摘要
目的探讨星状神经节阻滞(SGB)对老年患者腹腔镜胃肠道恶性肿瘤根治术后睡眠障碍(POSD)的影响。方法选择择期行腹腔镜胃肠道恶性肿瘤根治术的老年患者40例,男23例,女17例,年龄≥65岁,BMI 18.5~24.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:术前行SGB组(S组)和对照组(C组),每组20例。使用体动记录仪记录术前1 d、术后1、2、3 d夜间的睡眠质量。采用匹兹堡睡眠指数(PSQI)量表评估术前1 d、术后1、2、3、5、7 d夜间的睡眠情况和POSD的发生情况,PSQI>7分为睡眠障碍,总分越高表示睡眠质量越差。检测并记录术前1 d、术后1 d及术后3 d时血浆IL-1、IL-6及IL-10浓度。结果与C组比较,S组术后1、2 d夜间总睡眠时间(TST)明显延长、睡眠效率及睡眠维持率明显增加、睡眠期变化指数明显降低、清醒次数明显减少(P<0.05),术后1 d夜间入睡后清醒时间(WASO)明显缩短、体动次数明显减少(P<0.05),术后1、2 d夜间PSQI评分及POSD发生率明显降低(P<0.05),术后1 d IL-6浓度明显降低,术后3 d IL-1浓度明显降低,IL-10浓度明显升高(P<0.05)。结论星状神经节阻滞可减轻腹腔镜胃肠道恶性肿瘤根治术后炎症反应,改善患者术后睡眠障碍。
Objective To investigate the effects of stellate ganglion block(SGB)on postoperative sleep disturbance(POSD)in elderly patients undergoing laparoscopic radical surgery for gastrointestinal malignant tumor.Methods Forty elderly patients undergoing elective laparoscopic radical resection of gastrointestinal malignant tumor,23 males and 17 females,aged≥65 years,BMI 18.5-24.0 kg/m^(2),ASA physical statusⅠ-Ⅲ,were randomly divided into two groups using the random number table method:preoperative SGB treatment group(group S)and control group(group C),20 patients in each group.Quality of sleep was evaluated using a body movement recorder on the 1st night before surgery and on the 1st,2nd and 3rd postoperative nights,respectively.The PSQI scale and occurrence of POSD were used to assess sleep states on the 1st nights before surgery,and 1st,2nd,3rd,5th and 7th nights after surgery,respectively.PSQI>7 was considered as sleep disorder,and the higher the total score,the worse the sleep quality.Plasma IL-1,IL-6,and IL-10 concentrations were detected 1 day before surgery,1 and 3 days after surgery,respectively.Results Compared with group C,total sleep time(TST),sleep efficiency and sleep maintenance on the 1st and 2nd nights postoperatively in group S were significantly increased,and sleep period change index,number of wakefulness were significantly reduced(P<0.05),wake after sleep onset(WASO)and body movements on the 1st nights postoperatively were significantly reduced(P<0.05),PSQI scores and the incidence rate of POSD on the 1st and 2nd nights after surgery were significantly lower(P<0.05),IL-6 was significantly reduced 1 day after surgery,IL-1 was significantly reduced and IL-10 was significantly increased 3 days after surgery(P<0.05).Conclusion SGB can reduce postoperative inflammatory response,and improve POSD in patients undergoing laparoscopic radical gastrointestinal malignancy surgery.
作者
严诗婷
于乐洋
郁言龙
袁博
王莹
李宁
李虎
张冬生
张转
YAN Shiting;YU Leyang;YU Yanlong;YUAN Bo;WANG Ying;LI Ning;LI Hu;ZHANG Dongsheng;ZHANG Zhuan(Department of Anesthesiology,the Affiliated Hospital of Yangzhou University,Yangzhou 225012,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2023年第5期486-491,共6页
Journal of Clinical Anesthesiology
基金
扬州市卫生和计划生育委员会基金医学重点人才培养项目(ZDRC201815)
扬州大学附属医院院级课题重点项目(YZYY2017-07)。
关键词
星状神经节阻滞
睡眠质量
术后睡眠障碍
胃肠道
恶性肿瘤
Stellate ganglion block
Quality of sleep
Postoperative sleep disorder
Gastro￣intestinal
Malignancy
