术前睡眠质量对老年患者术后谵妄发生的影响

Effect of preoperative sleep quality on the occurrence of postoperative delirium in elderly patients

目的探讨术前睡眠质量对老年患者术后谵妄(POD)发生的影响。方法选择择期全凭静脉麻醉下经腹行肿瘤根治术患者,年龄65~86岁,BMI 18~25kg/m2,ASAⅠ-Ⅲ级。术前根据匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)分为睡眠障碍组(≥5分,D组)和睡眠正常组(<5分,C组),每组50例,男71例,女29例。两组均采用丙泊酚、舒芬太尼和罗库溴铵进行麻醉诱导和维持,麻醉深度维持在BIS值40~60。记录术中丙泊酚、舒芬太尼、阿托品、麻黄碱、艾司洛尔、硝酸甘油等使用情况,记录麻醉时间、手术时间、PACU停留时间和术后住院时间,记录术后1~5d数字疼痛(NRS)评分和恢复质量评分量表-40(QoR-40)总分。采用意识模糊评定量表(CAM)于术前1d和术后1~5d进行谵妄评估。结果 D组术前PSQI评分明显高于C组(P<0.05)。两组患者术中丙泊酚、舒芬太尼用量和血管活性药使用例数差异无统计学意义,麻醉时间、手术时间和PACU停留时间差异无统计学意义。D组术后住院时间明显长于C组(P<0.05)。术后1、2和3d,D组NRS评分明显高于C组,QoR-40总分明显低于C组(P<0.05)。术后1~5d,两组总计21例(21.0%)发生POD,其中D组15例(30.0%)和C组6例(12.0%),D组POD发生率明显高于C组(P<0.05)。D组POD患者的谵妄持续时间明显长于C组(P<0.05)。术后2dD组POD发生率明显高于C组(P<0.05)。结论术前睡眠障碍可增加老年患者POD发生率并对术后早期恢复质量产生负面影响,应引起重视。

Objective To investigate the effect of preoperative sleep quality on the occurrence of postoperative delirium（POD）in elderly patients.Methods One hundred patients,aged 65-86 years,BMI 18-25 kg/m2,ASA physical statusⅠ-Ⅲ,undergoing elective open-abdominal tumor radical surgery with total intravenous anesthesia were assigned into two groups according to Pittsburgh sleep quality index（PSQI）before surgery：sleep disorder group（group D,score≥5）or normal sleep group（group C,score〈5）,50 cases in each,71 male,29 female.In the two groups,the induction and maintenance of anesthesia were performed with propofol,sufentanil and rocuronium,the depth of anesthesia was guided by BIS monitor ranging from 40 to 60.The dosages of propofol and sufentanil and the cases of vasoactive agents were measured during surgery.The duration of anesthesia,operation,PACU stay and postoperative length of hospital stay were calculated.In the first 5 days following surgery,the scores of numerical rating scale（NRS）and the global scores of quality of recovery-40（QoR-40）were recorded.The evaluation of delirium by confusion assessment method（CAM）was performed at 6 time points,the day before and the first 5 days after surgery.Results Before surgery,the score of PSQI was higher in group D than in group C（P〈0.05）.During surgical procedures,the dosages of anesthetics,the cases of vasoactive agents,the duration of anesthesia and operation,PACU stay in group D did not significantly differ from those of group C.The postoperative length of hospital stay was longer in group D than in group C（P〈0.05）.In the first 3 days after surgery,the score of NRS were higher in group D than in group C（P〈0.05）,and the global score of QoR-40 were lower in group D than group C（P〈0.05）.21 patients（21.0%）were present POD in the two groups,there were 15 individuals in group D（30.0%）and 6 individuals in group C（12.0%）,the incidence of POD was higher in group D than group C（P〈0.05）.The duration of POD was longer in group D than in group C（P〈0.05）.At 2 dafter surgery,the incidence of POD in group D was significantly increased compared with group C（P〈0.05）.Conclusion The preoperative sleep disorder increases the occurrence of POD and plays a negative effect on postoperative early quality of recovery in the elderly,to which attention should be paid.