摘要
目的比较硬膜外镇痛和静脉镇痛对结直肠癌根治术患者术后睡眠质量的影响。方法选择择期行腹腔镜下结直肠癌根治术患者70例,性别不限,年龄25~65岁,ASAⅠ~Ⅱ级,18.5 kg/m^(2)≤BMI<28 kg/m^(2)。采用SPSS 19.0软件将患者随机分为硬膜外镇痛组(E组)和静脉镇痛组(V组)。E组全麻诱导前于T12-L1或T11-12节段旁侧入路穿刺置入硬膜外导管4~6 cm,术中及术后镇痛以硬膜外镇痛为主。V组未行硬膜外穿刺,术中及术后镇痛以静脉输注舒芬太尼为主。于术后1、3、7、30天时记录患者匹茨堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)和严重睡眠障碍的发生率;于术后3、7、30天记录患者术后恢复质量量表-15(Postoperative Quality of Recovery Scale-15,QoR-15)。记录患者切皮前和切皮时心率、收缩压和舒张压,麻醉后监护室(postanesthesia care unit,PACU)停留时间,PACU呼吸机支持通气时间和术后住院时间。观察患者住院期间主要不良事件的发生情况。结果2组患者术后1、3、7、30天时PSQI总分及严重睡眠障碍发生率差异无统计学意义;2组患者术后3、7、30天的QoR-15评分差异无统计学意义;2组患者PACU呼吸机支持通气时、术后住院时间、不良事件发生情况差异均无统计学意义。与V组比较,E组患者PACU停留时间较短(P<0.05),切皮时的收缩压和舒张压均较低(P<0.05);与术前比较,两组患者术后1、3、7、30天的PSQI总分增高(P<0.05);与术后30天比较,两组患者术后1、3、7天严重睡眠障碍发生率较高(P<0.05)。结论结直肠癌根治术患者术后1周内严重睡眠障碍的发生率较高,不同的镇痛方法可能对患者睡眠质量及术后恢复无影响。硬膜外镇痛能较好地抑制手术刺激,加快患者从PACU转出。
Objective To compare the effects of epidural analgesia and intravenous analgesia on postoperative sleep quality in patients undergoing radical resection of colorectal cancer.Methods Seventy patients who underwent elective laparoscopic radical resection of colorectal cancer were selected,with no gender limitation,age of 25-65 years old,ASAⅠ-Ⅱgrade,18.5 kg/m^(2)≤BMI<28 kg/m^(2).Using SPSS19.0 software,they were randomly divided into two groups,epidural analgesia group(group E)and intravenous analgesia group(group V).In group E,an epidural catheter of 4-6 cm was placed by puncture at the T12-L1 or T11-12 accessory approach before induction of general anesthesia,and intraoperative and postoperative analgesia was mainly based on epidural analgesia.In group V without epidural puncture,intravenous infusion of sufentanil was mainly used for analgesia during and after surgery.The Pittsburgh Sleep Quality Index(PSQI)and the incidence of severe sleep disorders were recorded on the 1,3,7,and 30 days after surgery,and the Postoperative Recovery Quality Scale-15(QoR-15)was recorded on the 3,7 and 30 days after the surgery.We recorded heart rate,systolic and diastolic blood pressure of the patients before and during the skin incision,postanesthesia care unit(PACU)stay time,PACU ventilator support ventilation time and postoperative hospital stay,and observe the occurrence of major adverse events during the patient's hospitalization.Results There was no significant difference in the total PSQI score and the incidence of severe sleep disorders on the 1,3,7 and 30 days after the operation between the two groups.There was no significant difference in QoR-15 score on the 3,7 and 30 days after operation between the two groups.There was no significant differences in the PACU ventilator support ventilation time,postoperative hospital stay,and adverse events between the two groups.Compared with group V,patients in group E had shorter PACU stay(P<0.05),and lower systolic and diastolic blood pressure during skin incision(P<0.05).Comp
作者
石超
贾利红
杨礼
许平波
张军
SHI Chao;JIA Li-hong;YANG Li;XU Ping-bo;ZHANG Jun(Department of Anesthesiology,Fudan University Shanghai Cancer Center-Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2023年第2期224-230,共7页
Fudan University Journal of Medical Sciences
