睡眠障碍对无痛胃肠镜检查患者丙泊酚用量及术后睡眠质量的影响  

Effects of sleep quality on propofol dosage and postoperative sleep quality in painless gastroenteroscopy patients

作　　者：毛畅远 肖悦 曹雅男 段文斌 胡益民 MAO Chang-yuan;XIAO Yue;CAO Ya-nan;DUAN Wen-bin;HU Yi-min(Graduate School,Bengbu Medical College,Bengbu 233030,Anhui,China;Department of Anesthesiology,The Affiliated Changzhou No.2 People′s Hospital with Nanjing Medical University,Changzhou 213003,Jiangsu,China)

机构地区：[1]蚌埠医学院研究生院,蚌埠233030 [2]南京医科大学附属常州市第二人民医院麻醉科,常州213003

出　　处：《东南国防医药》2022年第5期470-475,共6页Military Medical Journal of Southeast China

基　　金：江苏常州市应用基础研究计划项目(CJ20210112)。

摘　　要：目的探讨睡眠障碍对无痛胃肠镜检查患者丙泊酚用量及术后睡眠质量的影响。方法选择2021年10月-2022年4月于常州市第二人民医院无痛中心接受无痛胃肠镜检查的80例患者。根据匹兹堡睡眠质量指数(PSQI)和Epworth嗜睡量表(ESS),评估患者术前睡眠质量水平和白日嗜睡严重程度。按照PSQI诊断术前有无睡眠障碍进行分组,其中,PSQI>7分为睡眠障碍组(n=40),PSQI≤7分为睡眠正常组(n=40);2组患者诱导前静脉缓慢推注舒芬太尼0.05~0.1μg/kg。再缓慢静脉推注丙泊酚,推注速度10 mg/s,待患者意识消失、呼唤无应答、睫毛反射消失、警觉/镇静评分(OAA/S)≤2级,停止静注丙泊酚,进行胃肠镜操作。观察并记录2组患者操作过程中丙泊酚用量、术前及术后24 h和7d等不同时间点PSQI评分、术中呼吸抑制、体动反应等不良反应发生情况及诱导时间、苏醒时间、胃肠镜操作时间、检查结束至进入恢复室的时间。使用Pearson法分析PSQI和ESS评分及丙泊酚用量和苏醒时间之间的相关性。结果主要指标:与睡眠正常组患者比较,睡眠障碍组患者丙泊酚首次量、总用量和单位体表单位时间用量较睡眠正常组明显增多(P<0.05),患者术后24 h和7 d的PSQI评分较术前减小(P<0.05);次要指标:睡眠障碍组患者苏醒时间较睡眠正常组明显延长(P<0.05)。Pearson法分析显示患者PSQI评分和ESS评分与丙泊酚用量和苏醒时间相关。2组术中呼吸抑制、体动反应、腹痛和恶心呕吐等发生情况和检查结束至进入恢复室的时间比较差异无统计学意义(P>0.05)。结论患者术前睡眠障碍会使无痛胃肠镜检查中静脉麻醉药丙泊酚的用量增加,且会出现苏醒延迟现象,患者的白日嗜睡程度与丙泊酚用量的增加有关,静脉麻醉药的应用使患者睡眠障碍情况在短期内得到改善。Objective To investigate the effect of sleep quality on the dosage of propofol and postoperative sleep quality in patients undergoing painless gastroenteroscopy.Methods Eighty patients with painless gastroenteroscopy in the Painless Center of our hospital from October 2021 to April 2022 were selected.Preoperative sleep quality and daytime sleepiness severity were assessed according to Pittsburgh Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS).Groups were divided according to whether there was sleep disorder before PSQI diagnosis.PSQI>7 was divided into sleep disorder group(n=40),PSQI≤7 was divided into normal sleep group(n=40).Sufentanil was slowly injected into the vein before induction in both groups 0.05-0.1 g/kg.Propofol was then slowly injected intravenously at a rate of 10 mg/s.After the patient′s consciousness disappeared,no response to call,eyelash reflex disappeared,and alarm/sedation score(OAA/S)≤2,the intravenous injection of propofol was stopped and gastroenteroscopy was performed.Two groups of patients with dosage of propofol in the process of operation,preoperative and postoperative 24 hours and 7 d PSQI score and so on different time points and adverse reactions such as respiratory depression,body dynamic response′s start time and the induction time,operation time,stomach and awakening time,check the end time to enter the recovery room were observed and recorded.Pearson method was used to analyze the correlation between PSQI and ESS scores,propofol dosage and awakening time.Results Main indicators:Compared with the normal sleep group,the initial dosage,total dosage and dosage per unit body surface per unit time of propofol in the sleep disorder group were significantly increased(P<0.05).The PSQI scores of patients at 24 h and 7 days after surgery were decreased compared with those before surgery(P<0.05).Secondary indicators:Compared with the normal sleep group,the waking time of the sleep disorder group was significantly longer than that of the normal sleep group(P<0.05).There we

关 键 词：睡眠障碍 白日嗜睡 无痛胃肠镜检查 丙泊酚用量 临床疗效 

分 类 号：R614[医药卫生—麻醉学]