三甲医院临床护士睡眠质量与焦虑抑郁的相关性

目的 了解三甲医院临床护士睡眠质量与焦虑、抑郁的现状,并探讨其相关性.方法 采用匹兹堡睡眠质量指数量表、焦虑自评量表、抑郁自评量表对310名三甲医院临床护士进行调查.结果 临床护士睡眠质量评分为(6.57±3.44)分,焦虑评分为(47.42±10.30)分,抑郁评分为(49.22±10.38)分.不同第一学历及夜班频率的护士睡眠质量评分比较,差异有统计学意义(均P＜0.01).护士睡眠质量与焦虑、抑郁呈正相关(均P＜0.01).结论 三甲医院临床护士睡眠质量亟待提高,应采取有效措施进行干预,以改善其睡眠质量及身心健康水平.     

失眠症患者的睡眠行为与应对方式及其心理干预

目的探讨失眠症患者的睡眠行为、应对方式及其心理干预的效果。方法采用睡眠行为特征量表、应对方式问卷对72例失眠症患者(干预组)和72例睡眠正常者(对照组)进行测评,干预组实施心理干预。结果干预组干预前睡眠的不合理信念、非功能性睡眠行为和夜间焦虑以及自责的评分均明显高于对照组(均P<0.01),而睡眠效率以及解决问题的评分明显低于对照组(P<0.01);经过8周的心理干预后,失眠症患者睡眠的不合理信念、非功能性睡眠行为和夜间焦虑以及解决问题、自责因子分与入组时相比,差异有显著性意义(P<0.01,P<0.05)。结论失眠症患者存在睡眠的不合理信念、非功能性睡眠行为和夜间焦虑,解决问题能力低,心理干预能有效改善患者的睡眠行为和应对方式。     

三叉神经痛射频消融术干预性护理对改善患者睡眠质量及疼痛程度的效果

目的探讨三叉神经痛射频消融术干预性护理对改善患者睡眠质量及疼痛程度的效果。方法回顾性分析2019-07—2020-07间于信阳市中心医院疼痛科接受射频消融术治疗的78例三叉神经痛患者的临床资料。依据护理方法分为常规护理组和干预性护理组,各39例。比较2组患者的一般资料、睡眠质量(PSQI)及疼痛程度评分(VAS)。结果 2组患者的一般资料差异无统计学意义(P>0.05)。干预性护理组干预后的VAS评分(3.10±1.05)分低于对照组的(4.15±1.29)分,PSQI评分(8.13±1.32)分低于对照组的(9.03±1.56)分,差异有统计学意义(P<0.05)。结论干预性护理措施可减轻接受射频消融术的三叉神经痛患者的疼痛程度,改善其睡眠质量。     

费登奎斯动中觉察干预对护士睡眠改善及疲劳恢复的影响

目的 探讨费登奎斯动中觉察干预对护士睡眠改善及疲劳恢复的影响。方法 将山西省某三级甲等医院外科工作的轮班护士,按参与研究的先后顺序分为干预组36人和对照组37人。干预组实施为期8周的费登奎斯动中觉察干预,对照组不实施任何干预。比较干预前、干预6周、干预8周两组护士匹茨堡睡眠质量指数量表得分和中文版多维疲劳量表得分。结果 两组主观睡眠质量、睡眠潜伏期、睡眠持续时间、习惯性睡眠效率得分及睡眠总分比较,差异有统计学意义(均P<0.05);两组疲劳总分的时间效应、组间效应及交互效应差异有统计学意义(均P<0.05)。结论 费登奎斯动中觉察干预可有效改善护士睡眠质量,促进疲劳恢复。     

