国际麻醉学与复苏杂志   2024, Issue (8): 0-0
    
无阿片药麻醉对鼾症手术患者术后睡眠和恢复质量的影响
代莉, 郭华静, 潘道波, 邓恢伟1()
1.常德市第一人民医院
The effect of opioid‑free anesthesia on postoperative sleep and recovery quality in patients undergoing snoring surgery
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摘要:

目的 评价无阿片药麻醉(OFA)对鼾症手术患者术后睡眠和恢复质量的影响。 方法 选择2023年1月至2024年1月在中南大学湘雅医学院附属常德医院择期行鼾症术的患者120例,年龄18~45岁,体重指数(BMI)28~45 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,采用随机数字表法分为OFA组(OF组)和对照组(C组),每组60例。OF组采用右美托咪定、艾司氯胺酮、利多卡因、丙泊酚、罗库溴铵麻醉诱导,艾司氯胺酮、右美托咪定、七氟醚维持;C组采用舒芬太尼、丙泊酚、罗库溴铵诱导,瑞芬太尼、七氟醚维持。于术前1 d(D−1)、术后第1天(D1)、术后第3天(D3)早晨采用匹兹堡睡眠质量指数(PSQI)评分和15项恢复质量量表(QoR‑15)评分评估患者睡眠质量和恢复质量情况;术前2晚(N−2)、术后当晚(N0)、术后第2晚(N2)佩戴运动手表记录睡眠结构情况。记录患者手术一般资料,麻醉诱导前(T0)、气管插管前(T1)、气管插管后即刻(T2)、手术开始时(T3)、苏醒时(T4)、苏醒后10 min(T5)心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、脑电双频指数(BIS),D1、术后第2天(D2)、D3时静息和运动数字分级评分法(NRS)疼痛评分,术后不良反应及患者满意度评分。 结果 与N−2时比较,两组患者N0、N2时睡眠时间增加,睡眠效率增高,入睡后觉醒时间减少(均P<0.05),N0时入睡潜伏期延长(P<0.05);与D−1时比较,两组患者D1、D3时PSQI评分降低(均P<0.05),D1时QoR‑15评分降低(P<0.05)。与T0时比较:OF组心率在T2时增快(P<0.05),MAP在T3时降低(P<0.05),BIS在T1~T3时降低(均P<0.05);C组心率在T1、T3时降低(均P<0.05),MAP在T1~T3时降低(均P<0.05),BIS在T1~T4时降低(均P<0.05)。与C组比较:OF组N0时睡眠时间较长,睡眠效率较高,入睡潜伏期较短,入睡后觉醒时间较短(均P<0.05);D1时PSQI评分较低,QoR‑15评分较高(均P<0.05);T1、T2时心率较快(均P<0.05),T1~T3时MAP较高(均P<0.05);D1、D2时运动NRS疼痛评分较低(均P<0.05);恶心呕吐发生率较低,满意度评分较高(均P<0.05)。两组患者其余指标差异无统计学意义(均P>0.05)。 结论 OFA可改善鼾症手术患者术后睡眠质量和恢复质量,提高患者满意度。

关键词: 无阿片药麻醉; 鼾症; 睡眠质量; 恢复质量
Abstract:

Objective To evaluate the effect of opioid‑free anesthesia (OFA) on postoperative sleep and recovery quality in patients undergoing snoring surgery. Methods A total of 120 patients, aged 18‒45 years, with a body mass index (BMI) of 28‒45 kg/m2 and American Society of Anesthesiologists (ASA) level Ⅰ‒Ⅲ, who underwent snoring surgery at the Changde Hospital, Xiangya School of Medicine, Central South University from January 2023 to January 2024 were selected. They were divided into an OFA group (OF group) and a control group (C group) by using a random number table method, with 60 patients in each group. The dexmedetomidine, esketamine, lidocaine, propofol, and rocuronium were used for induction, while esketamine, dexmedetomidine, and sevoflurane for maintenance in the OF group; the sufentanil, propofol, and rocuronium were used for induction, while remifentanil and sevoflurane for maintenance in the C group. The patient's postoperative sleep and recovery qualities were evaluated by using the Pittsburgh sleep quality index (PSQI) scores and 15‑item Quality of Recovery (QoR‑15) scales on the first morning before surgery (D−1), the first day after surgery (D1), and the third day after surgery (D3). The patients wore a sport‑watch 2 nights before surgery (N−2), on the night after surgery (N0), and the second night after surgery (N2) for recording the sleep quality. The patient's general surgical information, including heart rate, mean arterial pressure (MAP), pulse oxygen saturation (SpO2), bispectral index (BIS) were recorded at the time points before anesthesia induction (T0), before tracheal intubation (T1), immediately after tracheal intubation (T2), at the beginning of surgery (T3), at awakening (T4), and 10 minutes after awakening (T5). The resting and exercise Numerical Rating Scale (NRS) pain scores for D1, the second day after surgery (D2), and D3. Postoperative adverse reactions and patient satisfaction were also recorded and analyzed. Results Compared with N−2, patients of both groups showed an increase in sleep time and sleep efficiency, a decrease in awake time after falling asleep on N0 and N2 (all P<0.05), and a prolonged sleep latency on N0 (P<0.05). Compared with D−1, both groups of patients had a decrease in PSQI scores on D1 and D3 (all P<0.05), and a decrease in QoR‑15 scores at D1 (P<0.05). Compared with T0, the heart rate increased at T2 (P<0.05), the MAP decreased at T3 (P<0.05), and BIS decreased at T1‒T3 (all P<0.05) in the OF group; the heart rate decreased at T1 and T3 (all P<0.05), MAP decreased at T1‒T3 (all P<0.05), and BIS decreased at T1‒T4 (all P<0.05) in the C group. Compared with C group, OF group had longer sleep time, higher sleep efficiency, shorter sleep latency, and shorter awakening time after falling asleep at N0 (all P<0.05); the PSQI score was low and the QoR‑15 score was high on D1 (all P<0.05); the heart rate was fast at T1‒T2 (all P<0.05), and MAP was high at T1‒T3 (all P<0.05); the NRS pain score was low on D1 and D2 (all P<0.05); while the incidence of nausea and vomiting was low, and the patient satisfaction score was high (all P<0.05). There was no statistical difference in other indicators between the two groups (all P>0.05). Conclusions OFA can improve the postoperative sleep and recovery quality of patients undergoing snoring surgery and increase patient satisfaction rate.

Key words: Opioid‑free anesthesia; Snoring; Sleep quality; Recovery quality