[1]阚清芳,王义凯,周　飞,等.右美托咪定对行甲状腺癌根治术患者术后睡眠质量和血清中食欲素A水平的影响[J].新乡医学院学报,2022,39(5):474-480.[doi:10.7683/xxyxyxb.2022.05.015]
　KAN Qingfang,WANG Yikai,ZHOU Fei,et al.Effects of dexmedetomidine on postoperative sleep quality and serum orexin A level in patients undergoing radical thyroidectomy[J].Journal of Xinxiang Medical University,2022,39(5):474-480.[doi:10.7683/xxyxyxb.2022.05.015]
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右美托咪定对行甲状腺癌根治术患者术后睡眠质量和血清中食欲素A水平的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年5
页码:
474-480
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

Title:
Effects of dexmedetomidine on postoperative sleep quality and serum orexin A level in patients undergoing radical thyroidectomy
作者:
阚清芳1; 王义凯1; 周　飞1; 刘　伟1; 贾瑞平2
（1.亳州市人民医院麻醉科，安徽　亳州　236800；2.新乡市中心医院骨科，河南　新乡　453099）
Author(s):
KAN Qingfang1; WANG Yikai1; ZHOU Fei1; LIU Wei1; JIA Ruiping2
(1.Department of Anesthesiology，the People′s Hospital of Bozhou,Bozhou 236800,Anhui Province，China;2.Department of Orthopaedics,Xinxiang Central Hospital,Xinxiang 453099,Henan Province,China)
关键词:
右美托咪定; 术后睡眠质量; 食欲素A; 甲状腺癌根治术
Keywords:
dexmedetomidine; postoperative sleep quality; orexin A; radical thyroidectomy
分类号:
R614
DOI:
10.7683/xxyxyxb.2022.05.015
文献标志码:
A
摘要:
目的　探讨右美托咪定对行甲状腺癌根治术患者术后睡眠质量以及血清中食欲素A水平的影响。方法　选择2020年1月至2021年6月在亳州市人民医院行全身麻醉下甲状腺癌根治术患者76例为研究对象，按照随机数字表法将患者分为观察组和对照组，每组 38 例。观察组患者在麻醉诱导前10 min静脉泵注右美托咪定0.5 μg·kg-1（生理盐水稀释至20 mL），术中以0.5 μg·kg-1·h-1（速率为5 mL·h-1）维持至手术结束；对照组患者麻醉诱导前10 min泵入生理盐水20 mL，术中以5 mL·h-1持续泵注生理盐水至手术结束。分别于术前1 d和术后１、3、5 d，应用匹兹堡睡眠质量指数量表(PSQI)评估患者主观睡眠情况，计算睡眠障碍发生率；应用酶联免疫吸附试验法检测血清中食欲素 A水平，40项恢复质量评定量表（QoR-40）评估患者术后恢复质量。比较2组患者术后12 h内睡眠总时间、苏醒时间、复苏室停留时间、麻醉药用量及术后不良反应发生情况。结果　术前1 d和术后5 d时，2组患者PSQI评分比较差异无统计学意义（P>0.05）；术后1、3 d时，观察组患者PSQI评分显著低于对照组（P<0.01）。2组患者术后1、3、5 d时的PSQI评分显著高于术前1 d，术后3、5 d时PSQI评分显著低于术后1 d，术后5 d时PSQI评分显著低于术后3 d（P<0.01）。术后1、3 d时，观察组患者睡眠障碍发生率显著低于对照组（P<0.05）；术后5 d时，观察组与对照组患者睡眠障碍发生率比较差异无统计学意义（P>0.05）。观察组患者术后1、3、5 d时睡眠障碍发生率比较差异无统计学意义（P>0.05）。对照组患者术后1 d与术后3 d时睡眠障碍发生率比较差异无统计学意义（P>0.05）；对照组患者术后5 d时睡眠障碍发生率显著低于术后1、3 d（P<0.05）。术前1 d、术后5 d时，2组患者血清中食欲素A水平比较差异无统计学意义（P>0.05）；术后1、3 d时，观察组患者血清中食欲素A水平显著低于对照组（P<0.01）。对照组患者术后1、3 d时血清中食欲素A水平高于术前1 d和术后5 d时（P<0.01），术后1 d时与术后3 d时及术后5 d时与术前1 d时血清中食欲素A水平比较差异无统计学意义（P>0.05）。观察组患者术前1 d、术后1、3、5 d 时血清中食欲素A水平比较差异无统计学意义（P>0.05）。术前1 d及术后3、5 d时，2组患者QoR-40评分比较差异无统计学意义（P>0.05）；术后1 d时，观察组患者QoR-40评分显著高于对照组（P<0.01）。2组患者术后1 d时QoR-40评分显著低于术前1 d（P<0.01）；对照组患者术后3 d时QoR-40评分显著低于术前1 d（P<0.01），2组患者术后3 d时QoR-40评分显著高于术后1 d（P<0.01）；观察组患者术后3 d时与术前1 d时QoR-40评分比较差异无统计学意义（P>0.05）；2组患者术后5 d时QoR-40评分显著高于术后1 d（P<0.01），对照组患者术后5 d时QoR-40评分显著高于术后3 d（P<0.01），观察组患者术后5 d时与术后3 d时QoR-40评分比较差异无统计学意义（P>0.05）；2组患者术后5 d时与术前1 d时QoR-40评分比较差异无统计学意义（P>0.05）。观察组患者手术日睡眠总时间显著长于对照组，丙泊酚、瑞芬太尼用量显著少于对照组（P<0.01）；2组患者苏醒时间、复苏室停留时间比较差异无统计学意义（P>0.05）。观察组患者术后寒战发生率低于对照组（P<0.05），2组患者术后躁动、苏醒延迟、恶心呕吐、心动过缓发生率比较差异无统计学意义（P>0.05）。结论　甲状腺癌根治术术中辅助应用右美托咪定能够减少患者血清食欲素A的水平，改善患者术后睡眠质量，减少睡眠障碍的发生，有利于患者术后恢复，且不良反应少。
Abstract:
Objective　To investigate the effects of dexmedetomidine on postoperative sleep quality and srum orexin A level in patients underwent radical thyroidectomy.Methods　Seventy-six patients who underwent radical thyroidectomy under general anesthesia in the People′s Hospital of Bozhou from January 2020 to June 2021 were selected as the research subjects,and they were randomly divided into observation group and control group,with 38 cases in each group.The patients in the observation group were intravenously injected 0.5 μg· kg-1 of dexmedetomidine (diluting normal saline to 20 mL) before 10 min of anesthesia induction，and which was maintained with 0.5 μg· kg-1·h-1until the end of the operation.The patients in the control group was pumped with 20 mL of normal saline before 10 min of anesthesia induction,and 5 mL·h-1 of normal saline was continuously pumped until the end of the