右美托咪定对老年妇科手术患者术后睡眠和恢复质量的影响  

Effects of Dexmedetomidine on Postoperative Sleep and Quality of Recovery

作　　者：何江 张欣宁 李翠翠[1] 黄义洲 李恒[1] He Jiang;Zhang Xinning;Li Cuicui(Department of Anesthesiology,Department of Gynecology,the Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People′s Hospital,Qingyuan,Guangdong 511518,China)

机构地区：[1]广州医科大学附属第六医院·清远市人民医院麻醉科,妇科,广东清远511518

出　　处：《四川医学》2023年第11期1121-1126,共6页Sichuan Medical Journal

基　　金：广东省医学科学技术研究基金项目(编号:B2021282)。

摘　　要：目的评价右美托咪定对老年妇科手术患者术后睡眠和恢复质量的影响。方法选择2021年7月至2023年5月在我院择期行妇科腹腔镜手术的患者77例,随机分为右美托咪定组(试验组39例)和生理盐水组(对照组38例)。试验组患者术前1 d至术后5 d晚上给予右美托咪定1.5μg/kg滴鼻;对照组给予生理盐水滴鼻,容量与使用方法与试验组一致。记录患者入院时(Adm)、术前1 d(Pre)、术后1 d(POD1)、术后3 d(POD3)、术后5 d(POD5)的理查兹-坎贝尔睡眠量表(RCSQ)评分、VAS评分、40项恢复质量(QoR-40)评分,以及术后30 d(POD30)的匹兹堡睡眠质量指数(PSQI)评分;同时记录患者的肠道排气时间、独立下床活动时间、镇痛药物用量、恶心呕吐发生率和出院时间等早期康复的客观指标。结果两组患者手术前后睡眠均有所恶化,试验组RCSQ评分在Pre、POD1、POD3及POD5显著高于对照组,且随时间延长而逐渐升高,在POD5基本恢复至入院时水平,对照组在POD30睡眠未能恢复至术前水平,睡眠障碍患者比例升高(P<0.05);与Pre比较,两组POD1时QoR-40及各维度评分均下降,对照组POD3时身体舒适度、情绪状态、疼痛评分及总分下降(P<0.05);与对照组比较,试验组QoR-40总分、情绪状态、身体舒适度、疼痛感受评分在不同时点均有所增加(P<0.05);与对照组相比,试验组肠道恢复排气时间、独立下床活动时间和出院时间缩短,VAS评分更低,应用镇痛药物人次减少,患者满意度提高,差异有统计学意义(P<0.05)。结论围术期短期应用右美托咪定能改善妇科腹腔镜手术患者的术后睡眠质量和早期恢复质量,缩短住院时间,提高患者围术期体验和满意度。Objective To evaluate the effect of dexmedetomidine on postoperative sleep and recovery quality in elderly patients undergoing gynecological surgery.Methods From July 2021 to May 2023,77 patients,scheduled for elective gynecological laparoscopic surgery in our hospital were randomly divided into dexmedetomidine group(experimental group,n=39)and normal saline group(control group,n=38).Patients in experimental group were received intranasal dexmedetomidine 1.5μg/kg from 1 day before surgery to 5 days after surgery.Control group was given normal saline nasal drops,and the volume and method of use were the same as those of the experimental group.The Richards Campbell Sleep Questionnaire(RCSQ),VAS score,40-items quality of recovery score(QoR-40)were recorded on admission(Adm),preoperative 1 day(Pre),first postoperative day(POD1),3 postoperative days(POD3),and 5 postoperative days(POD5),and the Pittsburgh sleep quality index(PSQI)score at 30 postoperative days(POD30).At the same time,the objective indicators of early rehabilitation such as intestinal exhaust time,independent ambulation time,analgesic drug consumption,incidence of nausea and vomiting,and discharge time were recorded.Results The perioperative sleep quality in two groups were deteriorated.The RCSQ score of the experimental group was significantly higher than that of control group at Pre,POD1,POD3 and POD5,and gradually increased with time.The RCSQ score in experimental group basically recovered to POD5,while sleep score in control group did not recover to preoperative level at POD30 and the proportion of patients with sleep disorders increased(P<0.05).Compared with Pre,QoR-40 score and each dimension score at POD1 were decreased,while the physical comfort,emotional state,pain score and total score of control group at POD3 were decreased(P<0.05).Compared with control group,QoR-40 score,emotional state,physical comfort and pain score in experimental group were increased at different time(P<0.05).Compared with control group,intestinal recovery time,independ

关 键 词：右美托咪定 妇科腹腔镜手术 睡眠质量 术后恢复质量 

分 类 号：R614[医药卫生—麻醉学]