Effect of Intraoperative Dexmedetomidine Dose on Postoperative First Night Sleep Quality in Elderly Surgery Patients: A Retrospective Study With Propensity Score-Matched Analysis.
Effect of Intraoperative Dexmedetomidine Dose on Postoperative First Night Sleep Quality in Elderly Surgery Patients: A Retrospective Study With Propensity Score-Matched Analysis.
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术中右美托咪定剂量对老年手术患者术后首夜睡眠质量的影响：一项倾向计分配对分析的回顾性研究。
DOI：
10.3389/fmed.2020.00528
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发表时间：
2020
影响因子：
3.9
通讯作者：
Zhu T
中科院分区：
文献类型：
--
作者：
Cai J;Chen Y;Hao X;Zhu X;Tang Y;Wang S;Zhu T
背景：手术后睡眠障碍在老年手术患者中很常见，它往往会恶化手术后的恢复。本研究旨在探讨术中右美托咪定剂量对术后睡眠质量的影响。方法：根据电子病历系统提供的术中右美托咪定使用情况，将4,349例老年手术患者分为3组：术中未使用右旋美托咪定1,374例，使用右旋美托咪定0.1~0.2μg/kg/h(低地塞米松组)917例，使用右美托咪胺0.2μg/kg/h(高地塞米丁组)2,058例。记录术后第1晚睡眠障碍的数值评定量表(NRS)，并以NRS≥6的发生率作为主要结局。结果：术中应用右旋美托咪定的患者NRS(P<；0.001)和严重睡眠障碍的发生率(P<；0.001)均低于未使用右美托咪定的患者。低DEX组患者的发病率最低，其次是高DEX组和非DEX组(6.7%比13.7%比19.5%)。经过倾向性评分匹配后，90 6对老年手术患者被纳入低和高地塞组，低地塞组的不良反应率(2.7±2.1比3.1±2.4，P<；0.001)低于高地塞组。低DEX组严重睡眠障碍的发生率低于高DEX组(6.6%比12.8%)，优势比为0.48(95%可信区间为0.35~0.67)。结论：老年患者术中应用右旋美托咪定可明显改善术后首夜睡眠质量。小剂量(0.1~0.2μg/kg/h)右美托咪定对睡眠质量有改善作用，建议改善术后睡眠质量。
Background: Postoperative sleep disorder is common in elderly surgery patients, and it often worsens their recovery after surgery. This study aimed to explore the effect of intraoperative dexmedetomidine dose on postoperative sleep quality. Methods: Based on information regarding dexmedetomidine use during surgery from an electronic medical record system, 4,349 elderly surgery patients were divided into three groups: 1,374 without intraoperative use of dexmedetomidine (Non-DEX), 917 with dexmedetomidine 0.1–0.2 μg/kg/h (Low-DEX), and 2,058 with dexmedetomidine >0.2 μg/kg/h (High-DEX). The numerical rating scale (NRS) for sleep disturbance during the first night after surgery was recorded, and the incidence of NRS ≥ 6 was considered the primary outcome. Results: NRS (P < 0.001) and incidence of severe sleep disturbance (P < 0.001) were lower in patients receiving intraoperative dexmedetomidine than in those without the intraoperative use of dexmedetomidine. Patients in the Low-DEX group had the lowest incidence, followed by those in the High-DEX and Non-DEX groups (6.7% vs. 13.7% vs. 19.5%). After propensity score matching, 906 pairs of elderly surgery patients were included in the Low-DEX and High-DEX groups, and the Low-DEX group had lower NRS (2.7 ± 2.1 vs. 3.1 ± 2.4, P < 0.001) than the High-DEX group. The incidence of severe sleep disturbance was lower in the Low-DEX group than in the High-DEX group (6.6% vs. 12.8%) with an odds rate of 0.48 (95% confidence interval, 0.35 to 0.67). Conclusions: For elderly patients, intraoperative dexmedetomidine use can significantly improve the quality of the first night sleep after surgery. Low-dose (0.1–0.2 μg/kg/h) dexmedetomidine can have an improvement effect on sleep quality, and it is recommended to improve the quality of postoperative sleep.
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