亚麻醉剂量艾司氯胺酮对全子宫切除术患者术后睡眠质量的影响

Effects of sub-anesthetic dose of esketamine on postoperative sleep quality of patients undergoing total hysterectomy

目的探讨术前给予亚麻醉剂量艾司氯胺酮对腹腔镜全子宫切除术患者术后睡眠的影响。方法选择2021年10月至2022年5月在山西医科大学第一医院于全身麻醉下行腹腔镜全子宫切除术的患者106例,采用随机数字表法将入选患者分为艾司氯胺酮组和对照组,每组53例。艾司氯胺酮组患者于手术切皮前给予0.3 mg/kg艾司氯胺酮。术前1 d、手术当天和术后2 d分别采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)和抑郁自评量表(Self-rating depression scale,SDS)评估患者睡眠质量和抑郁状态,并使用可穿戴智能手环记录患者睡眠时长。记录患者术后4 h和48 h的疼痛数字评分(Numerical rating Scale,NRS)和阿片类药物的用量。记录患者术中及术后不良反应的发生率。结果两组患者术前PSQI评分、SDS评分、睡眠时长和觉醒次数比较,差异无统计学意义(P>0.05);艾司氯胺酮组患者术后PSQI评分、SDS评分及觉醒次数[7.90±3.02,30.32±8.15,3(2.25)]低于对照组[10.94±4.08,38.79±9.59,4(2)](P<0.05);艾司氯胺酮组患者术后总睡眠时长和深睡眠时长(357.54±62.98,93.62±30.17)多于对照组(316.15±59.26,63.65±21.47)(P<0.05);艾司氯胺酮组患者术后NRS评分和阿片类药物[2(1),82.16±4.53]用量少于对照组[2(2),88.50±4.28](P<0.05);两组患者术中及术后不良反应发生率比较差异无统计意义(P>0.05)。结论术前给予亚麻醉剂量艾司氯胺酮可以改善腹腔镜全子宫切除术患者术后睡眠质量,且未增加术中及术后不良反应的发生率。

Objective To investigate the effect of preoperative sub-anesthetic dose of esketamine on postoperative sleep in patients undergoing laparoscopic total hysterectomy.Methods A total of 106 patients who underwent laparoscopic total hysterectomy under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to May 2022 were selected.The selected patients were divided into esketamine group and control group by random number table method,53 patients in each group.Patients in the esketamine group were given 0.3 mg/kg esketamine before surgical incision.The pittsburgh sleep quality index(PSQI)and the self-rating depression scale(SDS)were used to evaluate the sleep quality and depressive state of the patients 1 day before surgery,on the day of surgery and 2 days after surgery,respectively.The wearable smart bracelet was used to record the patient′s sleep duration.The numerical rating scale(NRS)score and opioid consumption were recorded at 4 h and 48 h after operation.The incidence of intraoperative and postoperative adverse reactions was recorded.Results There was no significant difference in preoperative PSQI score,SDS score,sleep duration or the number of awakenings between the two groups(P>0.05).The postoperative PSQI score,SDS score and the number of awakenings in the esketamine group[7.90±3.02,30.32±8.15,3(2.25)]were lower than those in the control group[10.94±4.08,38.79±9.59,4(2)](P<0.05);postoperative total sleep duration and deep sleep duration in the esketamine group(357.54±62.98,93.62±30.17)were more than those in the control group(316.15±59.26,63.65±21.47)(P<0.05);the postoperative NRS score and opioid consumption in the esketamine group[2(1),82.16±4.53]were lower than those of the control group[2(2),88.50±4.28](P<0.05);there were no significant difference in the incidence rate of intraoperative and postoperative adverse reactions between the two groups(P>0.05).Conclusion Preoperative administration of sub-anesthetic dose of esketamine can improve postoperative sleep quality in patients with laparoscopic hysterectomy without increasing the incidence of intra-operative and postoperative adverse reactions.