术前睡眠质量对腹腔镜下胆囊切除术结局影响

Effect of preoperative sleep quality on outcome of laparoscopic cholecystectomy

目的 探讨术前病人睡眠质量与腹腔镜下胆囊切除术结局之间的关联,为改善该类病人术后结局提供相关指导意见。方法 采用随机数字表法,选取2021年6月至2022年1月在安徽医科大学附属巢湖医院就医的需腹腔镜下胆囊切除术病人,收集病人基线信息,此外术前住院期间对该部分病人采用匹兹堡睡眠质量指数评价表进行睡眠质量评估,依据量表评估准则,将最终得分≥7纳入到低睡眠质量组(n=23),得分<7分纳入高睡眠质量组(n=41)。同时对两组病人术后结局进行评估,包括术后镇痛泵的使用、术后并发症、术后高血压评分及术后首次下床时间,综合评判确定睡眠质量与术后结局之间的关联。结果两组病人基线资料,年龄、性别、文化程度、家庭住址等均差异无统计学意义,两组病人均衡可比。结局指标结果显示高质量睡眠组术后未发生呕吐38人高于低质量睡眠组17人,高质量睡眠组术后首次活动时间(22.91±17.38)h低于低质量睡眠组术后首次活动时间(34.61±20.03)h(P<0.05),logistic回归分析调整了性别、年龄、文化程度、家庭住址、术前血压分级等多项指标后,低睡眠质量组与高睡眠质量组相比,术后更容易发生呕吐症状且恢复时间更长[OR=33.37,95%CI:(1.46,762.65);β=0.19,95%CI:(0.02,0.36)];在此基础上,针对手术时长、气腹时间以及术前镇静剂使用情况等混杂因素进行调整,结果仍然与之前保持一致。结论 胆囊切除术病人术前良好的睡眠质量可以有效地缓解腹腔镜下手术对病人带来的负面影响,包括病人术后病人的恢复情况以及并发症。因此临床上针对病人睡眠问题采取合理有效措施,改善病人的睡眠质量,可以对手术结局产生良好的影响。

Objective To investigate the relationship between preoperative sleep quality and laparoscopic cholecystectomy outcomes and to provide guidance for improving postoperative outcomes in this patient population.Methods A random number table method was used to select patients requiring laparoscopic cholecystectomy who were admitted to Chaohu Hospital of Anhui Medical University from June 2021 to January 2022,and baseline information was collected from the patients.Sleep quality was assessed using the Pittsburgh Sleep Quality Index rating scale for this group of patients before surgery.Based on the scale assessment guidelines,a final score of≥7 was included in the low sleep quality group(n=23),and a score of<7 was included in the high sleep quality group(n=41).Postoperative outcomes were also assessed in both groups,including postoperative analgesic pump use,postoperative complications,postoperative hypertension scores,and time to first postoperative bed release,to determine the association between sleep quality and postoperative outcomes in a comprehensive evaluation.Results The baseline data,age,sex,education level and home address of the patients in both groups were not statistically significant,and the patients in both groups were balanced and comparable.The results of outcome indicators revealed that 38 patients in the high-quality sleep group did not experience postoperative vomiting compared with 17 patients in the low-quality sleep group,and the time to first postoperative activity was lower in the high-quality sleep group(22.91±17.38)h than in the low-quality sleep group(34.61±20.03)h(P<0.05).Logistic regression analysis adjusted for a number of indicators,including sex,age,education level,home address,and preoperative blood pressure classification,showed that the low sleep quality group was more likely to experience postoperative vomiting and had a longer recovery time than the high sleep quality group[OR=33.37,95%CI:(1.46,762.65);β=0.19,95%CI:(0.02.0.36)];on this basis,the results remained consistent with the previous results when adjusted for confounding factors such as operative length,pneumoperitoneum time,and preoperative sedation use.Conclusions Good sleep quality in cholecystectomy patients before surgery can effectively alleviate the negative impact of laparoscopic surgery on patients,including the recovery of patients and complications after surgery.Therefore,taking reasonable and effective measures to improve the sleep quality of patients with clinical sleep problems can have a good impact on the surgical outcome.