右美托咪定辅助镇静对椎管内麻醉患者术后主观睡眠质量的影响  

Effect of Dexmedetomidine-assisted Sedation on the of Subjective Sleep Quality in Patients undergoing Spinal Anesthesia

作　　者：钟培冰 俞建钧 林颖仡 肖微 缪秀英[2] 曾凯[2] 陈花[3] ZHONG Peibing;YU Jianjun;LIN Yingyi;XIAO Wei;MIU Xiuying;ZENG Kai;CHEN Hua(Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China;Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350003, China)

机构地区：[1]福建医科大学附属龙岩第一医院麻醉科,龙岩364000 [2]福建医科大学附属第一医院麻醉科,福州350005 [3]福建中医药大学附属第二人民医院,福州350003

出　　处：《福建医科大学学报》2021年第5期432-437,共6页Journal of Fujian Medical University

基　　金：福建省康复技术重点实验室开放课题(KF2019011)。

摘　　要：目的评价右美托咪定辅助镇静对行椎管内麻醉患者术后睡眠质量的影响。方法选取择期行椎管内麻醉下大隐静脉高位结扎和剥脱术的患者51例,使用随机数字表法分成右美托咪定组(n_(1)=25)和对照组(n_(2)=26)。待麻醉平稳后,右美托咪定组开始予右美托咪定6μg/(kg·h)速率静脉泵注10 min,给予负荷剂量后,以0.6μg/(kg·h)的速率持续泵注至手术结束;对照组泵注等量的0.9%氯化钠溶液。记录患者术前匹兹堡睡眠质量指数(PSQI)量表评分及术前1天(D_(0))、术后第1天(D_(1))和术后第2天(D_(2))St.Mary's医院睡眠问卷(SMH)量表评分等主观睡眠质量参数,同时使用wGT3X-BT体动记录仪记录患者D_(1)、D_(2)的睡眠效率、入睡潜伏期、总睡眠时间、觉醒时间、觉醒次数等客观睡眠质量参数,D_(1)、D_(2)视觉模拟量表(VAS)疼痛评分,术前血清褪黑素、5-羟色胺、皮质醇水平和术后住院天数等。结果与对照组比较,右美托咪定组在D_(1)的SMH量表评分总分、SMH量表入睡障碍评分低于对照组(P<0.05),且在D_(2)SMH量表入睡障碍评分仍低于对照组(P<0.05);两组患者的客观睡眠质量参数比较,差别无统计学意义(P>0.05)。结论行椎管内麻醉下大隐静脉高位结扎和剥脱术的非老年患者,术中使用右美托咪定辅助镇静会加剧其术后主观睡眠质量的下降程度,但尚无证据表明对术后客观睡眠质量产生影响。Objective To evaluate the effect of dexmedetomidine-assisted sedation on postoperative sleep quality in patients undergoing spinal anesthesia.Methods There were 51 patients undergoing high ligation and stripping of the great saphenous vein under spinal anesthesia,using random number table method to divide patients into dexmedetomidine group(n_(1)=25)and control group(n_(2)=26).After the anesthesia was stable,dexmedetomidine group started intravenous pumping of dexmedetomidine 6μg/(kg·h)for 10 min as a loading dose and then continued pumping at a rate of 0.6μg/(kg·h)until the operation ended.Control group was injected intravenously with an equal amount of 0.9%sodium chloride solution.We then recorded the patient's preoperative Pittsburgh Sleep Quality Index(PSQI)scores,the St.Mary's Hospital Sleep Questionnaire(St.Mary's Hospital Sleep Questionnaire,SMH)scale scores of 1 day before surgery,1st day after surgery and 2nd day after surgery,and visual analogue scale(VAS)pain scores on the first and second days after surgery.At 1 day before operation,1st day after operation and 2nd day after operation,we also recorded the patient's objective sleep parameters such as sleep efficiency,latency to fall asleep,total sleep time,awakening time,number of awakenings recorded by wGT3X-BT actigraphy(Actigraphy),as well as preoperative serum melatonin,cortisol,serotonin levels and postoperative hospital stays.Results Compared with the control group,the total score of the SMH scale and the sleep-onset disorder score of the SMH scale in the dexmedetomidine group on the first postoperative day were lower than those of the control group(P<0.05),and on the second day after surgery,the sleep-onset disorder score of dexmedetomidine group was still lower than that of control group(P<0.05).There was no significant difference between the two groups in terms of the objective sleep quality parameters recorded by the actigraph.Conclusion For non-elderly patients undergoing high ligation and stripping of the great saphenous vein under intra

关 键 词：右美托咪定 椎管内麻醉 镇静 睡眠 

分 类 号：R47[医药卫生—护理学]