operation.At 3 day before operation and 1,3 and 5 days after operation,the subjective sleep status of patients was evaluated by Pittsburgh sleep quality index (PSQI) and the incidence of sleep disorders was calculated,the level of orexin A in serum was detected by enzyme-linked immunosorbent assay,the quality of postoperative recovery was evaluated by 40 item recovery quality assessment scale (QoR-40).The total sleep time,recovery time,residence time in resuscitation room,anesthetic dosage and postoperative adverse reactions were compared between the two groups.Results　There was no significant difference in PSQI score of patients between the two groups at 1 day before operation and 5 days after operation (P>0.05).At 1 day and 3 days after operation,the PSQI score of patients in the observation group was significantly lower than that in the control group (P<0.01).The PSQI score of patients in the two groups at 1,3 and 5 days after operation was significantly higher than that at 1 day before operation,the PSQI score of patients in the two groups at 3,5 days after operation was significantly lower than that at 1 day after operation,and the PSQI score of patients in the two groups at 5 days after operation was significantly lower than that at 3 day after operation (P<0.01).At 1 day and 3 days after operation,the incidence of sleep disorders in the observation group was significantly lower than that in control group (P<0.05);there was no significant difference in the incidence of sleep disorders between observation group and control group at 5 days after operation (P>0.05).There was no significant difference in the incidence of sleep disorders at 1,3 and 5 days after operation in the observation group (P>0.05).There was no significant difference in the incidence of sleep disorders in the control group at 1 day and 3 days after operation (P>0.05);the incidence of sleep disorder in the control group at 5 days after operation was significantly lower than that at 1 day and 3 days after operation (P<0.05).There was no significant difference in serum orexin A levels of patients between the two groups at 1 day before operation and 5 days after operation (P>0.05).At 1 day and 3 days after operation,the serum orexin A level in the observation group was significantly lower than that in the control group (P<0.01).The level of orexin A in serum of patients in the control group at 1 day and 3 days after operation was significantly higher than that at 1 day before operation and 5 days after operation (P<0.01);there was no significant difference in the level of orexin A in serum of patients at 1 day after operation and 3 days after operation in the control group (P>0.05);there was no significant difference in the level of orexin A in serum of patients at 5 days after operation and 1 day before operation in the control group (P>0.05).There was no significant difference in serum orexin A level of patients in observation group at 1 day before operation and 1,3 and 5 days after operation (P>0.05).There was no significant difference in QoR-40 score of patients between the two groups at 1 day before operation,3 days after operation and 5 days after operation (P>0.05);1 day after operation,the QoR-40 score of patients in the observation group was significantly higher than that in the control group (P<0.01).The QoR-40 score of patients at 1 day after operation was significantly lower than that at 1 day before operation in the two groups (P<0.01);at 3 days after operation,the QoR-40 score of patients in the control group was significantly lower than that at 1 day before operation (P< 0.01),and the QoR -40 score of patients in the two groups was significantly higher than that at 1 day after operation (P<0.01);at 3 days after operation,there was no significant