术前睡眠质量对开胸手术老年患者苏醒躁动及早期康复的影响

Effect of preoperative sleep quality on emergence agitation and early postoperative recovery of elderly patients with thoracotomy surgery

目的 评价术前睡眠质量对开胸手术老年患者苏醒躁动(emergence agitation, EA)及术后早期康复的影响。方法 纳入2019年11月—2022年12月河南省人民医院收治的择期接受开胸手术的老年(年龄65~80岁)患者100例。术前依据匹兹堡睡眠质量指数(PSQI)将患者分为睡眠障碍组(PSQI≥5分)和睡眠正常组(PSQI<5分),每组50例。所有患者均接受相同的麻醉方法和苏醒期相同的EA预防措施。两组患者在麻醉结束后即刻(T_(1))、5(T_(2))、10(T_(3))、15(T_(4))、20(T_(5))、30(T_(6))、60 min(T_(7))采用四分法进行EA评分,EA评分2分及以上提示患者发生EA,统计上述时点的EA发生情况。分别于术前1 d、术后1 d、3 d、5 d及7 d检测患者白细胞计数(WBC)、中性粒细胞计数(N)和中性粒细胞百分比;并记录麻醉时间、手术时间、麻醉后恢复室(PACU)停留时间和术后住院时间。结果 与睡眠障碍组相比,T_(2)~T_(5)时睡眠正常组EA评分为4分的患者比例显著减低(P<0.05),T_(3)时睡眠正常组EA发生率显著降低(P<0.05)。术后3 d、5 d和7 d时睡眠正常组白细胞计数、中性粒细胞计数、中性粒细胞百分比较睡眠障碍组均明显降低(P<0.05)。睡眠正常组术后住院时间较睡眠障碍组显著减少(P<0.05)。结论 在开胸手术老年患者中,术前正常的睡眠质量可降低EA评分及发生比例,促进患者术后早期康复。

Objective To evaluate the effect of preoperative sleep quality on emergence agitation(EA) and early postoperative recovery in elderly patients undergoing thoracotomy.Methods A total of 100 elderly patients(aged 65-80 years old) admitted to our hospital from November 2019 to December 2022 for elective thoracotomy surgery were included. Patients were divided into sleep disorder group [Pittsburgh Sleep Quality Index(PSQI) score ≥5] and normal sleep group(PSQI score 5) based on preoperative PSQI. All patients received the same anesthesia and EA prevention measures during recovery. EA was evaluated using a four-point scale at 0(T_(1)), 5(T_(2)), 10(T_(3)), 15(T_(4)), 20(T_(5)), 30(T_(6)), and 60(T_(7)) minutes after anesthesia cessation. EA score ≥2 indicated EA. White blood cell count(WBC), neutrophil count(N), neutrophil percentage were measured before surgery, and 1, 3, 5, and 7 days after surgery. Anesthesia time, surgery time, post-anesthesia care unit(PACU) stay time, and postoperative hospital stay were recorded.Results Compared with the sleep disorder group, the proportion of patients with EA score of 4 in the normal sleep group was significantly reduced at T_(2)-T_(5)(P<0.05), and the incidence of EA was significantly reduced at T_(3)(P<0.05). WBC, N, and neutrophil percentage in the normal sleep group were significantly lower than those in the sleep disorder group at 3, 5, and 7 days after surgery(P<0.05). The postoperative hospital stay in the normal sleep group was significantly shorter than that in the sleep disorder group(P<0.05).Conclusion Normal preoperative sleep quality can reduce EA score and incidence, and promote early postoperative recovery in elderly patients undergoing thoracotomy.