正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响

Effect of mindfulness-based therapy on postoperative cognitive function and sleep quality in elderly patients after surgery under local anesthesia

背景术后认知功能障碍(POCD)是术后常见的并发症之一,老年患者发病率较高。POCD对患者术后康复影响较大。目的探讨正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响,为降低老年患者POCD发生风险、改善睡眠质量提供参考。方法采用简单随机抽样法,选取2022年3月—2023年3月在绵阳市第三人民医院接受非全身麻醉手术的78例老年患者为研究对象,采用随机数字表法分为研究组和对照组各39例。两组均接受常规治疗及护理,研究组此基础上接受正念疗法干预。于术前1天以及术后第1、3、5天,采用简易精神状态量表(MMSE)评定患者的认知功能,于术前1天及术后第3天采用匹兹堡睡眠质量指数量表(PSQI)评定患者的睡眠质量。结果两组MMSE评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义(F=78.251、197.071、371.915,P均<0.05)。进一步分析显示,术后第1、3、5天,研究组MMSE评分均高于对照组,差异均有统计学意义(t=-3.579、-1.764、-0.253,P均<0.05)。术后第1、3、5天,研究组POCD发生率均低于对照组,差异均有统计学意义(χ^(2)=2.631、3.471、5.135,P均<0.05)。术后第3天,研究组PSQI总评分低于对照组(P<0.05),且研究组PSQI总评分、睡眠潜伏期、主观睡眠质量、日间功能障碍以及催眠药物使用因子评分均低于术前(F=43.175、12.594、11.092、4.579、3.514,P均<0.01)。结论正念疗法可能有助于降低老年患者非全身麻醉术POCD的发生率,并改善其睡眠质量。

Background Postoperative cognitive dysfunction(POCD)is a common complication in elderly patients after surgery,and has a great impact on postoperative rehabilitation of patients.Objective To explore the effect of mindfulness-based therapy on cognitive function and sleep quality in elderly patients after surgery under local anesthesia,so as to provide references for reducing their incidence risk of POCD and improving sleep quality.Methods The simple random sampling method was utilized to select 78 elderly patients who underwent surgery under local anesthesia in The Third Hospital of Mianyang from March 2022 to March 2023.Participants were assigned into study group and control group,each with 39 cases.All patients were subjected to conventional treatment and nursing interventions,and study group added mindfulness-based therapy on this basis.Mini-Mental State Examination(MMSE)was administered to patients on 1 day before surgery,and on the 1st,3rd and 5th day after surgery.Pittsburgh Sleep Quality Index(PSQI)was employed on 1 day before surgery and on the 3rd day after surgery.Results MMSE scores revealed a significant time effect,group effect and time×group interaction effect(F=78.251,197.071,371.915,P<0.05).Analysis of simple effect denoted that study group scored higher on MMSE on the 1st,3rd and 5th day after surgery compared with control group,with statistical significance(t=-3.579,-1.764,-0.253,P<0.05).Study group reported lower incidence rates of POCD on the 1st,3rd and 5th day after surgery compared with control group,with statistical significance(χ^(2)=2.631,3.471,5.135,P<0.05).On the 3rd day after surgery,study group scored lower on PSQI than control group(P<0.05),and PSQI total score,sleep latency,subjective sleep quality,daytime dysfunction and hypnotic drug use factor scores of study group were lower than baseline,with statistical significance(F=43.175,12.594,11.092,4.579,3.514,P<0.01).Conclusion Mindfulness-based therapy may have certain value in reducing incidence of POCD and improving sleep quality in elderly patients who underwent surgery under local anesthesia.