星状神经节阻滞联合耳穴贴压对髋关节置换术患者术后睡眠障碍的影响

Effect of Ultrasound-guided Stellate Ganglion Block Combined with Auricular Acupressure on Postoperative Sleep Disturbance in Patients Undergoing Hip Replacement

目的探讨超声引导下星状神经节阻滞(stellate ganglion block,SGB)联合耳穴贴压对髋关节置换(total hip arthroplasty,THA)患者术后睡眠障碍(postoperative sleep disturbance,POSD)的影响。方法选取择期在腰硬联合麻醉下初次行THA的患者105例,男52例,女53例,年龄25~75岁,BMI 18~28 kg/m 2,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分为耳穴组、SGB联合耳穴组(联合组)和假刺激组,每组35例。耳穴组患者予患肢同侧耳穴行王不留行籽耳贴贴压,联合组患者在耳穴组基础上,行超声引导下SGB,假刺激组患者给予不带王不留行籽的耳穴贴,方法同耳穴组。记录患者术前1 d匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分。记录术后当晚实际睡眠时长,深、浅、快速眼动睡眠(rapid eye movement,REM)时长及占比,觉醒次数及时长。记录术后当晚St.Mary’s医院(St.Mary’s Hospital,SMH)睡眠问卷评分和静息视觉模拟评分法(VAS)评分。记录术后1 d患者自控镇痛(PCA)次数、追加镇痛药量和恶心、呕吐发生率。记录患者住院天数、SGB和耳贴不良反应发生情况。结果与假刺激组比较,耳穴组和联合组患者术后当晚实际睡眠时长、深睡眠时长及占比、睡眠效率明显增加(均P<0.05),联合组患者POSD发生率、夜间觉醒次数及时长明显减少,REM时长明显增加(均P<0.05)。与耳穴组比较,联合组患者实际睡眠时长、深睡眠时长、REM时长和睡眠效率明显增加(均P<0.05)。与假刺激组比较,耳穴组和联合组患者睡眠深度和SMH总分明显升高(均P<0.05),联合组患者夜醒频率、日间功能及睡眠满意度得分明显升高(均P<0.05)。结论SGB联合耳穴贴压可明显改善THA患者术后当晚的主客观睡眠质量,且能降低POSD发生率。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)combined with auricular acupressure on postoperative sleep disturbance(POSD)in patients undergoing total hip arthroplasty(THA).Methods In all,105 patients(ASAⅠ-Ⅱ)who were scheduled to undergo initial THA under combined spinal-epidural anesthesia were randomly assigned into 3 groups(n=35 in each group):auricular acupressure group,SGB+auricular acupressure group(combination group)and sham group.The auricular acupressure group received auricular acupressure on the same side of the operation limb.The combination group underwent ultrasound-guided SGB on the basis of auricular acupressure group.While the sham group was given auricular acupressure without semen vaccariae,and the other steps were the same as auricular acupressure group.The Pittsburgh Sleep Quality Index(PSQI)scores were recorded 1 day before the surgery.Patient condition was recorded on the 1st night after operation,including actual sleep duration,durations and proportions of deep sleep,light sleep and rapid eye movement(REM),as well as the number and duration of awakenings.St.Mary’s Hospital(SMH)Sleep Questionnaire scores and resting visual analogue scale(VAS)scores were recorded on the 1st night after operation.The times of patient-controlled analgesia(PCA),the amount of additional analgesics and the incidence of nausea and vomiting were recorded on the 1st day after operation.The length of hospital stay,SGB and auricular acupressure related adverse effects were also recorded.Results Compared with sham group,the actual sleep duration,duration and proportion of deep sleep,and sleep efficiency of patients in auricular acupressure group and combination group on the 1st night after operation were increased significantly(all P<0.05).The incidence of POSD,number and duration of awakenings were significantly reduced,while the duration of REM was significantly increased in combination group(all P<0.05).Compared with auricular acupressure group,the actual sleep duration,deep sleep and REM duration,and sleep efficiency of patients in combination group were significantly increased(all P<0.05).Compared with sham group,the sleep depth and total score of SMH in auricular acupressure group and combination group were significantly increased(all P<0.05),and the frequency of night awakenings,daytime function and sleep satisfaction scores of combination group were significantly increased(all P<0.05).Conclusion SGB combined with auricular acupressure can significantly improve the subjective and objective sleep quality of patients undergoing THA on the night after the surgery and reduce the incidence of POSD.