麻醉方式对老年髋部骨折患者术后睡眠的影响

Effects of different anesthesia methods on postoperative sleep quality in elderly patients with hip fracture

目的探讨椎管内麻醉和全身麻醉(GA)两种麻醉方式对老年髋部骨折患者术后睡眠质量的影响。方法本研究是一项前瞻性队列研究,连续选取2019年11月至2020年8月于北京积水潭医院收治的年龄大于65岁的髋部骨折患者,根据麻醉方式分为腰硬联合麻醉组(CSEA组)和全身麻醉组(GA组),每组69例。CSEA组实施腰硬联合麻醉,GA组实施全身麻醉方案,两组均采用相同的镇痛方案。采用睡眠日志评估主观睡眠,包括睡眠质量、睡眠时长、觉醒次数;使用可穿戴智能设备评估客观睡眠质量,包括总睡眠时间(TST)、快动眼(REM)睡眠、浅睡眠及深睡眠时间;使用疼痛数字评分(NRS)记录术后静息及运动时疼痛情况。结果与CSEA组相比,GA组手术当晚睡眠质量评分明显降低(P<0.05),觉醒次数显著增加(P<0.05),深睡眠时间显著缩短(P<0.05)。结论与CSEA相比,接受GA的老年髋部骨折患者手术当晚睡眠障碍更严重。

Objective To compare the effect of spinal anesthesia and general anesthesia(GA)on postoperative sleep quality in elderly patients undergoing hip surgery.Methods In this prospective cohort-based study,patients with hip fracture,aged≥65 years were divided into 2 groups according to the anesthesia method:combined spinal plus epidural anesthesia(CSEA)group and GA group(n=69 each)from November 2019 to August 2020.All patients received the same perioperative pain management.Subjective sleep quality was assessed by the sleep diaries recording sleep quality,total sleep time,and number of awakenings.The objective sleep quality was assessed by sleep tracker recording total sleep time(TST),rapid-eye-movement(REM)time,light sleep time and deep sleep time.Numeric Rating Scales(NRS)were used to assess the intensity of postoperative pain.Results Compared with CSEA group,the Sleep Quality Score and deep sleep time were significant lower(P<0.05),and the number of awakenings(P<0.05)was significant higher in GA group in the intraday night of surgery.Conclusions Compared with CSEA group,sleep disruption is more severe in the GA group at the intraday night of the patients with hip fracture.