恢复体验干预对护士睡眠质量和工作投入的影响

目的探讨恢复体验干预对护士睡眠质量和工作投入的改善效果。方法将114名恢复体验较弱的临床护士随机分为干预组和对照组各57名。对照组护士给予常规医院人文关怀,干预组在此基础上进行为期4周的恢复体验干预。分别于干预前、干预后3 d内、干预后1个月和干预后3个月采用恢复体验问卷(REQ)、匹兹堡睡眠质量量表(PSQI)和工作投入量表简化版(UWES-9)对两组护士进行调查。结果干预组干预后不同时间恢复体验、睡眠质量和工作投入显著优于对照组(干预、时间及交互效应均P0.01)。结论恢复体验干预可以显著提高护士的睡眠质量和工作投入状况。     

重症监护室患者睡眠剥夺的集束护理干预策略

目的探讨重症监护室患者睡眠剥夺的集束护理干预策略,提高患者睡眠质量。方法将重症监护室有睡眠剥夺现象的患者326例按入住时间分为对照组160例和观察组166例。对照组给予常规护理及睡眠卫生宣教,观察组在此基础上,接受集束化护理干预,包括改善环境、加强护理人员培训、建立相对固定的作息制度、对病理生理因素的干预、提高患者应对水平。结果干预后观察组匹兹堡睡眠指数量表各维度分及总分显著低于对照组(均P<0.05)。结论对重症监护室患者采用集束化干预策略进行睡眠护理,可提高患者的睡眠质量。     

护理干预对重症监护病房病人睡眠障碍的影响

目的:探讨护理干预对ICU病人睡眠障碍的影响.方法:将60例ICU病人随机分为干预组和对照组(各30例).对照组进行常规护理;干预组在对照组基础上进行护理干预,包括健康教育、疼痛护理、改善环境和心理护理等,并在干预前后采用匹兹堡睡眠质量指数(PSQI)量袁进行睡眠质量评价和比较.结果:干预组通过护理干预,病人睡眠障碍明显减轻.两组比较差异有统计学意义(P<0.05).结论:针对影响重症监护病房病人的睡眠因素,对病人实施健康教育,以改善其睡眠障碍,提高睡眠质量,有助于促进病人早日康复.     

综合干预对骨质疏松老年人疼痛及睡眠质量的影响

目的观察睡眠规范管理、疼痛管理联合脉冲电磁场治疗对骨质疏松老年人疼痛及睡眠质量的干预效果。方法于2015年1月至7月期间,选取在华北理工大学附属医院骨质疏松门诊就诊的存在睡眠障碍的骨质疏松老年患者80例,遵循不平衡指数最小原则将研究对象分为干预组和对照组,对照组给予常规睡眠健康教育配合抗骨质疏松基础治疗,干预组在对照组的基础上,根据课题组前期研究结果,设计实施规范睡眠管理方案、疼痛管理联合脉冲磁场治疗的综合干预。收集患者的一般资料,并分别于干预前和干预5周后,评测患者疼痛程度(NRS)和睡眠质量(PSQI),观察疗效。结果干预后干预组患者NRS评分(3.89±2.894)较对照组(5.80±2.785)有所降低,干预组患者PSQI评分除睡眠时间这一维度外,总分及其余各维度明显低于对照组,差异有统计学意义(P0.05)。结论综合干预能有效缓解骨质疏松老年人的疼痛程度,提高睡眠质量。     

基于循证和德尔菲法构建ICU患者睡眠管理方案

目的 提高ICU 患者的睡眠质量。方法 采用循证方法筛选最佳证据,经研究小组讨论构建ICU 睡眠管理初步方案;采用德 尔菲法向20名危重症领域医疗护理专家进行2轮函询。结果 纳入12项高质量证据,构建包括失眠诊断、睡眠质量评估、睡眠危 险因素评估、睡眠危险因素干预、其他提高睡眠质量措施的5个方面共11项内容的睡眠管理方案;专家积极性为100% ,权威系 数0.84,变异系数0.17~0.21,W 值0.196、0.249,均P<0.01。结论 本ICU 患者睡眠管理方案构建过程严谨,结果可靠,可用 于临床ICU 患者的睡眠管理,以验证该管理方案的适用性。     

