右美托咪定用于患者自控式睡眠调节对胃肠肿瘤患者术后睡眠障碍的疗效  

Efficacy of dexmedetomidine for patient-controlled sleep regulation in improving postoperative sleep disorders in patients with gastrointestinal tumors

作　　者：谷梓毓 刘雨 丁怡彤 吴周全 Gu Ziyu;Liu Yu;Ding Yitong;Wu Zhouquan(Graduate School of Dalian Medical University,Dalian 116044,China;Department of Anesthesiology,The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]大连医科大学研究生院,大连116000 [2]南京医科大学附属常州第二人民医院麻醉科,常州213000

出　　处：《中华麻醉学杂志》2024年第5期609-614,共6页Chinese Journal of Anesthesiology

基　　金：江苏省卫建委2020年高层次卫生人才"6个一工程"(LGY2020037);2022年度南京医科大学常州临床医学中心临床研究项目(CMCC202214)。

摘　　要：目的评价右美托咪定用于患者自控式睡眠调节对胃肠肿瘤患者术后睡眠障碍的疗效。方法选择2023年5月至2023年11月于南京医科大学附属常州第二人民医院行腹腔镜下胃肠道肿瘤切除术患者150例,ASA分级Ⅱ或Ⅲ级,性别不限,年龄40~80岁,术前匹兹堡睡眠质量指数(PSQI)评分≤7分,术后1 d PSQI评分>7分。采用随机数字表法将患者分为3组(n=50):生理盐水组(NS组)和右美托咪定不同给药方式组(DEX1组、DEX2组)。术后常规镇痛48 h之后,DEX1组和DEX2组在PCA镇痛泵中加入右美托咪定400μg、阿托品1 mg,稀释至100 ml,DEX1组背景输注剂量2.5 ml/h,DEX2组首次剂量6 ml,背景输注剂量0.5 ml/h,PCA剂量4 ml,锁定时间10 min。NS组在PCA镇痛泵中加入生理盐水,自控给药方法同DEX2组。于术后1、3、7 d和1个月时记录PSQI评分,术后1、3和7 d时记录VAS评分和多导睡眠图监测。于术前1 d行抑郁量表(PHQ)评分,术后7 d行15项恢复质量(QoR-15)评分。记录患者PACU停留时间、麻醉药物用量、48 h内镇痛泵按压总次数、镇痛药物用量及住院时间。结果与NS组相比,DEX1组和DEX2组术后3和7 d时N1期睡眠比率、觉醒指数降低,N2期睡眠比率、睡眠效率升高,术后3、7 d和1个月时PSQI评分、术后7 d时VAS评分降低,住院时间缩短,DEX2组QoR-15评分升高(P<0.05)。与DEX1组相比,DEX2组N3期睡眠比率升高,术后3和7 d时PSQI评分降低,QoR-15评分升高(P<0.05)。多因素logistic回归分析显示,右美托咪定患者自控式睡眠调节是术后睡眠障碍的保护因素(P<0.05)。结论对于胃肠道肿瘤术后睡眠障碍患者,术后连续3 d患者自控式给予右美托咪定可改善睡眠结构,提高主观睡眠质量,促进术后恢复。Objective To evaluate the efficacy of dexmedetomidine for patient-controlled sleep regulation in improving postoperative sleep disorders in patients with gastrointestinal tumors.Methods One hundred and fifty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients,regardless of gender,aged 40-80 yr,with a preoperative Pittsburgh Sleep Quality Index(PSQI)score of≤7 and a PSQI score of>7 on the 1st day after surgery,undergoing elective laparoscopic resection of gastrointestinal tumors from May 2023 to December 2023 in the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University,were divided into 3 groups(n=50 each)using a random number table method:normal saline group and dexmedetomidine via different routes of administration groups(DEX1 group,DEX2 group).After the routine use of 48 h postoperative analgesia,dexmedetomidine 400μg and atropine 1 mg in 100 ml of normal saline were added to the analgesic pump in DEX1 and DEX2 groups,DEX1 group received a background infusion at a rate of 2.5 ml/h,and after an initial dose of 6 ml,the patient-controlled analgesia(PCA)pump was programmed to deliver 4 ml with a lockout interval of 10 min and background infusion at 0.5 ml/h in DEX2 group.In NS group,normal saline was added to the PCA pump,and the methed of petient-controlled administration was the same as those previously described in DEX2 group.PSQI scores were recorded at days 1,3 and 7 and 1 month postoperatively,and visual analogue scale scores were recorded on postoperative days 1,3 and 7.Personal Health Questionnaire Depression Scale scores were assessed and the polysomnogram was monitored on the preoperative day 1,and 15-item Quality of Recovery(QoR-15)scale scores were assessed on postoperative day 7.The duration of PACU stay,consumption of anesthetic drugs,the total pressing times of PCA within 48 h,consumption of analgesic drugs and lenth of hospital stay were recorded.Results Compared with NS group,the sleep stage N1 ratio and arousal index were significantly

关 键 词：睡眠觉醒障碍 手术后并发症 胃肠肿瘤 右美托咪啶 患者自控式睡眠调节 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]