右美托咪定对心外科术后患者睡眠质量的改善作用

目的研究右美托咪定对心外科术后患者睡眠质量的影响。方法利用多导睡眠图对2018年1月至2018年12月长海医院心脏术后患者进行睡眠监测,选择最终符合条件的患者63例为研究对象,按随机数字表法分为试验组32例和对照组31例。试验组患者从晚上22:00试验开始时持续静脉注射右美托咪定,次日晨6:00停止注射,连续注射3晚。镇静目标为镇静程度评估表(richmond agitation-sedation scale,RASS)评分-1~2分,右美托咪定的负荷剂量为0.5μg/kg,时间不超过20 min,然后以0.2~0.7μg/(kg·h)持续静脉注射,期间不使用其他镇静剂。对照组患者晚间不注射右美托咪定以及其他镇静药物。此段时间用多导睡眠仪监测两组患者的睡眠。观察目标为两组患者睡眠总时间、睡眠效率、觉醒次数、睡眠各阶段时间。试验期间白天的睡眠由床旁护士记录患者睡眠次数。结果试验组与对照组比,有更少的觉醒次数(3.1~3.61)次vs.(8.87~9.77)次,P<0.01],更高的睡眠效率(68%~71.29%vs.25.1%~28.87%,P<0.01),更长的睡眠第二阶段(249.55~266.89)min vs.(59.12~71.59)min,P<0.01],差异有统计学意义。两组患者睡眠第一阶段比较,差异无统计学意义(63.61~7.05)min vs.(56.37~63.33)min,P>0.05]。结论夜间持续输注右美托咪定显著提高了患者睡眠效率、减少睡眠觉醒次数、增加睡眠第二阶段的时间,在一定程度上改善了心外科术后患者的睡眠质量。

Improvement of sleep quality in patients after cardiac surgery treated with dexmedetomidine

Objectives To study the specific effects of dexmedetomidine on sleep quality in patients after cardiacsurgery.MethodsPolysomnography was used to monitor sleep condition in patients after cardiac surgery in ChanghaiHospital from January 2018 to December 2018.Totally 62 eligible patients were randomly divided into two groups,32 inexperimental group and 31 in control group.Patients in experimental group continued to be infused dexmedetomidinesince 22:00 pm,and stopped infusion at 6 am(10:00 pm to 6:00 am of next day)for three consecutive infusions.The sedation target was RASS score of-1-2,and the loading dose of dexmedetomidine was 0.5μg/kg for no more than20 min.Then the continuous intravenous pumping was performed with the dose of 0.2-0.7μg(/kg·h),and no othersedatives were used during this period.In control group,the patients were not given dexmedetomidine or other sedativedrug infusions in the evening.During this period,polysomnography was used to monitor the sleep of the patients in bothgroups.The observation targets were the total sleep duration,sleep efficiency,number of awakenings,duration of eachstage of sleep,etc.in the two groups.The number of sleep of the patients was recorded by the bedside nurse during thedaytime sleep.ResultsCompared with control group,the patients in experimental group had significantly fewer num-ber of awakenings(3.1-3.61 vs.8.87-9.77,P<0.01),significantly higher sleep efficiency(68%-71.29%vs.25.1%-28.87%,P<0.01),and significantly longer second stage of sleep(249.55-266.89)min vs.(59.12-71.59)min,P<0.01].There was no significant difference between the two groups in the first stage of sleep(63.61-7.05)min vs.(56.37-63.33)min,P>0.05].ConclusionsContinuous infusion of dexmedetomidine at night significantly improves the patient’s sleep efficiency,reduces the number of awakenings and increases the second stage of sleep,thus improvesthe sleep quality of patients after cardiac surgery to some extent.