全膝关节置换患者围术期睡眠质量及影响因素分析

目的研究ERAS管理模式下全膝关节置换(TKA)患者围手术期睡眠质量及其危险因素，为今后临床干预研究提供重要理论依据。 方法采用一般情况调查表、匹兹堡睡眠质量问卷(PSQI)、Epworth嗜睡量表(ESS)、视觉模拟评分(VAS)、流行病学研究中心抑郁量表(CESD)及Zung焦虑自评量表(ZSAS)对满足入排标准的118例初次单侧TKA患者术前2周、手术当天和术后1、2、4、8、12周的睡眠质量进行评价，logistic回归分析其睡眠障碍的影响因素。纳入标准：年龄>18岁；初次单侧全膝关节置换患者。排除标准：膝关节置换术后翻修或同期双侧TKA患者；术前2周规律服用安眠药者或有精神病史者。 结果TKA患者术前睡眠障碍(PSD)的发生率为53.4%，手术当天达87.3%，随后开始下降，术后2周又接近高峰，术后4周后快速下降。术后2周内各时间点PSQI、ESS得分比术前2周增加，术后4周后PSQI、ESS得分显著减少(t＝7.136、5.269，均为P<0.001)，且PSQI与ESS得分之间存在正相关(r＝0.380，P<0.001)。术后各时间点VAS得分比术前2周均减少，且PSQI与VAS得分之间存在正相关(r＝0.198，P＝0.032)。Logistic回归分析提示疼痛、焦虑、抑郁是术后2周PSD的独立危险因素[比值比(OR)＝1.384，P＝0.007；OR＝1.260，P＝0.038；OR＝1.203，P＝0.049]。 结论超过一半以上的TKA患者术前即已存在PSD，术后发生率更高，且可持续2周以上，疼痛、焦虑、抑郁情绪是PSD的三个独立危险因素。

Investigation of perioperative sleep quality and its risk factors in patients undergoing total knee arthroplasty

ObjectiveTo investigate perioperative sleep quality of total knee arthroplasty (TKA) patients managed with enhanced recovery protocol and analyze its risk factors to provide scientific base for clinical intervention in future. MethodsA general survey, Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale(ESS), visual analogue scale(VAS) score, the center for epidemiologic studies depression scale(CESD) and Zung Self-rating anxiety scale(ZSAS) were employed to measure sleep quality in 118 TKA patients who fulfilled the inclusion and exclusion criteria at preoperative two weeks, the day of surgery and postoperative one, two, four, eight, and 12 weeks. The influencing factors were analyzed by multivariate logistic regression. Inclusion criteria: older than 18 years; unilateral elective primary TKA. Exclusion criteria: the patients were undergoing revision surgery or bilateral TKA; regularly using sleep-related medication or having mental diseases. ResultsThe prevalence of sleep disturbance was as high as 53.4% preoperatively, which peaked 87.3% on the day of operation, then began to decline, but re-peaked two weeks after operation, and then rapidly decreased. PSQI and ESS score significantly increased postoperatively from baseline to two weeks before decreasing rapidly to a lower level than preoperative baseline at four weeks postoperatively(t=7.136, 5.269, both P<0.001) and a positive correlation was found between ESS and PSQI scores(r=0.380, P<0.001). VAS score decreased from baseline over all time points in the postoperative period and a positive correlation was found between VAS and PSQI score(r=0.198, P=0.032). Multivariate logistic regression analysis demonstrated that pain, anxiety and depression were three risk factors associated with postoperative sleep disturbance[odds ratio(OR)=1.384, P=0.007; OR=1.260, P=0.038; OR=1.203, P=0.049]. ConclusionsPSD existed in more than half of the patients undergoing TKA perioperatively which may worsen afterwards and would last longer than two weeks. Pain, anxiety and depression are the three independent risk factors.