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| 盐酸戊乙奎醚对全麻老年患者全膝关节置换术后早期睡眠的影响 |
| Effects of penehyclidine hydrochloride on early sleep function after total knee arthroplasty in elderly patients under general anesthesia |
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| DOI：10.12089/jca.2019.03.012 |
| 中文关键词: 全膝关节置换术 盐酸戊乙奎醚 老年患者 术后早期睡眠 |
| 英文关键词: Total knee replacement Penehyclidine hydrochloride Elderly patients Early postoperative sleep |
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| 中文摘要: |
目的 探讨盐酸戊乙奎醚术前用药对全麻老年患者术后早期睡眠的影响。
方法 选择全凭静脉麻醉下择期行首次全膝关节置换术（TKA）患者60例，男15例，女45例，年龄65～80岁，BMI 20～30 kg/m2，ASA Ⅱ或Ⅲ级，采用随机数字表法分为盐酸戊乙奎醚组（P组）和对照组（C组），每组30例。P组在术前30 min肌注盐酸戊乙奎醚1 mg；C组则给予生理盐水1 ml。采用脑电双频谱指数（BIS）监测术后第1晚睡眠时间、睡眠效率和睡眠质量；采用匹兹堡睡眠量表（PSQI）于术前1 d、术后24、72 h评估两组患者睡眠，总分≥7分为术后睡眠障碍，记录两组患者术后早期睡眠障碍的发生率；采用数字模拟评分（VAS）评估患者术前1 d、术后24、72 h静息和活动时疼痛程度。观察术后3 d盐酸戊乙奎醚相关口干、面红等不良反应发生情况。
结果 术后第1晚P组睡眠时间明显短于C组，睡眠效率和睡眠质量明显低于C组（P<0.05）。与术前1 d比较，术后1、3 d 两组睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分和PSQI评分均明显升高（P<0.05）；与术后1 d比较，术后3 d 两组患者睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分和PSQI评分均明显降低（P<0.05）；术后1 d P组患者睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍评分和PSQI评分明显高于C组（P<0.05）。术后1 d P组患者睡眠障碍发生率明显高于C组（P<0.05）；术后3 d 两组患者睡眠障碍发生率差异无统计学意义。两组患者不同时点静息和活动时VAS评分差异均无统计学意义。两组患者术后3 d均未发现与盐酸戊乙奎醚相关的口干、面红等不良反应。
结论 术前应用盐酸戊乙奎醚可降低老年患者术后早期睡眠质量，干扰其术后早期睡眠。 |
| 英文摘要: |
Objective To investigate the effects of penehyclidine hydrochloride on early postoperative sleep function in elderly patients.
Methods Sixty patients, 15 male and 45 female, aged 65 - 80 years, BMI 20 to 30 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for the primary elective total knee arthroplasty (TKA) under total intravenous anesthesia, were randomly divided into two groups (n=30 each) using a random number table：penehyclidine hydrochloride group (group P) and control group (group C). Patients in group P were administrated the intramuscular injection of penehyclidine hydrochloride 1 mg 30 min before operation. Patients in group C were administrated the intramuscular injection of normal saline 1 ml 30 min before operation. Sleep time, sleep efficiency and sleep quality at the first night after operation were evaluated with the Bispectral index (BIS) monitor. Pittsburgh sleep quality index (PSQI) was used to evaluate the sleep functions 1 d before and 1, 3h after operation. Postoperative sleep disturbance was defined by the score of PSQI ≥ 7. The incidences of early sleep disorder after operation of the two groups were recorded. The visual analog scale (VAS) was used to evaluate pain intensity during rest and activity 1 d before and 24,72 h after operation. The adverse effects, such as dry mouth and facial flushing related to penehyclidine hydrochloride were observed 3 d after operation.
Results Compared to group C, the sleep time was significantly shortened, and the sleep efficiency and the sleep quality were significantly decreased at the first night after operation in group P (P < 0.05). Compared to 1 d before operation, the sleep quality, sleep latency, sleep time, sleep efficiency, sleep disorder, daytime dysfunction and PSQI scores 1，3d after operation of both groups were significantly increased (P < 0.05). Compared to 1 d after operation, the sleep quality, sleep latency, sleep time, sleep efficiency, sleep disorder, daytime dysfunction and PSQI scores 3 d after operation of both groups were significantly decreased (P < 0.05). Compared to group C, the sleep quality, sleep latency, sleep time, sleep efficiency, sleep disorders and PSQI scores were significantly increased in group P (P < 0.05). Compared to group C, the incidence of postoperative sleep disturbance was higher in group P (P < 0.05). There was no significant difference of the incidence of postoperatively sleep disturbances 3 d after operation between the two groups. There was no statistical difference in the VAS score during rest or activity between the two groups 1 d before and 1, 3 d after operation. No adverse effects such as dry mouth and facial flushing occured 3 d after operation in two groups.
Conclusion Preoperative administration of penehyclidine hydrochloride can decrease the early postoperative sleep quality and disturb the early postoperative sleep function in elderly patients. |
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