超声引导下星状神经节阻滞对幕上肿瘤切除术患者术后睡眠障碍的影响

Effect of ultrasound-guided stellate ganglion block on postoperative sleep disorders in patients with supratentorial tumor resection

目的探讨术前在超声引导下行星状神经节阻滞(stellate ganglion block,SGB)对幕上肿瘤切除术患者术后睡眠障碍(postoperative sleep disturbance,POSD)的影响。方法择期行幕上肿瘤切除术的患者60例,采用随机数字表法分为SGB组(S组)和对照组(C组),每组30例。两组麻醉诱导及麻醉维持药物相同,S组麻醉诱导前行超声引导下右侧SGB,C组不进行SGB。术前1 d采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表评估患者近1个月的睡眠情况,术后第2天采用阿森斯睡眠评估量表(Athens Insomnia Scale,AIS)对患者术后首夜睡眠进行评分;采用智能手环监测患者术后首夜深睡眠时长、睡眠总时长。记录麻醉诱导前(T0)、插管即刻(T1)、切皮时(T2)、术毕(T3)、拔管时(T4)的MAP、心率。记录患者术后24 h恶心呕吐发生率、VAS评分及术后住院时间。结果T0时两组患者MAP、心率差异无统计学意义(P>0.05);S组T1、T2、T4时MAP低于C组(P<0.05)。与T0比较,C组T1~T4时MAP升高(P<0.05),T1、T2时心率升高(P<0.05);S组T1~T4时MAP、心率差异无统计学意义(P>0.05)。与C组比较,S组患者易醒、总睡眠时间、总睡眠质量、白天身体功能影响率降低(P<0.05),术后首夜无睡眠障碍发生率、术后首夜深睡眠时长、总睡眠时长、深睡眠时长/总睡眠时长增加(P<0.05),术后无补救镇痛发生率增加(P<0.05),术后VAS评分降低(P<0.05)。两组患者不良反应发生率、术后住院天数、术后首夜浅睡眠时长差异无统计学意义(P>0.05)。结论幕上肿瘤切除术患者术前行SGB可延长术后首夜睡眠时间,提高睡眠质量。

Objective This study aims to investigate the effect of preoperative ultrasound-guided stellate ganglion block(SGB)on postoperative sleep disturbance(POSD)in patients undergoing supratentorial tumor resection.Methods Sixty patients who were scheduled to undergo supratentorial tumor resection were divided into stellate ganglion block group(group S,n=30)and control group(group C,n=30),according to random number table method.Both groups were given the same anesthetic drugs.Group S received ultrasound-guided right SGB before anesthesia induction,while group C could not receive SGB.The Pittsburgh Sleep Quality Index(PSQI)was used one day before the operation to evaluate the sleep quality of the patients in the last month while the Athens Insomnia Scale(AIS)was used to score the sleep quality of the patients on the first night after the operation and on the second day after the operation.The smart bracelet was used to monitor the patient's first night deep sleep duration and total sleep duration.The mean arterial pressure(MAP)and heart rate were recorded before anesthesia induction(T0),immediately after intubation(T1),at skin incision(T2),at the end of operation(T3)and at extubation(T4).The incidence of nausea and vomiting 24 h after operation,VAS score and postoperative hospital stay were recorded.Results There was no significant difference in MAP and heart rate between the two groups at T0(P>0.05).The MAP at T1,T2 and T4 in group S was lower than that in group C(P<0.05).Compared with T0,MAP in group C increased at T1-T4,and heart rate increased at T1 and T2(P<0.05).There was no significant difference in MAP and heart rate at T1-T4 in group S(P>0.05).Compared with group C,the patients in group S were easy to wake up,total sleep time,total sleep quality and daytime physical function influence rate decreased(P<0.05).The incidence of no sleep disturbance on the first night after operation in group S was lower than that in group C,while the incidence of no sleep disorder on the first night after operation,the length of deep sleep,the total sleep time and the ratio of deep sleep time to total sleep time in the first night after operation increased(P<0.05).In group S,the incidence of postoperative non-remedial analgesia increased and the postoperative VAS score decreased(P<0.05).There was no significant difference in the incidence of adverse reactions,postoperative hospital stay and postoperative light sleep between the two groups(P>0.05).Conclusions Preoperative planetary ganglion block can prolong the sleep time of the first night after operation.At the same time,the patients can have better sleep quality.