全麻联合硬膜外阻滞对老年衰弱患者胃肠肿瘤术后睡眠的影响  

Effect of general anesthesia combined with epidural block on postoperative sleep in frail elderly patients undergoing gastrointestinal tumor surgery

作　　者：汤颜鞠 高巨 翁丽波 穆子涵 葛亚丽 Tang Yanju;Gao Ju;Weng Libo;Mu Zihan;Ge Yali(The Yangzhou School of Clinical Medicine of Dalian Medical University,Dalian 116044,China;Department of Anesthesiaology,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University Clinical Medical College,Yangzhou University,Yangzhou 225000,China)

机构地区：[1]大连医科大学扬州临床医学院,大连116044 [2]扬州大学附属苏北人民医院麻醉科扬州大学临床医学院,扬州225000

出　　处：《中华麻醉学杂志》2022年第5期517-521,共5页Chinese Journal of Anesthesiology

基　　金：江苏省青年医学重点人才项目(QNRC2016337)。

摘　　要：目的评价全麻联合硬膜外阻滞对老年衰弱患者胃肠肿瘤术后睡眠的影响。方法择期行开腹胃肠肿瘤手术的衰弱患者(衰弱筛查量表评分>2分)90例,性别不限,年龄65~80岁,BMI 18~30 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=45):全麻组(GA组)和全麻联合硬膜外阻滞组(GE组)。GA组实施静吸复合全麻,GE组麻醉诱导前行硬膜外阻滞,全麻实施方式同GA组,术中根据BIS值及流汗流泪、心率、血压调整丙泊酚与瑞芬太尼用量。术后进行静脉镇痛,维持VAS评分≤3分。于术前1 d和术后1、3、7 d夜晚采用可穿戴设备监测睡眠参数。于术前1 d与术后1、3、7、30 d记录匹兹堡睡眠指数(PSQI)及术后15项恢复质量量表(QoR-15)评分,记录术中丙泊酚、舒芬太尼与瑞芬太尼用量;记录术后48 h内补救镇痛情况和镇痛泵按压总次数;采用免疫比浊法测定术前1 d与术后1 d血清C反应蛋白(CRP)浓度;记录术后7 d内不良反应发生情况。结果与GA组比较,GE组瑞芬太尼用量减少,术后1和3 d睡眠总分、深睡比例和快动眼睡眠比例、QoR-15评分升高,PSQI降低,术后恶心呕吐发生率降低(P<0.05),血清CRP浓度、补救镇痛率和镇痛泵按压总次数差异无统计学意义(P>0.05)。结论全麻联合硬膜外阻滞能改善老年衰弱患者胃肠肿瘤术后短期睡眠质量及术后恢复质量。Objective To evaluate the effect of general anesthesia combined with epidural block on postoperative sleep in the frail elderly patients undergoing gastrointestinal tumor surgery.Methods Ninety frail patients of either sex,aged 65-80 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiology physical statusⅡ-Ⅲ,scheduled for elective open gastrointestinal tumor surgery(FRAIL score>2),were divided into 2 groups(n=45 each)using a random number table method:general anesthesia group(GA group)and general anesthesia combined with epidural block group(GE group).Combined intravenous-inhalational anesthesia was carried out in group GA.Epidural block was performed before induction of anesthesia,and the method of general anesthesia was the same as that described in group GA,and the consumption of propofol and remifentanil was adjusted according to the BIS value,sweat and tears,heart rate and blood pressure during operation in group GE.Postoperative intravenous analgesia was performed to maintain VAS score≤3.Wearable devices were used to monitor sleep parameters at 1 day before surgery and 1,3 and 7 days after surgery.Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of Recovery-15 questionnaire at 1 day before surgery and 1,3,7 and 30 days after surgery.The intraoperative consumption of propofol,sufentanil and remifentanil were recorded.The requirement for postoperative rescue analgesia and total pressing times of patient-controlled analgesia(PCA)within 48 h after surgery were recorded.Serum C-reactive protein concentrations were determined by immunoturbidimetry at 1 day before surgery and 1 day after surgery,and the adverse reactions at 7 days after surgery were recorded.Results Compared with group GA,the consumption of remifentanil was significantly reduced,the total sleep score,deep sleep ratio,rapid eye movement ratio and Quality of Recovery-15 score were increased,the Pittsburgh Sleep Quality Index was decreased,and the incidence of postoperative nausea and vomiting w

关 键 词：麻醉 全身 麻醉 硬膜外 睡眠 手术后并发症 老年人 衰弱 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]