difference in QoR -40 score of patients in the observation group compared with that at 1 day before operation (P>0.05);at 5 days after operation,the QoR-40 score of patients in the two groups was significantly higher than that at 1 day after operation (P<0.01),the QoR-40 score of patients in the control group was significantly higher than that at 3 days after operation (P<0.01),and there was no significant difference in QoR-40 score of patients in the observation group compared with that at 3 days after operation (P>0.05).There was no significant difference in QoR-40 score of patients at 5 days after operation and 1 day before operation in the two groups (P>0.05) .The total sleep time on operation day of patients in the observation group was significantly longer than that in the control group,and the dosages of propofol and remifentanil were significantly lower than that in the control group (P<0.01).There was no significant difference in recovery time and residence time in resuscitation room between the two groups (P>0.05).The incidence of postoperative shivering of patients in the observation group was significantly lower than that in control group (P<0.05),and there was no significant difference in the incidence of postoperative agitation,delayed awakening,nausea,vomiting and bradycardia of patients between the two groups (P>0.05).Conclusion　The adjuvant application of dexmedetomidine during radical thyroidectomy can reduce the serum level of orexin A,improve the postoperative sleep quality and reduce the occurrence of sleep disorders of patients,which is conducive to postoperative recovery with less adverse reactions.

参考文献/References:

［1］　WANG J,YU F,SHANG Y,et al.Thyroid cancer:incidence and mortality trends in China,2005-2015［J］.Endocrine,2020,68(1):163-173.
［2］　WANG S,HUANG H,WANG L,et al.A psychological nursing intervention for patients with thyroid cancer on psychological distress and quality of life:arandomized clinical trial［J］.J Nerv Ment Dis,2020,208(7):533-539.
［3］　楼旭丹,陈芳,柴启亮,等.老年甲状腺癌的风险评估和睡眠质量的诊断价值分析［J］.老年医学与保健,2021,27(6):1134-1138.
LOU X D,CHEN F,CHAI Q L,et al.Risk assessment of thyroid cancer and diagnostic value of sleep quality in the elderly［J］.Geriatr Health Care,2021,27(6):1134-1138.
［4］　刘星扬,郭立哲,王锷.老年患者睡眠障碍对术后康复影响的研究进展［J］.中华麻醉学杂志,2021,41(7):888-892.
LIU X Y,GUO L Z,WANG E.Progress in effect of sleep disorders on postoperative recovery in elderly patients［J］.Chin J Anesth,2021,41(7):888-892.
［5］　HAN X,SUN X,LIU X,et al.Single bolus dexmedetomidine versus propofol for treatment of pediatric emergence delirium following general anesthesia［J］.Paediatr Anaesth,2022,32(3):446-451.
［6］　MOODY O A,ZHANG E R,VINCENT K F,et al.The neural circuits underlying general anesthesia and sleep［J］.Anesth Analg,2021,132(5):1254-1264.
［7］　CAI J,CHEN Y,HAO X,et al.Effect of intraoperative dexmedetomidine dose on postoperative first night sleep quality in elderly surgery patients:aretrospective study with propensity score-matched analysis［J］.Front Med (Lausanne),2020,7:528.
［8］　ZHAO P,YOU Y,WANG Z,et al.Orexin A peptidergic system:comparative sleep behavior,morphology and population in brains between wild type and Alzheimer′s disease mice［J］.Brain Struct Funct,2022,227(3):1051-1065.
［9］　WATERS K.Review of the efficacy and safety of lemborexant,a dual receptor orexin antagonist (DORA),in the treatment of adults with insomnia disorder［J］.Ann Pharmacother.2022,56(2):213-221.
［10］　CHANG Q,XIA Y,BAI S,et al.Association between pittsburgh sleep quality index and depressive symptoms in Chinese resident physicians［J］.Front Psychiatry,2021,12:564815.
［11］　MIKLC＇ BUBLIC＇ M,MIKLI C＇ P,BARL P,et al.Croatian version of the quality of recobery questionnaire (QoR-40):transcultural adaptation and validation［J］.Acta Clin Croat,2021,60(2):237-245.
