超声引导下星状神经节阻滞对全膝关节置换术后睡眠障碍发生率的影响：一项随机对照试验

The effect of ultrasound-guided stellate ganglion block on the incidence of sleep disorders after total knee arthroplasty: a randomized controlled trial

摘要:

目的:探讨超声引导下星状神经节阻滞(SGB)对全膝关节置换术(TKA)患者术后睡眠障碍(PSD)发生率的影响。方法:择期全身麻醉下行全膝关节置换术患者98例。使用计算机生成的方案,将患者随机分为两组:全身麻醉组(GA组,n=49)和全身麻醉联合星状神经节阻滞组(SGB组,n=49)。SGB组使用0.375%罗哌卡因5 ml进行超声引导下右侧SGB；GA组在相同部位消毒穿刺但不进行阻滞。采用阿森斯失眠量表(AIS)评估患者术后睡眠情况,采用数字疼痛评分(NRS)评估患者术后疼痛程度,采用汉密尔顿焦抑郁量表(HAMA、HAMD)评估患者术后焦虑忧郁；记录补救镇痛情况、术后不良反应发生情况以及患者住院时间。结果:GA、SGB组患者术后第1天PSD发生率分别为53.06%、24.50%,差异有统计学意义(P<0.05)。SGB组术后连续3天、第7天NRS、AIS、HAMA和HAMD评分均低于GA组,且第1天、2天评分差异有统计学意义(P<0.05)。SGB组补救镇痛药物用量(195 mg)低于GA组(270 mg),各不良反应发生率均低于GA组,差异无统计学意义(P＞0.05)。结论:超声引导下SGB可有效降低TKA患者术后第一天PSD发生率,改善睡眠质量,加快患者康复进程。

Abstract:

Objective ：To explore the effect of ultrasound-guided stellate ganglion block (SGB) on the incidence of postoperative sleep disturbances (PSD) in patients undergoing total knee arthroplasty (TKA). Methods ：98 patients underwent total knee arthroplasty under elective general anesthesia. Using a computer-generated protocol, patients were randomly divided into two groups: the general anesthesia group (GA group, n=49) and the general anesthesia combined with stellate ganglion block group (SGB group, n=49）.The SGB group used 5 ml of 0.375% ropivacaine for ultrasound-guided right SGB; The GA group disinfected and punctured the same area without blocking. The Athens Insomnia Scale (AIS) was used to assess the incidence of postoperative sleep disorders (PSD) , the Numerical Rating Scale (NRS) was used to assess postoperative pain, and the Hamilton Anxiety Rating Scale (HAMA, HAMD) was used to assess postoperative anxiety and depression; Record the situation of remedial analgesia, occurrence of postoperative adverse reactions, and patient hospitalization time. Result：The incidence of PSD on the first day after surgery in the GA and SGB groups was 53.06% and 24.50% respectively, with a statistically significant difference (P<0.05). The NRS,AIS, HAMA,and HAMD scores of the SGB group were lower than those of the GA group for 3 consecutive days and 7 days after surgery, and the difference in scores on the 1st and 2nd days was statistically significant (P<0.05). The dosage of remedial analgesic drugs in the SGB group (195 mg) was lower than that in the GA group (270 mg),the incidence of adverse reactions in the SGB group was lower than that in the GA group, and the difference was not statistically significant (P>0.05). Conclusion：Ultrasound guided SGB can effectively reduce the incidence of postoperative PSD in TKA patients on the first day, improve sleep quality, and accelerate the patient""s recovery process.