膝关节镜术后患者睡眠质量的现状及其影响因素分析

Current status and influencing factors of sleep quality in patients after knee arthroscopy

目的探讨膝关节镜术后患者睡眠障碍的相关因素。方法分析2017年10月1日-2018年4月1日期间于四川大学华西医院接受膝关节镜手术的155例患者的临床资料,采用匹茨堡睡眠质量指数量表进行评估,并根据评分划分为睡眠障碍组和无睡眠障碍组;正念水平则采用正念注意觉知量表(Mindful Attention Awareness Scale,MAAS)进行评估。运用二分类logistic回归分析评估MAAS与睡眠障碍的关系。结果纳入病例中,男135例,女20例,平均年龄为(34.12±12.13)岁,发生睡眠障碍者64例。单因素分析表明,付费方式、单双侧病变、MAAS评分是影响睡眠的相关因素(P<0.05)。多因素分析表明,有医疗保险[比值比(odds ratio,OR)=0.118,95%置信区间(confidence interval,CI)(0.021,0.671),P=0.016]、术后疼痛[OR=3.379,95%CI(1.164,9.812),P=0.025]、双侧病变[OR=3.842,95%CI(1.040,14.191),P=0.044]、MAAS评分≥68分[OR=0.046,95%CI(0.018,0.121),P<0.001]是睡眠障碍的独立预测因素。结论术后减少患者疼痛、给予正念训练可能改善患者睡眠质量,减少睡眠障碍发生。

Objective To investigate the relative factors of sleep disorders in patients after arthroscopic knee surgery. Methods The clinical data of 155 patients undergoing arthroscopic knee surgery in West China Hospital of Sichuan University from October 1 st 2017 to April 1 st 2018 were analyzed. The sleep quality index was assessed by the Pittsburgh Sleep Quality Index. According to the scores, the patients were divided into two groups: the sleep disorder group and the non-sleep disorder group. Mindfulness level were evaluated by Mindful Attention Awareness Scale(MAAS). The binary logistic regression was used to assess the relationship between MAAS and sleep disorders. Results Among the enrolled cases, there were 135 males and 20 females, with an average age of(34.12±12.13) years;64 patients had poor sleep quality. The results of univariate analysis showed that the payment method, single or bilateral lesions, and MAAS score were the factors affecting sleep(P<0.05). The results of multivariate analysis indicated that with medical insurance [odds ratio(OR)=0.118, 95% confidence interval(CI)(0.021, 0.671), P=0.016], postoperative pain [OR=3.379,95%CI(1.164, 9.812), P=0.025], bilateral lesions [OR=3.842, 95%CI(1.040, 14.191), P=0.044], and MAAS score ≥68[OR=0.046, 95%CI(0.018, 0.121), P<0.001] were independent predictive factors for sleep disorders(P<0.05). Conclusion Postoperative pain reduction and mindfulness training may improve the patients’ sleep quality and reduce the incidence of sleep disorders.