睡眠质量对全膝关节置换术后早期康复的影响:一项前瞻、双盲、随机对照临床研究

The effect of sleep quality on early recovery after total knee arthroplasty: a prospective,double-blind,randomized controlled clinical study

目的探讨睡眠质量对全膝关节置换术(TKA)后早期康复的影响。方法选择安徽医科大学第一附属医院2017年3—9月符合纳入标准的行初次单侧TKA术的72例病人,对其进行前瞻性、随机化研究,按1∶2比例、随机数字表法分为试验组(24例)和对照组(48例),术后通过口服唑吡坦提高睡眠质量的24例为试验组,术后口服等剂量维生素B6(安慰剂)的48例为对照组,分别记录两组术后24 h及72 h静息状态时疼痛视觉模拟评分(visual analogue scale,VAS),术后3 d的总蛋白、白蛋白、血红蛋白值,术后住院天数,屈膝90°所需天数,术后3 d的SCL-90量表评分。结果两组病人术前基线资料如年龄、性别、体质量指数、术前膝关节HSS评分等均差异无统计学意义(P>0.05),具有可比性。试验组术后24 h静息状态VAS评分[(3.50±0.59)分比(4.06±0.70)分]及72 h静息状态VAS评分[(2.00±0.42)分比(2.42±0.54)分]、术后住院天数[(6.25±1.15)d比(7.15±1.83)d]、屈膝90°所需天数[(2.83±0.70)d比(3.52±1.01)d]、术后3 d焦虑得分[(11.79±1.32)分比(13.04±1.75)分]及抑郁得分[(13.96±0.96)分比(16.58±2.13)分]均明显低于对照组(P<0.05),试验组术后3 d的总蛋白[(63.28±4.51)g/L比(55.19±4.65)g/L]、白蛋白[(37.79±2.57)g/L比(33.66±2.94)g/L]及血红蛋白值[(107±13.98)g/L比(95.83±14.06)g/L]均明显高于对照组(P<0.05)。结论提高TKA术后睡眠质量,能加速病人康复。

Objective To investigate the effect of sleep quality on early recovery after total knee arthroplasty(TKA).Methods From March 2017 to September 2017 in The First Affiliated Hospital of Anhui Medical University,a total of 72 patients undergoing primary unilateral TKA who met the inclusion criteria were enrolled in the study.According to the 1∶2 ratio and random number table method,all included patients were randomly assigned into treatment group(TG,24 cases)taking oral administration of Zolpidem and control group(CG,48 cases)accepting oral administration of the same dose of vitamin B6(placebo)after surgery.The outcomes were observed,including the resting state visual analogue scale(VAS)pain score 24 h and 72 h postoperatively,total protein,albumin,and hemoglobin 3 d postoperatively,postoperative hospital stay,the number of days required for 90 degree of knee flexion and SCL-90 score 3 d postoperatively.Results General information such as age,gender,body mass index and preoperative knee joint HSS score between two groups had no significant difference(P>0.05).Compared to the CG group,the resting state VAS pain score postoperative 24 h[(3.50±0.59)vs.(4.06±0.70)]and 72 h[(2.00±0.42)vs.(2.42±0.54)],postoperative hospital stay[(6.25±1.15)d vs.(7.15±1.83)d],the number of days required for 90 degree of knee flexion[(2.83±0.70)d vs.(3.52±1.01)d],the anxiety[(11.79±1.32)vs.(13.04±1.75)]and depression[(13.96±0.96)vs.(16.58±2.13)]3 d after operation were significantly lower in the TG group(P<0.05).In TG group,the values of total protein[(63.28±4.51)g/L vs.(55.19±4.65)g/L],albumin[(37.79±2.57)g/L vs.(33.66±2.94)g/L]and hemoglobin[(107±13.98)g/L vs.(95.83±14.06)g/L]3 d after operation were significantly higher than those in CG group(P<0.05).Conclusion Improving the sleep quality after TKA can accelerate the recovery of the patients.