右美托咪定联合经皮穴位神经电刺激改善全麻后睡眠质量的临床研究

Clinical study of dexmedetomidine combined with transcutaneous electrical acupoint stimulation to improve sleep quality after general anesthesia

目的:探究右美托咪定联合经皮穴位神经电刺激(transcutaneous electrical acupoint stimulation, TEAS)对全麻后睡眠质量的改善作用。方法:75例拟行腹腔镜下胆囊切除术的患者,采用数字表法随机分为右美托咪定组(右美组)(n=25)、经皮穴位电刺激组(TEAS组)(n=25)和联合组(n=25)。右美组患者全麻时泵注右美托咪定,并在术后3 d的每晚睡前进行右美托咪定滴鼻;TEAS组患者全麻过程中和术后3 d的每晚睡前进行TEAS干预;联合组采用右美托咪定和TEAS 2种干预。对比3组患者术后3晚的阿森斯失眠量表(Athens insomnia scale, AIS)评分和视觉模拟量表(visual analogue scale, VAS)评分,干预前、气管插管时、牵拉胆囊时和拔管时的心率和平均动脉压(mean arterial pressure, MAP)及苏醒期躁动、恶心、呕吐等不良反应。结果:与右美组或TEAS组相比,联合组术后3晚的AIS评分降低;与TEAS组相比,右美组术后第1、2、3晚AIS评分升高,差异有统计学意义(P<0.05)。与右美组或TEAS组相比,联合组术后第1、2天VAS评分降低;与TEAS组相比,右美组术后第1、2天VAS评分升高,差异有统计学意义(P<0.05)。3组患者术后第3天VAS评分、术后3 d的心率和MAP差异均无统计学意义(P>0.05)。3组患者苏醒期躁动、恶心、呕吐等不良反应的发生率差异均无统计学意义(P>0.05)。结论:右美托咪定联合经皮穴位神经电刺激可显著改善腹腔镜下胆囊切除术患者全麻术后短期的睡眠质量。

OBJECTIVE To investigate the effect of dexmedetomidine combined with transcutaneous electrical acupoint stimulation(TEAS)on sleep quality after general anesthesia.METHODS Seventy-five patients who were scheduled to undergo laparoscopic cholecystectomy were randomly divided into dexmedetomidine group,TEAS group and combination group according to the random number table.There were 25 patients in each group.Patients in dexmedetomidine group were received dexmedetomidine during general anesthesia,and intranasal dexmedetomidine was administrated before bedtime every night for 3 days after operation.Patients in TEAS group underwent TEAS intervention during general anesthesia and before bedtime every night for 3 days after surgery.Dexmedetomidine and TEAS were both used in combination group.The Athens insomnia scale(AIS)score and visual analogue scale(VAS)score of three groups were compared for three nights after surgery.The heart rate(HR)and mean arterial pressure(MAP)of three groups were compared before intervention,during intubation,the moment when the gallbladder was pulled,and at extubation.At the same time,we assessed adverse effects such as agitation,nausea and vomiting during awakening.RESULTS Compared with that in dexmedetomidine group or TEAS group,the AIS score in combination group was significantly reduced three nights after surgery(P<0.05).Compared with that in TEAS group,the AIS score was significantly higher than that in dexmedetomidine group three nights after surgery(P<0.05).Compared with those in dexmedetomidine group or TEAS group,the VAS scores on the first and second days after surgery in combination group were significantly reduced(P<0.05).Compared with those in TEAS group,the VAS scores on the first and second days after surgery were significantly increased in dexmedetomidine group(P<0.05).There were no significant differences in VAS score on the third postoperative day,HR and MAP during 3 days after surgery(P>0.05).There was no significant difference in the incidence of adverse reactions,such as agitation,nausea and vomiting,during the awakening period in the three groups(P>0.05).CONCLUSION Dexmedetomidine combined with transcutaneous electrical acupoint stimulation could significantly improve short-term sleep quality after general anesthesia in patients undergoing laparoscopic cholecystectomy.