［12］　周军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响［J］.新乡医学院学报,2019,36(4):353-356.
ZHOU J,ZHANG Y Y,CONG X H,et al.Effect of dexmedetomidine on agitation during gengral anesthesia recovery period in children underwent tonsillectomy［J］.J Xinxiang Med Univ,2019,36(4):353-356.
［13］　杨舒婷,张倩,许一凡,等.非心脏手术患者术后睡眠障碍预测模型的建立与验证［J］.中华麻醉学杂志,2021,41(4):421-426.
YANG S T,ZHANG Q,XU Y F,et al.Establishment and validation of prediction model for postoperative sleep disturbance in patients undergoing non-cardiac surgery［J］.Chin J Anesth,2021,41(4):421-426.
［14］　O′GARA B P,GAO L,MARCANTONIO E R,et al.Sleep,pain,and cognition:modifiable targets for optimal perioperative brain health［J］.Anesthesiology,2021,135(6):1132-1152.
［15］　IRWINM R.Sleep and inflammation:partners in sickness and in health［J］.Nat Rev Immunol,2019,19(11):702-715.
［16］　ROCHE J,VOS A G,LALLA-EDWARD S T,et al.Importance of testing the internal consistency and construct validity of the Pittsburgh Sleep Quality Index (PSQI) in study groups of day and night shift workers:example of a sample of long-haul truck drivers in South Africa［J］.Appl Ergon,2022,98:103557.
［17］　WU X H,CUI F,ZHANG C,et al.Low-dose dexmedetomidine improves sleep quality pattern in elderly patients after noncardiac surgery in the Intensive Care Unit:apilot randomized controlled trial［J］.Anesthesiology,2016,125(5):979-991.
［18］　张鸿燕,李双月.右美托咪啶对腹腔镜胆囊切除术后患者早期睡眠的影响［J］.浙江医学,2019,41(6):587-590.
ZHANG H Y,LI S Y.Dexmedetomidine improves early postoperative sleep quality in patients undergoing laparoscopic cholecystectomy［J］.Zhejiang Med J,2019,41 (6):587-590.
［19］　王开,段光友,赵鹏,等.右美托咪定术中持续泵注对脊柱手术患者术后睡眠质量的改善作用［J］.第三军医大学学报,2020,42(10):1002-1007.
WANG K,DUAN G Y,ZHAO P,et al.Effects of intraoperative continuous pumping of dexmedetomidine on postoperative sleep quality in patients undergoing spinal surgery［J］.J Third Milit Med Univ,2020,42(10):1002-1007.
［20］　VAZQUEZ-DEROSE J,SCHWARTZ M D,NGUYEN A T,et al.Hypocretin/orexin antagonism enhances sleep-related adenosine and GABA neurotransmission in rat basal forebrain［J］.Brain Struct Funct，2016,221(2):923-940.
［21］　WANG C,WANG Q,JI B,et al.The orexin/receptor system:molecular mechanism and therapeutic potential for neurological diseases［J］.Front Mol Neurosci,2018,11:220.
［22］　张莹,徐亮,尹荣真,等.40项恢复质量评分量表评估老年胃肠道肿瘤切除术患者早期恢复质量的研究［J］.中国医师进修杂志,2019,42 (1):2-5.
ZHANG Y,XU L,YIN R Z,et al.Evaluation of early recovery quality in elderly patients with gastrointestinal tumor resection by quality of recovery-40 questionnaire［J］.Chin J Postgrad Med,2019,42 (1):2-5.
［23］　GE D J,QI B,TANG G,et al.Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal hysterectomy:a double-blind,randomized clinical trial［J］.Sci Rep,2016,6:21514.

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　CHEN Shengyang,ZHANG Yongqiang,LIU Jun,et al.Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting[J].Journal of Xinxiang Medical University,2021,38(5):828.[doi:10.7683/xxyxyxb.2021.09.006]
[10]周世凤,詹　玮,边成富.右美托咪定对行肝叶切除术原发性肝癌患者氧化应激、肝功能及外周血单核细胞内Toll样受体2和Toll样受体4表达的影响[J].新乡医学院学报,2020,37(9):869.[doi:10.7683/xxyxyxb.2020.09.015]
　ZHOU Shifeng,ZHAN Wei,BIAN Chengfu.Effect of dexmedetomidine on oxidative stress，liver function and expression of Toll-like receptor 2 and Toll-like receptor 4 in peripheral blood monouclear cells in patients with primary liver cancer undergoing hepalobectomy[J].Journal of Xinxiang Medical University,2020,37(5):869.[doi:10.7683/xxyxyxb.2020.09.015]

更新日期/Last Update: 2022-05-05