术前睡眠质量对全膝关节表面置换患者术后早期康复及生活质量的影响

Effect of Preoperative Sleep Quality on Early Recovery and Quality of Life after Total Knee Arthroplasty

目的探讨术前睡眠质量对全膝关节表面置换术后早期康复和生活质量的影响。方法采用便利抽样法,选取南京某三级甲等医院诊断为膝骨关节炎患者,拟行单侧全膝关节表面置换术的196例患者,术前采用匹兹堡睡眠质量指数量表进行睡眠质量调查,得分<7分(n=79)纳入高睡眠质量组,得分≥7分(n=117)纳入低睡眠质量组。2组均评估术后第1、第2、第3 d视觉模拟疼痛评分、术后首次下床活动时间、术后1个月西安大略省和麦克马斯特大学骨关节炎指数评分和生活质量评分。结果重复测量方差分析结果显示,2组全膝关节置换患者术后第1~第3天视觉模似疼痛评分评分比较,差异具有有统计学意义(P<0.05)。高睡眠质量组术后首次下床活动时间、术后1个月西安大略省和麦克马斯特大学骨关节炎指数总分和功能评分低于低睡眠质量组(P<0.05);术后1个月高睡眠质量组生活质量评分高于低睡眠质量组(P<0.05)。结论膝骨关节炎患者术前良好的睡眠质量能缓解全膝关节置换患者术后早期疼痛,可促进患者早期下床活动,有利于改善早期生活质量。建议骨科医护人员重视全膝关节置换患者术前睡眠质量质量对术后情况的影响,重点关注术前睡眠质量差的患者,根据患者特点采取针对性的护理措施,改善其睡眠质量,优化术前状态。

Objective To investigate the effect of preoperative sleep quality on early rehabilitation and quality of life after total knee arthroplasty.Methods With convenience sampling method,196 patients with knee osteoarthritis who planned unilateral total knee arthroplasty from one tertiary grade A hospital were investiagted by using Pittsburgh Sleep Quality Index Scale.Then patients were divided into group A(high quality of sleep group,PSQI<7,n=79)and group B(PSQI≥7,n=117,low quality of sleep group).Prospective cohort study was used.VAS score 1,2 and 3 days after the surgery,time of first postoperative activity out of bed,Western Ontario and McMaster Universities Index(WOMAC)and MOS12-item Short Form Health Survey(SF-12)were evaluated in both groups.Results Repeated measures analysis of variance revealed that VAS scores 3 days after the surgery showed statistically significant difference between the two groups(P<0.05).The first time of getting out of bed activity,WOMAC total score and function score of group A were lower than those of group B(P<0.05).SF-12 score of group A was higher than that of group B one month after the operation(P<0.05).Conclusion Good sleep quality before the operation can accelerate postoperative rehabilitation process and improve the quality of life in early postoperative period.It is suggested that orthopedic medical staff should pay attention to the influence of preoperative sleep quality of patients with total knee replacement,particularly to the patients with poor preoperative sleep quality.Targeted nursing measures according to the characteristics of patients is conducive to the improvement of their sleep quality,thus to optimize their preoperative status.