癌症疼痛规范化治疗与睡眠-觉醒节律的相关性研究

Correlation between good pain management and sleep-wake rhythm

摘要:

目的：观察癌痛规范化治疗（good pain management，G.P.M）的临床疗效与治疗前后患者睡眠-觉醒节律变化。方法：收集2012年6月至2014年5月期间，在郑州市第九人民医院、河南省人民医院就诊的癌症疼痛病人264例，随机分组，分别接受癌痛规范化治疗和对症治疗；在接受癌痛规范化治疗或对症治疗前及治疗1周后，分别采用数字分级法（numeric rating scale，NRS）对其疼痛程度进行评分，并进行统计学分析。查找随机数列表，从2组中各随机抽取30人，治疗前后进行24 h睡眠监测，并根据脑电图（electroencephalogram，EEG）、肌电图（electromyogram，EMG）及眼动图（electronystagmogram，EOG）进行睡眠-觉醒节律分析，分析患者睡眠总时间、浅睡眠时间、深睡眠时间和快动眼睡眠时间（rapid eye move sleep，REM），进行统计学分析。结果：癌痛规范化治疗可明显缓解患者疼痛，降低NRS评分，延长睡眠总时间和快动眼睡眠时间；增加总睡眠时间中浅睡眠及快动眼睡眠比重，对症治疗对睡眠影响意义不大。结论：癌痛规范化治疗可有效缓解癌痛，延长睡眠时间，改善睡眠-觉醒节律，提高睡眠质量。

Abstract:

Objective：To observe the clinical curative effect of good patient management（GPM） and the changes of patients’ sleep-wake rhythm before and after treatment. Methods：The data of 264 patients who accepted treatment during June 2012 to May 2014 in the Ninth People’s Hospital of Zhengzhou city and Henan Province People’s Hospital were collected. They were divided into 2 groups randomly，one group accepted GPM while the other received symptomatic treatment. Degree of pain was scored by numeric rating scale（NRS） respectively before and at one week after GPM or symptomatic treatment. The results were analyzed with statistics. The results of 24-hour sleep monitoring of 30 randomly selected cases were recorded before and after treatment respectively. Then the sleep-wake rhythm based on electroencephalogram，electromyogram and electronystagmogram was analyzed. The total sleep time，the time of light sleep，deep sleep and rapid eye move（REM） sleep were recorded and analyzed statistically. Results：GPM can signifi－cantly relieve pain，reduce the NRS score，prolong total sleep time and REM sleep time，raise the proportion of light sleep and REM sleep in total sleep time，but symptomatic treatment can’t. Conclusion：GPM could relieve cancer pain，prolong sleep time，improve sleep-wake rhythm and sleep quality.