右美托咪定对腹腔镜结直肠肿瘤手术老年患者术后睡眠的影响

Effects of Dexmedetomidine on Postoperative Sleep in Elderly Patients Undergoing Laparoscopic Colorectal Tumor Surgery

目的评估右美托咪定(DEX)对行腹腔镜下结直肠肿瘤手术的老年患者术后睡眠质量的影响,探讨DEX影响术后睡眠的机制。方法选择择期行腹腔镜下结直肠肿瘤手术的老年患者80例(年龄60~80岁),随机分为DEX实验组(DEX 0.2μg·kg^(-1)·h^(-1),n=41)和对照组(生理盐水50 mL,n=39)。于术后第1、2、3天使用匹兹堡睡眠质量指数(PSQI)量表评估2组患者的主观睡眠质量;使用视觉模拟评分(VAS)评估术后疼痛情况;使用wGT3X-BT体动记录仪记录2组患者的睡眠效率、潜伏期、睡眠时间、觉醒时间和觉醒次数等睡眠参数;采集患者术后第1、2、3天外周血,测量血清促食欲素A(OXA)水平,统计患者术后并发症情况。结果2组患者的PSQI评分比较,差别有统计学意义(P<0.001);2组患者的睡眠时间、睡眠效率、潜伏期、觉醒时间和觉醒次数比较,差别有统计学意义(P<0.05);与对照组比较,实验组术后睡眠效率明显提高,睡眠潜伏期明显缩短,觉醒时间和觉醒次数明显降低。实验组的血清OXA水平、各时间点VAS均低于对照组,差别有统计学意义(P<0.001)。实验组术后恶心呕吐、感染发生率均低于对照组,但差别无统计学意义(P>0.05)。实验组心律失常发生率高于对照组,差别无统计学意义(P>0.05)。实验组术后谵妄发生率较对照组明显降低,差别有统计学意义(P=0.033)。结论术中持续输注DEX能够明显改善行腹腔镜下结直肠肿瘤手术的老年患者术后睡眠质量,延长睡眠时间,减少觉醒次数,降低睡眠潜伏期,提高术后睡眠效率,降低血清OXA浓度,减轻术后疼痛,减少术后谵妄发生。

Objective To observe and evaluate the postoperative sleep quality of patients undergoing laparoscopic colorectal tumor surgery under the intervention of dexmedetomidine(DEX),and to explore the possible mechanism of DEX on postoperative sleep.Methods 80 elderly patients(aged 60-80 years)undergoing elective laparoscopic colorectal tumor surgery were randomly divided into DEX group(DEX 0.2μg·kg^(-1)·h^(-1),n=41)and control group(Normal saline 50 mL,n=39).The Pittsburgh Sleep Quality Index(PSQI)and visual analogue scale(VAS)were used to evaluate the patients subjective sleep quality and postoperative pain on the 1st,2nd,and 3rd day after operation.The sleep parameters such as sleep efficiency,latency,sleep time,awakening time,and awakening number of times were recorded by wGT3X-BT body movement recorder.The serum orexin-A(OXA)level was measured on the 1st,2nd,and 3rd day after operation,and the postoperative complications were counted.Results There was a statistically significant difference in PSQI scores between the two groups(P<0.001).There were statistically significant differences in sleep time,sleep efficiency,latency,awakening time and number of awakening times between the two groups(P<0.05).Compared with the control group,the sleep efficiency of the experimental group was significantly increased,the sleep latency was significantly shortened,and the awakening time and number of awakening times were significantly reduced.The serum OXA level(P<0.001)and VAS score at each time point(P<0.001)in the experimental group were lower than those in the control group,and the difference was statistically significant.The incidence of postoperative nausea and vomiting and infection in the experimental group were lower than those in the control group,but the differences were not statistically significant(P>0.05).The incidence of arrhythmia in the experimental group was higher than that in the control group,but the difference was not statistically significant(P>0.05).The incidence of postoperative delirium in the experimental group was significantly lower than that in the control group,the difference was statistically significant(P=0.033).Conclusion Intraoperative continuous infusion of DEX can significantly improve postoperative sleep quality,prolong sleep time,reduce awakening times and sleep latency in elderly patients undergoing laparoscopic colorectal tumor surgery,so as to improve postoperative sleep efficiency,reduce serum OXA concentration,relieve postoperative pain and reduce the occurrence of postoperative delirium.