关节置换患者围手术期睡眠质量及影响因素研究

Investigation of perioperative sleep quality and its influencing factors in patients undergoing total joint arthroplasty

背景:加速康复外科在我国关节外科领域得到了广泛重视与推广,睡眠管理是其中的一个重要方面,但相关文献仍然较少。目的:探讨加速康复管理模式下的全关节置换(TJA)患者围手术期睡眠质量及其影响因素,以期为临床干预工作提供科学依据。方法:采用一般情况调查表、匹兹堡睡眠质量指数量表(PSQI)、Epworth嗜睡量表(ESS)、视觉模拟评分(VAS)及自行设计睡眠影响因素调查表对48例TJA患者术前2周、术前1 d、手术当天、术后第2天和术后1、2、4周的睡眠状况进行调查。结果:TJA术前睡眠障碍的发生率为41.7%,手术当天达81.3%,术后第2天开始下降,但术后2周又接近高峰,随后快速下降。术后2周内各时间点PSQI得分比术前2周增加,差异均有统计学意义(P<0.05),术后4周PSQI得分显著减少。手术当天的ESS得分与术前2周相似,术后第2天开始上升,术后1、2周时ESS得分比术前2周显著增加,且ESS与PSQI得分之间存在正相关;但术后4周的ESS得分比术前2周显著减少。术后各时间点VAS得分比术前2周显著减少,且术后1、2周VAS与PSQI得分之间存在正相关性。量表子项目分析表明,围手术期睡眠障碍(PSD)主要由于主观睡眠质量、睡眠时间和睡眠效率的显著降低及入睡时间增加导致。睡眠良好组比睡眠障碍组术后更易发生严重的PSD,且变化幅度更大。PSD的发生与性别无关,但与年龄有关,高龄患者更易发生。影响术后患者睡眠质量的主要因素是关节痛。结论:TJA术后睡眠质量显著低于入院前,持续2周左右,此后快速改善,4周时已优于术前2周,加速康复管理模式可能是PSD快速改善的原因。

Background: Enhanced recovery after surgery has been widely acknowledged and promoted in the field of joint surgery in China, and sleep management is one of those essential issues with paucity of published articles. Objective: To investigate perioperative sleep quality of total joint arthroplasty(TJA) patients managed with enhanced recovery protocol and explore its influencing factors to provide scientific base for clinical intervention in the future. Methods: A general survey, Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), visual analogue scale(VAS) score and self-designed sleep influencing factors questionnaire were employed to measure sleep quality in 48 TJA patients at preoperative 2 weeks, 1 day before surgery, the day of surgery, 2 days after surgery, and postoperative 1, 2, 4 weeks. Results: The incidence of preoperative sleep disorder was 41.7%, which peaked 81.3% on the day of operation, then began to decline 2 days after surgery, but re-peaked 2 weeks after operation, and then decreased rapidly. The PSQI score significantly increased at various time points within 2 weeks after operation compared with that 2 weeks before operation(P<0.05),and decreased rapidly 4 weeks after operation.ESS score at the day of operation was similar with that 2 weeks before operation, increased gradually from two days after operation, was higher significantly one and two weeks after operation compared with that 2 weeks before operation, and there was positive correlation between ESS and PSQI scores. ESS score at 4 weeks after operation significantly decreased compared with that 2 weeks before operation. VAS scores significantly decreased after operation compared with 2 weeks before operation and there was also positive correlation between VAS and PSQI score at 1 and 2 weeks after operation. perioperative sleep disturbance(PSD) was attributed mainly to significant decreased subjective sleep quality, sleep duration and sleep efficiency and increased sleep latency. Good sleeper group was more likely to suffer from severe sleep disturbance after surgery than poor sleeper group with bigger increase of PSQI score. There was no significant difference in PSQI score between genders, but more advanced patients were much easier to suffer from PSD than younger ones. The main factor affecting sleep quality after operation was joint pain. Conclusions: Sleep quality of TJA patients is significantly lower than that before admission, which lasted for about 2 weeks, then improved quickly, and gets better than 2 weeks before operation at 4 weeks after operation. Interventions of rapid recovery protocol might well be the reason of quick improvement of PSD.