|
| 小剂量艾司氯胺酮对老年衰弱患者胸腔镜手术后睡眠质量的影响 |
| Effect of low-dose esketamine on postoperative sleep quality in elderly frail patients undergoing thoracoscopic surgery |
| |
| DOI：10.12089/jca.2026.05.007 |
| 中文关键词: 艾司氯胺酮 睡眠 老年 衰弱 胸腔镜手术 |
| 英文关键词: Esketamine Sleep Aged Frailty Thoracoscopic surgery |
| 基金项目: |
|
| 摘要点击次数: 703 |
| 全文下载次数: 189 |
| 中文摘要: |
目的：评价小剂量艾司氯胺酮对老年衰弱患者胸腔镜手术后睡眠质量的影响。
方法：选择择期行胸腔镜手术患者，年龄65～80岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级，Fried衰弱量表评分≥3分。采用随机数字表法将患者分为两组：艾司氯胺酮组（E组）和对照组（C组）。两组麻醉诱导和维持方案相同。麻醉诱导后，E组静脉注射艾司氯胺酮0.1 mg/kg，并在术中连续静脉输注艾司氯胺酮0.1 mg·kg-1·h-1，持续至手术结束；C组给予等容量生理盐水静脉注射和连续静脉输注。主要指标为术后3 d RCSQ评分。次要指标包括术前1 d、术后1、2、3 d夜间睡眠参数（睡眠总分、深睡眠比例、浅睡眠比例、快动眼睡眠比例、睡眠连续性得分和清醒次数），术前1 d、术后7 d 理查兹-坎贝尔睡眠问卷（RCSQ）评分，术前1 d、术后3、7 d 15项恢复质量（QoR-15）评分，术后3、7 d睡眠障碍发生率，术后1、2 d静息时VAS疼痛评分，术后48 h内镇痛泵总按压次数、镇痛泵有效按压次数、氟比洛芬酯和曲马多补救镇痛率。不良反应包括术后恶心呕吐、视物模糊、谵妄、定向障碍等。
结果：共纳入患者98例，每组49例。与C组比较，E组术后1、2、3 d 睡眠总分、深睡眠比例和快速眼动睡眠比例明显升高，浅睡眠比例明显降低；术后3 d RCSQ评分、QoR-15评分明显升高（P＜0.05）。两组术前1 d和术后7 d RCSQ评分、QoR-15评分以及术后3、7 d睡眠障碍发生率、术后1、2 d静息时VAS疼痛评分、术后48 h内镇痛泵总按压次数、镇痛泵有效按压次数、氟比洛芬酯和曲马多补救镇痛率及术后不良反应发生率差异无统计学意义。
结论：术中应用小剂量艾司氯胺酮可改善老年衰弱患者胸腔镜手术后睡眠质量及术后恢复质量。 |
| 英文摘要: |
Objective: To evaluate the effect of low-dose esketamine on postoperative sleep quality in elderly frail patients undergoing thoracoscopic surgery.
Methods: Patients scheduled for elective thoracoscopic surgery were enrolled, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ, and Fried frailty scale score ≥ 3. The patients were randomly divided into two groups using a random number table: esketamine group (group E) and control group (group C). The induction and maintenance anesthesia protocols for both groups were the same. Group E was intravenously injected with esketamine 0.1 mg/kg after anesthesia induction, and continuous intravenous infusion of esketamine 0.1 mg·kg-1·h-1 was administered during the surgery until the end of the operation. Group C was given an equal volume of normal saline for intravenous injection and continuous intravenous infusion. The primary outcome was the Richards-Campbell sleep questionnaire (RCSQ) score on postoperative day 3. Secondary outcomes included the nighttime sleep parameters (total sleep scores, deep sleep proportion, light sleep proportion, rapid eye movement sleep proportion, score of sleep continuity, and number of nighttime awakenings) on preoperative day 1 and postoperative days 1, 2, and 3, the RCSQ scores on preoperative day 1 and postoperative day 7,the 15-item quality of recovery (QoR-15) scores on preoperative day 1, and postoperative day 3 and 7, the incidence of sleep disorders on postoperative days 3 and 7, the VAS pain scores at rest on postoperative days 1 and 2, the total number of pressings and effective number of pressings of the analgesic pump, and the rescue analgesic rate of flurbiprofen axetil and tramadol within 48 hours postoperatively. Adverse reactions included postoperative nausea and vomiting, blurred vision, delirium, and disorientation.
Results: Ninety-eight patients were included, 49 patients in each groups. Compared with group C, group E showed significantly increased total sleep scores, deep sleep proportion, rapid eye movement sleep proportion, and decreased light sleep proportion on postoperative days 1, 2, and 3, with elevated RCSQ and QoR-15 scores on postoperative day 3 (P < 0.05). There were no statistically significant differences between the two groups in the RCSQ score and QoR-15 score on preoperative day 1 and postoperative day 7, the incidences of sleep disorders on postoperative days 3 and 7, the VAS pain score at rest on postoperative days 1 and 2, the total number of pressings of the analgesic pump, the rescue analgesic rate of flurbiprofen axetil and tramadol within 48 hours postoperatively, and the incidence of adverse reactions.
Conclusion: Intraoperative administration of low-dose esketamine can improve both postoperative sleep quality and recovery quality in elderly frail patients undergoing thoracoscopic surgery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
