经鼻右美托咪定睡眠干预对老年结直肠癌患者术后康复的影响

Effect of Sleeping Intervention with Intranasal Dexmedetomidine on Quality of Postoperative Recovery in Elderly Patients with Colorectal Cancer

目的研究右美托咪定(Dex)鼻腔喷雾给药用于老年结直肠癌患者围术期睡眠干预,以促进其术后康复的安全性和有效性。方法选择拟择期行腹腔镜结直肠癌手术的老年患者64例,随机分为干预组32例和对照组32例,干预组患者入院后当晚至出院前每晚21:00~21:30给予鼻腔喷雾Dex 1.5μg/kg。对照组用同样的容量和速度经鼻喷雾生理盐水。两组整个围术期处理措施在恰当运用加速康复外科(ERAS)理念下执行。记录患者术后住院期间的睡眠质量评分、Dex不良反应的发生情况以及术后住院时间、住院费用和睡眠满意度。结果两组入院时匹兹堡睡眠质量指数(PSQI)评分分别为8.0(5.0~10.0)和7(5.5~9.5),差别无统计学意义(P>0.05),出院时两组PSQI各组分及总评分比较差别均有统计学意义(P<0.05);两组均未发生心动过速和呼吸抑制;两组高血压、低血压及心动过缓发生率比较差别无统计学意义(P>0.05);两组住院期间谵妄发生率、肛门排气时间、肛门排便时间、术后住院时间、住院总费用及睡眠满意度评分比较差别有统计学意义(P<0.05)。结论Dex鼻腔喷雾给药能够改善围术期老年结直肠癌患者的睡眠障碍,提高患者的睡眠满意度,减少应激,减少术后谵妄和不良反应,促进胃肠功能恢复,促进患者快速康复。

Objective To investigate efficacy and safety of Dexmedetomidin nasal spray for perioperative sleep intervention to improve the postoperative rehabilitation in elderly colorectal cancer patients.Method 64 elderly patients planning to undergo selective laparoscopic surgery for rectal cancer were randomized into intervention group(n=32)and control group(n=31).Nasal spray of Dexmedetomidin 1.5μg/kg was given to each patient in the intervention group during 21:00-21:30 pm per night from the day of admission until the day before discharge,while normal saline was given to patients in the control with the same method in the same speed.Peri-operative treatment for both groups was carried out while ERAS concept was applied properly.Post-operative data during hospital stay was recorded,including sleep quality score and the occurrence of delirium;the occurrence of untoward effects;postoperative gastrointestinal recovery such as anus exhausting time and anus defecation time;and postoperative hospital stay(day),hospitalization cost(Yuan)and sleep satisfaction.Results Pittsburgh Sleep Quality Index(PSQI)was 8.0(5.0~10.0)and 7(5.5~9.5)respectively for the two groups on admission day without significant difference(P>0.05).Significant intergroup difference was observed for components or total score of PSQI(P<0.05)on the day of discharge.No tachycardia or respiratory depression occurred in either group.There was no statistical significance between the intergroup difference concerning hypertension,hypotension or bradycardia(P>0.05).For incidence rate of delirium,anus exhausting time,anus defecation time,postoperative hospital stay,total expense and sleep satisfaction statistical,significance was noticed in the difference between the two groups(P<0.05).Conclusion Nasal spray of Dexmedetomidin seems capable of relieving dyssomnia in elderly perioperative rectal cancer patients,improving their sleep satisfaction degree;decreasing stress,postoperative delirium and untoward effects;enhancing the recovery of gastrointestinal functions,and facilitating their fast rehabilitation.