作者：米勒之声
术前睡眠质量对无痛胃镜患者丙泊酚血浆靶浓度及术后睡眠的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译 : 安丽
编辑 : 严旭
审校 : 曹莹
背景:术前睡眠障碍可导致围术期心理应激和血流动力学明显变化，影响麻醉安全性。研究表明，丙泊酚持续镇静可以改善重症监护病房(ICU)机械通气危重患者的睡眠，目前尚不清楚无痛胃镜检查患者的睡眠障碍是否会影响丙泊酚血浆靶浓度和术后睡眠质量。本研究旨在探讨术前睡眠质量对无痛胃镜检查患者丙泊酚血浆靶浓度及术后睡眠的影响。
方法：选择拟行无痛胃镜检查的门诊患者93例，年龄45~64岁，BMI：18.5~30kg/m2, ASA分级I或II级。所有患者在无痛胃镜检查前进行阿森斯失眠量表(AIS)评估。根据无痛胃镜检查前AIS评分将患者分为睡眠正常组(N组，AIS评分4分，47例)和睡眠障碍组(D组，AIS评分6分，46例)。采用靶控输注(target-controlled infusion, TCI)(Marsh模式)丙泊酚进行全身麻醉，采用脑电双频指数(Bispectral index, BIS)监测麻醉深度，无痛胃镜检查时维持BIS在50~65。分别于患者睫毛反射消失时(T1)、无痛胃镜检查前(T2)、推进胃镜时(T3)和无痛胃镜检查时(T4)记录丙泊酚血浆靶浓度(Cp)和单位体表面积的输注率。在无痛胃镜检查后第1天、第3天、1周和1个月电话随访患者AIS评分，评估患者术后睡眠情况。记录无痛胃镜检查期间不良反应发生情况，比较两组患者满意度及内镜医师对麻醉效果的满意度。
结果：与N组相比，D组丙泊酚各时间点的Cp和单位体表面积输注率显著升高（P<0.05）；与无痛胃镜检查前的AIS评分相比，两组患者的AIS评分在无痛胃镜检查后第1天显著升高（P<0.05）；两组在无痛胃镜检查后第3天、1周和1个月的AIS评分无显著差异（P>0.05）。两组在不良反应发生率、患者满意度和内窥镜医生对麻醉效果的满意度方面无显著差异。
结论:术前睡眠障碍会增加无痛胃镜检查患者丙泊酚Cp和体表面积输注速率。应用丙泊酚无痛胃镜检查后仅第1天患者的睡眠有影响。
原始文献来源：
Yuxue Qiu, Haitao Hou, Junxia Zhang, Xiaomei Wang, Lu Wang, Yanan Wu and Liqin Deng.The efect of preoperative sleep quality On the target plasma concentration of propofol And postoperative sleep in patients undergoing painlessgastroscopy.BMCAnesthesiology,(2023)23:9.Doi.org/10.1186/s12871-022-01957-2.
英文原文
The efect ofpreoperative sleep quality Onthetarget plasma concentration ofpropofol Andpostoperative sleep inpatients undergoing painless gastroscopy
Abstract
Background:This study aims to investigate the efect of preoperative sleep quality on the target plasma concentration of propofol and postoperative sleep in patients undergoing painless gastroscopy.
Methods:Ninety-three outpatients aged 45 to 64 years with body mass index (BMI) of 18.5–30 kg/m2 and ASA grades of I or II, who underwent painless gastroscopy, were selected. All patients were evaluated by the Athens insomnia scale (AIS) before the painless gastroscopy. The patients were divided into two groups according to the AIS score evaluated before painless gastroscopy: normal sleep group (group N, AIS score<4 points, 47 cases) and sleep disorder group (group D, AIS score>6 points, 46 cases). The target-controlled infusion (TCI) of propofol (Marsh model) was used for general anesthesia, the Bispectral index (BIS) was used to monitor the depth of anesthesia, and the BIS was maintained between 50 and 65 during the painless gastroscopy. The target plasma concentration (Cp) of propofol was recorded when the patient’s eyelash refex disappeared (T1), before the painless gastroscopy (T2), at the time of advancing the gastroscope (T3) and during the painless gastroscopy (T4), and the infusion rate per body surface area of propofol was calculated. The patient’s AIS score was followed up by telephone at day 1, day 3, 1 week, and 1 month after the painless gastroscopy to assess the postoperative sleep of the patient. The occurrence of adverse reactions during the painless gastroscopy was recorded; the patient’s satisfaction and the endoscopist’s satisfaction with the anesthesia efect were compared between the two groups.
Results: Compared with group N, the Cp at each time point and the infusion rate per body surface area of propofol in group D was increased signifcantly (P<0.05); compared with the AIS scores before the painless gastroscopy, the AIS scores of the two groups of patients were signifcantly increased day 1 after the painless gastroscopy (P<0.05); there were no signifcant diferences in the AIS scores of the two groups at day 3, 1 week, and 1 month after the painless
gastroscopy (P>0.05). There were no statistically signifcant diferences in the occurrence of adverse reactions and the patient’s satisfaction and the endoscopist’s satisfaction with the anesthesia efect between the two groups (P>0.05).
Conclusions:The preoperative sleep disturbance will increase the Cp and the infusion rate per body surface area of propofol in patients undergoing painless gastroscopy. Propofol only afects the patients’ sleep for day 1 after the painless gastroscopy.
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