右美托咪定对膝关节置换患者术后睡眠质量及早期功能恢复的影响

Effect of dexmedetomidine on postoperative sleep quality and early recovery of function in patients undergoing total knee arthroplasty

目的 探讨不同剂量右美托咪定复合舒芬太尼静脉自控镇痛(PCIA)对老年患者膝关节置换术后睡眠质量和早期膝关节功能恢复的影响。方法 选择2021年8月-2022年1月我院收治的行膝关节置换术的患者114例,随机分为右美托咪定高剂量组(High-Dex组)、右美托咪定低剂量组(Low-Dex组)和对照组(C组)。C组予舒芬太尼1.5μg/kg+托烷司琼6 mg, High-Dex组在C组基础上给予右美托咪定0.05μg/(kg·h),Low-Dex组在C组基础上给予右美托咪定0.025μg/(kg·h)。比较患者术后阿森斯失眠量表(AIS)评分、关节活动度(ROM)、NRS疼痛评分(静息、夜间、运动)。比较各组患者自控镇痛按压次数、补救镇痛及术后不良反应发生率。结果 与C组比较,Low-Dex组患者术后第2、3天AIS评分降低(P<0.05),High-Dex组患者术后第1、2、3、7天AIS评分降低(P<0.05)。与C组比较,Low-Dex组患者术后第3天关节活动度更大(P<0.05),High-Dex组患者术后第2、3天关节活动度更大(P<0.05)。Low-Dex组患者术后48 h静息NRS疼痛评分、第2晚夜间NRS疼痛评分低于C组(P<0.05),High-Dex组患者术后48 h及72 h的静息NRS疼痛评分、第2天及第3天的夜间NRS疼痛评分和活动时NRS疼痛评分均低于C组(P<0.05)。相关分析结果显示,术后3 d夜间NRS疼痛评分与AIS评分存在明显正相关关系(r=0.516,r=0.582,r=0.604,P<0.05),术后第2、3、7天的关节活动度与活动时NRS疼痛评分存在明显相关性(r=-0.847,r=-0.865,r=-0.674,P<0.05)。结论 右美托咪定复合舒芬太尼PCIA能通过改善患者术后疼痛,进而改善膝关节置换患者术后睡眠质量和早期膝关节功能恢复。0.05μg/(kg·h)右美托咪定复合舒芬太尼能更好地改善术后睡眠质量和疼痛,促进早期膝关节功能恢复。

Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanilin PCIA on early sleep quality and recovery of function in the elderly after knee arthroplasty.Methods A total of 114 patients undergoing knee arthroplasty from Aug ust 2021 to January 2022 were randomly divided into three groups.In High-Dex group, patients received patient-controlled intravenous analgesia(PCIA)with sufentanil 1.5 μg/kg+dexmedetomidine 0.05 μg/(kg·h)+ropisetron 6 mg.In Low-Dex group, patients were given PCIA with sufentanil 1.5 μg/kg+dexmedetomidine 0.025 μg/(kg·h)+ropisetron 6 mg.In control group(C),patients were given PCIA with sufentanil 1.5 μg/kg+tropisetron 6 mg.The Athens insomnia scale(AIS),range of motion(ROM),NRS pain score(at rest, night and ambulation),press times of PCIA,rescue analgesia and the incidence of postoperative adverse effects were compared among the groups.Results Compared with group C,the AIS scores decreased in Low-Dex group(postoperative day 2 and 3)and High-Dex group(postoperative day 1,2,3 and 7)(P<0.05).Patients in Low-Dex group had greater ROM than group C on postoperative day 3(P<0.05).In High-Dex group, the ROM was greater than group C on postoperative day 2 and 3(P<0.05).The resting NRS scores at 48 h and 72 h after operation in High-Dex group was lower than group C(P<0.05),and the resting NRS pain scores at 48 h after operation in Low-Dex group was lower than group C(P<0.05).The NRS scores at night in High-Dex group was lower than group C on postoperative day 2 and 3(P<0.05),the NRS scores at night in Low-Dex group was lower than group C on postoperative day 2(P<0.05).The NRS pain scores at ambulation of High-Dex group was lower than group C on postoperative day 2 and 3(P<0.05).The Spearman correlation analysis showed that nocturnal NRS pain scores were positively correlated with AIS scores on postoperative day 1 to 3(r=0.516,r=0.582,r=0.604,P<0.05),while ROM were negatively correlated with ambulatory NRS pain scores on postoperative day 1 to 3(r=-0.847,r=-0.865,r=-0.674,P<0.05).Conclusion Dexmedetomidine combined with sufentanil in PCIA can effectively improve the postoperative pain, which improves the early sleep quality and recovery of knee function after knee arthroplasty.Among the doses studied in this experiment, 0.05 μg/(kg·h)dexmedetomidine combined with sufentanil can better improve postoperative sleep quality and pain and promote the early functional recovery.