术后给予褪黑素对全身麻醉腹腔镜下子宫全切术患者术后睡眠的影响

Effects of postoperative melatonin on the postoperative sleeping of patients undergoing laparoscopic total hysterectomy under general anesthesia

目的探讨术后给予褪黑素对全身麻醉腹腔镜下子宫全切术患者术后睡眠的影响及可能机制。方法择期行全身麻醉腹腔镜下子宫全切术的患者120例,入选患者采用随机数字表法分为5 mg褪黑素组(A组)、10 mg褪黑素组(B组)和安慰剂组(C组),每组40例。于手术当天、术后第1天、术后第2天采集唾液后A组、B组、C组患者分别服用5 mg褪黑素、10 mg褪黑素和形状气味相同的安慰剂。分别于术前1 d、手术当天、术后第1天、术后第2天21:00采集患者唾液,采用ELISA法检测唾液中褪黑素、皮质醇浓度;术前1 d、术后第7天采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评估患者术前及术后睡眠障碍(postoperative sleep disturbance,PSD)发生率,采用简明围手术期疲劳评测量表(Identity Consequence Fatigue Scale,ICFS-10)评估患者疲劳状况;采用St.Mary′s医院睡眠问卷(St.Mary′s Hospital Sleep Questionnaire,SMH)评估患者术前2 d至术后第2天的每夜睡眠质量。记录手术时间、麻醉药物用量、补救镇痛药物用量、术后48 h内并发症等发生情况。记录术前1 d、拔管时、手术当天、术后第1~3天及术后第7天的疼痛数字评分(Numerical Rating Scale,NRS)。结果A组、B组、C组患者PSD发生率分别为44.7%、23.7%、65.8%,B组较C组明显降低(P<0.01)。手术当天、术后第1天A组、B组SMH评分明显高于C组(P<0.01),术后第1天B组SMH评分明显高于A组(P<0.05)。术后第1天、术后第2天A组、B组唾液褪黑素浓度较C组明显升高(P<0.05)。B组术后ICFS-10评分较C组明显降低(P<0.01)。3组患者术后唾液皮质醇水平较术前明显升高(P<0.01),组间同时点比较差异无统计学意义(P>0.05)。其余指标差异无统计学意义(P>0.05)。结论全身麻醉腹腔镜下子宫全切术后连续3 d(晚)口服10 mg褪黑素可以降低患者PSD发生率,口服5 mg褪黑素能够改善患者当晚睡眠质量,10 mg褪黑素与5 mg相比对患者睡眠质量改善效果更佳。

Objective To investigate the effects of postoperative melatonin on the postoperative sleeping in patients undergoing laparoscopic total hysterectomy under general anesthesia and possible underlying mechanisms.Methods A total of 120 patients who were scheduled for laparoscopic total hysterectomy under general anesthesia were enrolled.According to the random number table method,the patients were assigned to three groups(n=40):a 5 mg melatonin group(group A),a 10 mg melatonin group(group B)and a placebo group(group C).Patients in groups A,B,and C were administered with 5 mg melatonin,10 mg melatonin and a placebo with the same shape,taste and smell after collection of saliva on the surgery day,Day 1 after surgery and Day 2 after surgery.The saliva was collected from patients at 21:00 on the day before surgery,the surgery day,Day 1 after surgery and Day 2 after surgery.The levels of salivary cortisol and melatonin were measured by enzyme-linked immunosorbent assay(ELISA).The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the incidence of preoperative and postoperative sleep disorders one day before surgery and Day 7 after surgery.The Identity Consequence Fatigue Scale(ICFS-10)was used to evaluate patient fatigue one day before surgery and Day 7 after surgery.The quality of sleep per night from two days before surgery to Day 2 after surgery was assessed using the St.Mary's Hospital Sleep Questionnaire(SMH).The duration of operation,dosage of anesthetics and the use of rescue analgesics,the incidence of complications within 48 h after surgery were recorded.The Numerical Rating Scale(NRS)pain scores were recorded one day before surgery,during extubation,the surgery day,Days 1-3 after surgery,and Day 7 after surgery.Results The incidence of postoperative sleep disturbance(PSD)in groups A,B and C was 44.7%,23.7%and 65.8%,respectively,where group B presented remarkable decreases compared with group C(P<0.01).The SMH score of groups A and B was significantly higher than that of group C on the surgery day and Day 1 after surgery(P<0.01),and the SMH score of group B was significantly higher than that of group A Day 1 after surgery(P<0.05).Compared with group C,the content of salivary melatonin in groups A and B significantly increased on Days 1 and after surgery(P<0.05).After surgery,the ICFS-10 score of group B was significantly lower than of group C(P<0.01).The postoperative salivary cortisol level in the three groups was significantly higher than those before operation(P<0.01),and there was no significant difference between the groups at the same time point.There was no significant difference in other indexes(P>0.05).Conclusions Oral administration of 10 mg melatonin for three consecutive days after laparoscopic total hysterectomy under general anesthesia can reduce the incidence of PSD.Oral administration of 5 mg melatonin can improve patients'sleep quality at night,while 10 mg melatonin produced better improvement in patient sleep quality better than 5 mg melatonin.