社区老年类风湿关节炎患者自我管理行为对睡眠质量的影响

目的:探讨社区老年类风湿关节炎患者焦虑、抑郁水平及其睡眠质量,并分析两者的相关性。方法:采用慢性病自我管理量表和匹兹堡睡眠质量指数对220例社区老年类风湿关节炎患者进行问卷调查。结果:社区老年类风湿关节炎患者自我管理行为总分为(26.10±5.45)分,睡眠质量总分为(9.73±3.56)分,患者自我管理行为与睡眠质量总分呈负相关(r=-0.696,P<0.01)。结论:社区老年类风湿关节炎患者自我管理行为与睡眠质量密切相关。在今后工作中,应重视患者对疾病的自我管理行为,提供针对性的干预措施,提高患者的睡眠质量。     

Anesthetic management of obstructive sleep apnea patients

Presented is an illustrative case report ana a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be identified. Although sleep centers vary in their definitions, severe obstructive sleep apnea is diagnosed if the patient demonstrates an apnea index greater than 70 and an oxygen (O₂) desaturation less than 80% with cardiovascular sequelae. Severe sleep apnea patients are at extreme risk for general anesthesia. These risks should be discussed preoperatively with the patient. Unsupervised preoperative sedation should be avoided because of the extreme sensitivity of these patients to sedatives and airway obstruction.

Intraoperative management of the obstructive sleep apnea patient varies depending on the severity of the sleep apnea. Invasive monitoring may be necessary if the patient demonstrates evidence of cardiopulmonary dysfunction. With the assistance of the otolaryngologist, the anesthesiologist can formulate an approach to establishing an airway. Intraoperative opoids and sedatives should be limited.

The recovery o f the sleep apnea patient is extremely important and is the time when most airway emergencies occur. Extubation of the patient should occur when, appropriate surgical personnel and equipment are available in case of an airway emergency. Steroids may be used to decrease the amount of airway swelling. Supplemental O₂ should be used in patients who demonstrate desaturation. Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.     

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first‐line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.     

Prevalence of sleep disorders among ESRD patients

Abstract

Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group). In addition to laboratory investigations which included creatinine clearance using Cockroft and Gault formula, hemoglobin level (Hb), blood urea, serum creatinine, serum albumin, serum calcium and phosphorus and lipid profile, all subjects underwent one night of laboratory-based polysomnography (PSG) consisting of a standard montage of electroencephalography (EEG) (C3/A1 and O2/C3 or O1/C4), monopolar left and right electrooculography (EOG) referenced to the opposite mastoid, surface mentalis electromyography (EMG), respiratory airflow (measured by thermistor) and effort (piezoelectric sensors), electrocardiography (ECG), anterior tibialis EMG and pulse oximetry. For hemodialysis subjects, this study was performed on a night immediately following hemodialysis treatment. The results showed that patients on hemodialysis have sleep disorders, and that sleep disorders are common in group I and II than control group. The percentage of sleep disorders in hemodialysis patients were as follows: insomnia (69%), followed by obstructive sleep apnea syndrome OSAS (24%), RLS and periodic limb movement PLM (18%), nightmares (13%), EDS (12%), sleepwalking (2%), possible rapid eye movement behavior disorders RED (2%), possible narcolepsy (1.4%). While the percentage of sleep disorders in CKD patients were as follows: insomnia (54%), followed by RLS (19%), PLM (12%), OSAS (16%), nightmares (15%), EDS (15%), sleepwalking (4%), possible RBD (3%), possible narcolepsy (1%). There was inverse correlation between sleep disorders and Hb, albumin and creatinine clearance; also there was positive correlation between sleep disorder and phosphorus. We concluded that the sleep disorders are common in CKD patients either on conservative management or on regular hemodialysis. Treatment of anemia, hyperphosphatemia and hypoalbuminemia may improve sleep disorders among those patients.     

