睡眠质量对老年髋关节置换术后谵妄的影响

The effect of sleep quality on delirium after hip replacement in the elderly

目的分析行髋关节置换术老年患者术前睡眠质量与术后谵妄之间联系。方法回顾性收集在我院进行髋关节置换术的90例老年患者,男性46例、女性44例,年龄60~78岁,平均(72±5)岁。其治疗时间均在2018年1月至2019年1月之间,手术前采取匹兹堡睡眠质量指数量表对每位患者进行评估,依据患者睡眠情况将其分成睡眠正常组(n=43,睡眠指数<5分),睡眠障碍组(n=47,睡眠指数≥5分)。每组均使用罗库溴铵、舒芬太尼以及丙泊酚诱导麻醉。分别记录每组麻醉时间、手术时间、观察时间以及手术后住院天数。比较手术后1~5 d内NRS得分、QoR-40得分以及术后谵妄出现次数。结果90例患者均获得完整随访,随访率100.00%,随访时间6~18个月,平均(12.3±1.2)个月。睡眠障碍组在麻醉时间、手术时间、观察时间以及手术后住院天数方面均高于睡眠正常组(P<0.05);睡眠障碍组手术后1~5 d NRS得分为(3.4±1.1)分、(3.2±1.0)分、(2.7±0.8)分、(2.1±0.6)分、(1.8±0.5)分,均高于睡眠正常组[(2.7±1.3)分、(2.5±1.0)分、(2.2±0.9)分、(1.8±0.7)分、(1.5±0.6)分,P<0.05];睡眠障碍组手术后1~5 d QoR-40得分为(146.1±6.2)分、(149.5±6.3)分、(154.2±6.7)分、(158.5±4.1)分、(162.1±5.2)分,均低于睡眠正常组[(149.2±5.1)分、(152.3±5.1)分、(158.3±5.5)分、(161.2±5.2)分、(165.6±4.1)分,P<0.05)];睡眠障碍组与睡眠正常组手术后1~5 d谵妄总出现率分别是34.04%(16/47)、13.95%(6/47)(P<0.05)。结论手术前存在睡眠障碍会使患者术后谵妄出现几率上升,并且延长术后住院时间,不利于患者术后机体恢复,需对患者术前睡眠情况予以重视。

Objective To analyze the relationship between preoperative sleep quality and postopera-tive delirium in elderly patients undergoing hip replacement.Methods The study sample was collected from 90 elderly patients(46 males and 44 females,aged 60-78 years,mean 71.85±4.69 years old)who under-went hip arthroplasty in our hospital.The treatment time was from January 2018 to January 2019.Before op-eration,each patient was assessed by Pittsburgh Sleep Quality Index Scale.According to the sleep condition of patients,43 patients were divided into normal sleep group(sleep index<5 points)and 47 patients with sleep disorder group(sleep index≥5 points).Rocuronium,sufentanil and propofol were used to induce anes-thesia in each group.The time of anesthesia,operation,observation and hospitalization were recorded in each group.The scores of NRS,QoR-40 and the occurrence of delirium were compared between 1 day and 5 days after operation.All 90 patients were fully followed up,with a follow-up rate of 100.00%and a follow-up time of 6-18 months,with an average of(12.3±1.2)months.Results The anesthesia time,operation time,observation time and postoperative hospitalization days of sleep disorder group were higher than those of nor-mal sleep group(P<0.05);The NRS scores of sleep disorder group(3.4±1.1,3.2±1.0,2.7±0.8,2.1±0.6,1.8±0.5)at 1-5 days after operation in sleep disorder group were higher than those in normal sleep group(2.7±1.3,2.5±1.0,2.2±0.9,1.8±0.7,1.5±0.6)(P<0.05);QoR-40 scores of sleep disorder group(146.1±6.2,149.5±6.3,154.2±6.7,158.5±4.1,162.1±5.2)were lower than those of normal sleep group(149.2±5.1,152.3±5.1,158.3±5.5,161.2±5.2,165.6±4.1)(P<0.05);The total incidence of delirium was 34.04%(16/47)in sleep disorder group and 13.95%(6/47)in normal sleep group(P<0.05).Conclusion Sleep disturbance before operation can increase the incidence of delirium after operation,and prolong the hospital stay after operation,which is not con-ducive to the recovery of patients after operation.We should pay attention to the sleep condition before operation.