食管癌患者术前睡眠障碍与术后谵妄的相关性

目的探讨食管癌根治术患者术前睡眠障碍与术后谵妄(POD)的相关性,以及睡眠参数与POD的关系。方法选择2019年9—12月择期行食管癌根治术患者97例,男71例,女26例,年龄60～75岁,ASAⅠ或Ⅱ级。根据是否发生POD将患者分为两组:未发生POD组(nPOD组)和发生POD组(POD组)。采用双腔支气管插管全身麻醉,术中维持血流动力学平稳、采用小潮气量肺保护性通气策略,术后采用患者自控静脉镇痛(PCIA)。术前1 d采用匹兹堡睡眠质量指数(PSQI)量表评价睡眠质量,并记录入睡时间、觉醒次数、觉醒时间、睡眠时间等睡眠参数。术后1～7 d采用意识评估(CAM)量表进行认知功能评估。结果术后7 d内共有24例(25%)患者发生POD。与nPOD组比较,POD组术前合并睡眠障碍发生率明显升高,觉醒次数明显增多,觉醒时间明显延长,有效睡眠时间明显缩短,觉醒占总睡眠比例(WASO)明显升高(P0.05)。多因素Logistic回归分析结果显示,觉醒次数增加(OR=3.868,95%CI 1.645～9.006,P=0.002)和有效睡眠时间缩短(OR=3.802,95%CI 1.577～9.174,P=0.003)是POD的独立危险因素。结论术前合并睡眠障碍的食管癌根治术患者发生POD风险增加,睡眠中断以及有效睡眠时间缩短进一步增加POD发生风险。

Association between preoperative fragmented sleep and postoperative delirium in patients with esophageal cancer

Objective To investigate the association between preoperative sleep disorders and postoperative delirium (POD), and what sleep parameters are related to the occurrence of delirium.
Methods Ninety-seven patients undergoing elective radical resection of esophageal cancer from September to December 2019 were selected, who were divided into two groups: group nPOD and group POD. Pittsburgh sleep quality index (PSQI) was evaluated one day preoperatively, including the time of falling in sleep, awakening time, frequency of being awake, and sleep time. All patients received general anesthesia with bronchocatheter. Protective ventilation strategy with low tidal volume was conducted during the operation. Patient controlled intravenous analgesia was used postoperatively. Postoperative delirium was evaluated by the confusion assessment method (CAM) scale on 1-7 days after surgery.
Results There were 24 patients (25%) assessed as POD within 7 days after operation. The incidence of preoperative sleep disorder and awakening time, frequency of awake, total sleep time, effective sleep time, waking up after sleep on set (WASO) were higher in group POD compared to group nPOD (P < 0.05). Multivariate logistic regression analysis showed that frequency of being awake increase (OR = 3.868, 95% CI 1.645-9.006, P = 0.002) and the decrease of effective sleep time (OR = 3.802, 95% CI 1.577-9.174, P = 0.003) were the independent risk factors of POD.
Conclusion Fragmentary sleep and the decrease of effective sleep time are independent risk factors for POD in patients with esophageal cancer.