|
| 术中输注艾司氯胺酮或右美托咪定对心脏瓣膜置换术患者术后睡眠质量的影响 |
| Effect of intraoperative infusion of esketamine or dexmedetomidine on postoperative sleep quality in patients undergoing cardiac valve replacement |
| |
| DOI：10.12089/jca.2026.05.001 |
| 中文关键词: 艾司氯胺酮 右美托咪定 心脏瓣膜置换术 睡眠质量 |
| 英文关键词: Esketamine Dexmedetomidine Cardiac valve replacement Sleep quality |
| 基金项目: |
|
| 摘要点击次数: 959 |
| 全文下载次数: 252 |
| 中文摘要: |
目的：比较术中持续输注艾司氯胺酮和右美托咪定对心脏瓣膜置换术患者术后睡眠质量的影响。
方法：选择择期行心肺转流（CPB）下心脏瓣膜置换术患者，年龄50～80岁，BMI 18.5～28.0 kg/m2，ASA Ⅲ级，NYHA Ⅰ—Ⅲ级，左心室射血分数（LVEF）≥50%。采用随机数字表法将患者分为三组：艾司氯胺酮组（E组）、右美托咪定组（D组）和对照组（C组）。气管插管后，E组、D组和C组分别输注艾司氯胺酮0.3 mg·kg-1·h-1、右美托咪定0.3 μg·kg-1·h-1和等容量生理盐水至手术结束，三组其余麻醉方案和术后处理相同。主要指标为术后1 d阿森斯失眠量表（AIS）评分。次要指标包括术前1 d和术后3、7、30 d AIS评分，术后1、7 d夜间总睡眠时间、睡眠潜伏期、睡眠效率、深睡眠比例、浅睡眠比例、快动眼睡眠比例和清醒次数，术前1 d和术后1、3、7、30 d医院焦虑抑郁量表-抑郁分量表（HADS-D）评分，术后24、48 h静息时NRS疼痛评分以及术后住院时间。不良反应包括术后恶心、呕吐、头晕、谵妄、心脏不良事件等。
结果：共纳入患者166例，E组53例，D组57例，C组56例。与术前1 d比较，术后1、3、7、30 d三组AIS评分明显升高（P<0.05）。与C组比较，术后1、3、30 d E组和D组AIS评分明显降低（P<0.05）。与D组比较，E组术后3、7 d AIS评分明显降低；术后1、7 d总睡眠时间明显延长，睡眠效率明显升高，睡眠潜伏期明显缩短；术后1、3、7 d HADS-D评分、术后24、48 h静息时NRS疼痛评分以及心脏不良事件发生率明显降低，术后住院时间明显缩短（P<0.05）。
结论：艾司氯胺酮和右美托咪定均能改善心脏瓣膜置换术患者术后睡眠质量。与右美托咪定比较，艾司氯胺酮改善心脏瓣膜置换术患者的术后睡眠质量和减轻术后疼痛及抑郁状态的效果更好，更有利于患者术后康复。 |
| 英文摘要: |
Objective: To compare the effects of intraoperative continuous infusion of esketamine and dexmedetomidine on postoperative sleep quality in patients undergoing cardiac valve replacement.
Methods: Patients scheduled for elective cardiac valve replacement under cardiopulmonary bypass (CPB) were enrolled, aged 50-80 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅲ, NYHA cardiac functional class Ⅰ-Ⅲ, and left ventricular ejection fraction (LVEF) ≥ 50%. The patients were randomly assigned randomly to three groups using the random number table method: esketamine group (group E), dexmedetomidine group (group D), and control group (group C). After tracheal intubation, groups E, D, and C received continuous infusions of esketamine 0.3 mg·kg-1·h-1, dexmedetomidine 0.3 μg·kg-1·h-1, or equal-volume normal saline, respectively, until the end of surgery, with identical anesthetic protocols and postoperative management. The primary outcome was score of the Athens insomnia scale (AIS) on postoperative days 1. Secondary outcomes included the AIS scores on preoperative day 1 and postoperative days 3, 7, and 30, total sleep time, sleep latency, sleep efficiency, proportion of deep sleep, proportion of light sleep, proportion of rapid eye movement sleep, and number of awakenings on postoperative days 1 and 7, hospital anxiety and depression scale-depression subscale (HADS-D) scores on preoperative day 1 and postoperative days 1, 3, 7, and 30, NRS pain scores at rest at 24 and 48 hours postoperatively, and postoperative hospital stay. Adverse reactions included postoperative nausea, vomiting, dizziness, delirium, and cardiac adverse events.
Results: A total of 166 patients were enrolled, 53 patients in group E, 57 patients in group D, and 56 patients in group C. Compared with preoperative day 1, AIS scores significantly increased on postoperative days 1, 3, 7, and 30 in all three groups (P < 0.05). Compared with group C, groups E and D had significantly lower AIS scores on postoperative days 1, 3, and 30 (P < 0.05). Compared with group D, group E had significantly lower AIS scores on postoperative days 3 and 7, significantly longer total sleep time and higher sleep efficiency, and significantly shorter sleep latency on postoperative days 1 and 7, significantly lower HADS-D scores on postoperative days 1, 3, and 7, significantly lower NRS scores at rest at 24 and 48 hours postoperatively, significantly lower incidence of postoperative cardiac adverse events, and significantly shorter postoperative hospital stay (P < 0.05).
Conclusion: Both dexmedetomidine and esketamine improved postoperative sleep quality in patients undergoing cardiac valve surgery. However, compared with dexmedetomidine, esketamine was better in improving sleep quality and alleviating postoperative pain and depressive symptoms, thereby being more conducive to postoperative recovery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
