner M I, Rose E A
Department of Anesthesia, University Hospital, London, Ontario, Canada.
Anesthesiology. 1990 Jul;73(1):52-61. doi: 10.1097/00000542-199007000-00009.
Characteristics of nocturnal sleep were investigated in six patients after anesthesia and cholecystectomy and in another six after anesthesia and gastroplasty. All night polysomnographic recordings were obtained while each patient slept in a private surgical ward room through two nights before and five or six nights after operation. Anesthesia included thiopental, N2O, isoflurane, and fentanyl. Postoperative analgesia was provided with parenteral morphine. Other aspects of care were routine. Nocturnal sleep was markedly disturbed after both surgical procedures. Throughout the operative night and subsequent one or two nights, sleep was highly fragmented with the usual recurring cycles of sleep stages completely disrupted. Slow wave sleep was suppressed and rapid eye movement (REM) sleep virtually eliminated. During the following 2-4 nights, as other aspects of sleep recovered, REM sleep reappeared and then increased to greater than the preoperative amount. This increased REM sleep was marked by a heavy density of eye movement activity along with frequent patient reports of unusually distressing dreams or vivid nightmares. It is concluded that anesthesia with upper abdominal surgery leads to a severe disruption of nocturnal sleep followed by the release of highly intense REM sleep about the middle of the first postoperative week.
对6例麻醉及胆囊切除术后患者和另外6例麻醉及胃成形术后患者的夜间睡眠特征进行了研究。在每位患者于外科病房单人房间睡眠期间，于术前两晚及术后五或六晚进行了整夜多导睡眠图记录。麻醉用药包括硫喷妥钠、N2O、异氟烷和芬太尼。术后镇痛采用胃肠外吗啡。护理的其他方面均为常规操作。两种手术操作后夜间睡眠均受到明显干扰。在整个手术当晚及随后的一两个晚上，睡眠高度碎片化，正常的睡眠阶段反复循环被完全打乱。慢波睡眠受到抑制，快速眼动（REM）睡眠几乎消失。在接下来的2 - 4个晚上，随着睡眠的其他方面恢复，REM睡眠重新出现，然后增加到超过术前水平。这种增加的REM睡眠的特点是眼球运动活动密度很高，同时患者频繁报告有异常痛苦的梦境或生动的噩梦。结论是，上腹部手术麻醉导致夜间睡眠严重紊乱，随后在术后第一周中期左右出现高强度REM睡眠的释放。
