舒芬太尼联合右美托咪定在局麻下椎间孔镜手术治疗中对中老年患者睡眠质量的影响

Effects of Sufentanil Combined with Dexmedetomidine on the Sleep Quality of Middle-aged and Elderly Patients during Intervertebral Foraminal Surgery under Local Anesthesia

目的:探讨舒芬太尼联合右美托咪定在局麻下椎间孔镜手术治疗中对中老年患者睡眠质量的影响。方法:选择2018年12月至2019年10月在本院诊治的老年腰椎间盘突出症患者178例,根据随机数字表法将其分为舒芬太尼右美托咪定联合组与生理盐水对照组,每组各89例。所有患者都给予椎间孔镜手术治疗与0.5%利多卡因-0.25%罗哌卡因局麻,联合组在此基础上给予舒芬太尼右美托咪定诱导睡眠,调查和比较患者术中及术后睡眠质量。结果:两组的术口大小、术中出血量与术后住院时间对比差异无统计学意义(P>0.05),联合组的手术时间显著短于对照组(P<0.05),术后14 d感染、恶心呕吐等并发症的发生率(1.12%)显著低于对照组(8.87%,P<0.05),术后1 d、7 d与14 d的疼痛视觉模拟评分法(Visual analogue scales,VAS)评分显著低于对照组(P<0.05)。两组术后7 d的匹茨堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)均低于术后1 d(P<0.05);且联合组术中、术后1 d与7 d的PSQI都显著低于对照组(P<0.05)。结论:舒芬太尼联合右美托咪定用于中老年腰椎间盘突出症局麻下椎间孔镜手术治疗的镇痛效果良好,患者术中及术后睡眠质量佳,血流动力学稳定、术后康复快,且安全性较高。

Objective:To explore the effects of sufentanil combined with dexmedetomidine in the treatment of intervertebral foraminal surgery under local anesthesia on the sleep quality of middle-aged and elderly patients.Methods:178 cases of middle-aged and elderly patients with lumbar disc herniation were selected for diagnosis and treatment in our hospital from December 2018 to October2019,and were equally divided into the sufentanil dexmedetomidine combined group and the saline control group,with 89 cases each accorded to the random number table method.All patients were underwent intervertebral foramen surgery and were given 0.5%lidocaine mixtured 0.25%ropivacaine under local anesthesia.On the basis of this,the combination group was given sufentanil and dexmedetomidine to induce sleep,and investigated the sleep quality of patients during and after surgery.Results:There was no significant difference in surgical mouth size,intraoperative blood loss,and postoperative hospital stay between the two groups(P>0.05),and the operation time in the combined group was significantly shorter than that in the control group(P<0.05).The incidence of complications such as incision infection,nausea and vomiting at the 14 d in the combined group was 1.12%,which was significantly lower than the control group’s 8.87%(P<0.05).The visual analogue scales(VAS)scores of the combined group at 1 d,7 d and 14 d after surgery were significantly lower than those of the control group(P<0.05).The PSQI at 7 days after surgery in both groups was lower than that at 1 day after surgery,and the difference was statistically significant(P<0.05).The Pittsburgh Sleep Quality Index(PSQI)of the combined group was significantly lower than that of the control group at intraoperative and postoperative 1 d and 7 d(P<0.05).Conclusion:It has good sleep quality,good analgesia,haemodynamically stable,fewer postoperative complications and faster recovery in the treatment of local subanaesthesia intervertebral foraminal endoscopic surgery for lumbar disc herniation in middle-aged and elderly patients by used of sufentanil combined with dexmedetomidine.