阻塞性睡眠呼吸暂停综合征患者围术期气道管理的研究进展

阻塞性睡眠呼吸暂停综合征是一种常见的睡眠呼吸障碍疾病,其发生发展与多种因素有关。此类患者由于大多具有颈短粗、舌体肥大及口咽腔空间狭窄等异常解剖结构,会导致面罩通气以及插管困难,困难气道的发生率高。为降低此类患者围术期气道相关并发症的发生,本文就阻塞性睡眠呼吸暂停综合征患者围术期气道管理的研究进展进行综述,以期为临床提供参考。     

右美托咪定复合氯胺酮用于阻塞型睡眠呼吸暂停综合征患儿行药物诱导睡眠气道镜检查的可行性研究

目的探讨右美托咪定(dexmedetomidine,Dex)复合氯胺酮用于阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患儿行药物诱导睡眠气道镜检查(drug-induced sleep endoscopy,DISE)的效果及副作用。方法OSAS患儿70例,年龄3~12岁,ASA分级Ⅰ、Ⅱ级,性别不限,按随机数字表法分为A组和B组,每组35例。两组患儿在10 min内静脉输注Dex负荷剂量2μg/kg,再以1μg·kg^-1·h^-1静脉输注维持。A组在开始静脉注射Dex时即追加氯胺酮1 mg/kg,B组则在静脉注射Dex 5 min时追加氯胺酮1 mg/kg。所有患儿Ramsay评分>5分后开始检查。记录患儿检查一次性成功率,记录患儿清醒状态(T₀)、输注Dex负荷剂量5 min(T₁)、输注Dex负荷剂量10 min(T₂)、检查时(T₃)的生命体征,记录患儿因体动而追加氯胺酮的情况和用药后不良事件。结果B组检查一次性成功率高于A组(P<0.05)。B组患儿T₂时SpO₂低于A组,T₁时心率、DBP、SBP低于A组,差异有统计学意义(P<0.05)。A组患儿T₁、T₂、T₃时SpO₂、心率均较T₀降低(P<0.05),SBP、DBP较T₀升高(P<0.05);T₂、T₃时心率较T₁时降低(P<0.05);T₃时SpO₂较T₂时降低(P<0.05)。B组患儿T₁、T₂、T₃时SpO₂、心率较T₀下降(P<0.05);T₁时SBP较T₀降低(P<0.05),T₂时SBP较T₀升高(P<0.05),T₂、T₃时DBP较T₀升高(P<0.05);T₂、T₃时SpO₂较T₁时下降(P<0.05),心率、SBP较T₁时升高(P<0.05);T₂时DBP较T₁时升高(P<0.05),T₃时DBP较T₂时降低(P<0.05)。两组患儿不良事件发生情况差异无统计学意义(P<0.05)。B组中1例心动过缓患儿静脉注射阿托品后好转,1例患儿在T₁时发生3∶2和4∶3二度房室阻滞,静脉注射氯胺酮后消失。结论Dex复合氯胺酮同步给药较先后给药对OSAS患儿缺氧和血流动力学影响更轻,未发生严重的心动过缓和低血压,是OSAS患儿行DISE时合适的麻醉方案。     

Influence of paradoxical sleep deprivation and sleep recovery on testosterone level in rats of different ages

This study was performed to assess serum testosterone alterations induced by paradoxical sleep deprivation (PSD) and to verify their attenuation during sleep recovery (SR) based on different durations and ages. Wistar male rats aged 12 weeks for the younger group and 20 weeks for the elder group were randomly distributed into one of the following groups: a control group (cage and platform), 3-day SD, 5-day SD, 7-day SD, 1-day SR, 3-day SR and 5-day SR groups. For PSD, the modified multiple platform method was used to specifically limit rapid eye movement (REM) sleep. Differences in the testosterone and luteinizing hormone levels between the younger group and the elder group according to duration of PSD and SR recovery were analysed. Testosterone continued to fall during the sleep deprivation period in a time-dependent manner in both the younger (P=0.001, correlation coefficient r=-0.651) and elder groups (P=0.001, correlation coefficient r=-0.840). The elder group showed a significantly lower level of testosterone compared with the younger group after PSD. Upon SR after 3 days of PSD, the testosterone level continued to rise for 5 days after sleep recovery in the younger group (P=0.013), whereas testosterone concentrations failed to recover until day 5 in the elder group. PSD caused a more detrimental effect on serum testosterone in the elder group compared to the younger group with respect to decreases in luteinizing hormone (LH) levels. The replenishment of serum testosterone level was prohibited in the elder group suggesting that the effects of SD/SR may be age-dependent. The mechanism by which SD affects serum testosterone and how age may modify the process are still unclear.     

The predictors of central and obstructive sleep apnoea in haemodialysis patients.

BACKGROUND: Sleep apnoea (SA) is often observed in haemodialysis patients, but there have been few studies on types of SA and their predictors. We therefore investigated the prevalence and types of SA and the associations between types of SA and clinical factors in haemodialysis patients. METHODS: We initially examined nocturnal oxygen desaturation index (ODI) (desaturation of >4%/events per hour) in 119 haemodialysis patients (68 males, mean age of 61.4 years). Patients with ODI of more than five were diagnosed as having SA. Then, 30 patients underwent polysomnography and we measured Apnoea-hypopnoea index (AHI), which was calculated as the number of apnoeas plus hypopnoeas per hour of sleep. Clinical characteristics were examined in all patients. RESULTS: Forty-one (34.5%) of the 119 patients had SA. Twenty-seven (22.7%) of the 119 patients had SA with subjective symptoms such as daytime somnolence and snoring. There was a significant difference between body mass index (BMI) in patients with SA and that in patients without SA (22.5 vs 19.8 kg/m2, P<0.001). There were significantly higher prevalences of hypertension (85.4 vs 66.7%, P<0.05) and diabetes mellitus (36.6 vs 10.3%, P<0.01) in patients with SA than those in patients without SA. Multivariable analysis showed that BMI was independently associated with the occurrence of SA (OR 1.20, 95% CI 1.05-1.38). Mean AHI of 30 patients who underwent polysomnography was 53.2+/-28.9 [central apnoea, 4.1+/-5.6 (8%); obstructive apnoea, 21.7+/-21.5 (42%); mixed apnoea, 4.9+/-8.0 (9%); hypopnoea, 21.4+/-15.5 (41%)]. The number of obstructive apnoea events per hour was significantly correlated with BUN (r=0.490, P<0.01), Cr (r=0.418, P<0.05) and BMI (r=0.489, P<0.01) and was inversely correlated with serum bicarbonate (r=-0.646, P<0.01) and brain natriuretic peptide (BNP) (r=-0.481, P<0.01). The number of central apnoea events per hour was correlated inversely with PaO2 (r=-0.393, P<0.05) and PaCO2 (r=-0.388, P<0.05) and tended to be correlated with cardiothoracic ratio (CTR) (r=0.347, P=0.060). CONCLUSIONS: There is a high prevalence of SA in haemodialysis patients. The dominant type of SA in haemodialysis patients is obstructive sleep apnoea (OSA). Uraemia (BUN, Cr), metabolic acidosis (serum bicarbonate) and BMI are good predictors of OSA. PaO2, PaCO2 and CTR are good predictors of central sleep apnoea (CSA). Good management of these factors might improve SA in haemodialysis patients.     

Obstructive sleep apnoea

A patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.     

产妇睡眠质量与产后疲乏的相关性研究

目的探索睡眠质量对产后疲乏程度的影响。方法以方便抽样法抽取8所医院产妇265例,采用疲乏量表、匹兹堡睡眠质量指数量表进行调查。结果产妇睡眠质量评分6.46±2.51;34.72%睡眠质量好,65.28%睡眠质量差。睡眠质量好者产后疲乏得分显著低于睡眠质量差者(P0.01)。回归分析结果显示,睡眠质量是影响产后疲乏程度的重要因素(P0.01)。结论睡眠质量不佳是影响产后疲乏的重要因素。应关注产妇睡眠情况,采取有效措施改善睡眠状况,以减轻产后疲乏。