术前睡眠质量对膝关节置换术后早期康复的影响
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摘要
目的探讨术前睡眠质量对膝关节置换术后早期康复的影响。方法选择符合纳入标准的302例患者,对其术前进行睡眠质量评分(运用皮兹堡睡眠质量指数量表),得分小于7分的纳入高睡眠质量组(HSQG)共124例,得分大于等于7分的纳入低睡眠质量组(LSQG)共178例,分别记录两组术后24 h及72 h静息状态时疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后住院时间、屈膝90°所需时间、术后3 d的SCL-90量表评分、住院满意度(运用Likert Scale量表),应用COX比例风险模型分析术前睡眠质量与术后住院时间的关联。结果 HSQG组术后24 h及72 h静息状态VAS评分、术后住院时间、屈膝90°所需时间、术后3 d焦虑及抑郁得分均低于LSQG组,差异均有统计学意义(P <0. 05)。HSQG组住院满意度高于LSQG组,差异有统计学意义(P <0. 05)。将睡眠质量作为分类变量代入模型,结果显示,HSQG组术后住院天数是LSQG组的0. 677倍(95%可信区间:0. 529～0. 866)。结论术前睡眠质量高能加速患者膝关节置换术后早期康复。
Objective To investigate the effect of preoperative sleep quality on early recovery after total knee arthroplasty. Methods 302 patients undergoing TKA who meet the inclusion criteria were enrolled in the study. They were grouped according to the score of preoperative sleep quality( using the Pittsburgh Sleep Quality Index),and 124 cases were included in the high sleep quality group( HSQG) with a score of less than 7 points,while 178 cases were assigned into low sleep quality group( LSQG) with a score greater than 7 points. The outcomes including the resting state VAS( Visual Analogue Scale,VAS) pain score postoperative 24 h and 72 h,postoperative hospital stay,the number of days required for 90 degree of knee flexion,POD3 SCL-90 scores and patients' satisfaction( using Likert Scale) were observed. COX proportional hazards model was used to analyze the association between preoperative sleep quality and postoperative hospital stays. Results There was no significant difference in general information,such as age,sex,body mass index and preoperative knee joint HSS score,between the two groups. Compared to the LSQG group,the resting state VAS pain scores postoperative 24 h and 72 h,postoperative hospital stays,the number of days required for 90 degree of knee flexion,the anxiety and depression scores POD3 were significantly lower in the HSQG group( P < 0. 05). In HSQG group,the patients' satisfaction was significantly higher than that in LSQG group( P < 0. 05). While taking sleep quality as a categorical variable,the length of hospital stays in HSQG group was 0. 677( 95% CI: 0. 529-0. 866) times of the LSQG group. Conclusion High preoperative sleep quality can accelerate recovery after total knee arthroplasty.
Objective To investigate the effect of preoperative sleep quality on early recovery after total knee arthroplasty. Methods 302 patients undergoing TKA who meet the inclusion criteria were enrolled in the study. They were grouped according to the score of preoperative sleep quality( using the Pittsburgh Sleep Quality Index),and 124 cases were included in the high sleep quality group( HSQG) with a score of less than 7 points,while 178 cases were assigned into low sleep quality group( LSQG) with a score greater than 7 points. The outcomes including the resting state VAS( Visual Analogue Scale,VAS) pain score postoperative 24 h and 72 h,postoperative hospital stay,the number of days required for 90 degree of knee flexion,POD3 SCL-90 scores and patients' satisfaction( using Likert Scale) were observed. COX proportional hazards model was used to analyze the association between preoperative sleep quality and postoperative hospital stays. Results There was no significant difference in general information,such as age,sex,body mass index and preoperative knee joint HSS score,between the two groups. Compared to the LSQG group,the resting state VAS pain scores postoperative 24 h and 72 h,postoperative hospital stays,the number of days required for 90 degree of knee flexion,the anxiety and depression scores POD3 were significantly lower in the HSQG group( P < 0. 05). In HSQG group,the patients' satisfaction was significantly higher than that in LSQG group( P < 0. 05). While taking sleep quality as a categorical variable,the length of hospital stays in HSQG group was 0. 677( 95% CI: 0. 529-0. 866) times of the LSQG group. Conclusion High preoperative sleep quality can accelerate recovery after total knee arthroplasty.
引文
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[19]Cremeans-Smith JK,Millington K,Sledjeski E,et al. Sleep Disruptions Mediate the Relationship Between Early Postoperative Pain and Later Functioning Following Total Knee Replacement Surgery[J]. J Behav Med,2006,29(2):215-222.
[20]Affleck G,Urrows S,Tennen H,et al. Sequential daily relations of sleep,pain intensity,and attention to pain among women with fibromyalgia[J]. Pain,1996,68(2/3):363-368.
[21]Gore M,Brandenburg NA,Dukes E,et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning,symptom levels of anxiety and depression,and sleep[J]. J Pain Symptom Manage,2005,30(4):374-385.
[2]裴福兴.中国髋、膝关节置换的现状及展望[J].中国骨与关节杂志,2012,1(1):4-8.
[3]王坤正.浅谈中国关节置换外科的现状与未来[J].中华关节外科杂志:电子版,2015,9(6):12-14.
[4]戴尅戎,李慧武,严孟宁.我国人工关节加速发展的二十年[J].中华关节外科杂志:电子版,2015,9(6):1-4.
[5]Wilmore DW,Kehlet H. Management of patients in fast track surgery[J]. BMJ,2001,322(7284):473-476.
[6]Onen SH,Alloui A,Gross A,et al. The effects of total sleep deprivation,selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects[J]. J Sleep Res,2001,10(1):35-42.
[7]Doghramji K. Sleep Extension in Sleepy Individuals Reduces Pain Sensitivity:New Evidence Regarding the Complex,Reciprocal Relationship between Sleep and Pain[J].Sleep,2012,35(12):1587.
[8]Roehrs TA,Harris E,Randall S,et al. Pain sensitivity and recovery from mild chronic sleep loss[J]. Sleep,2012,35(12):1667-1672.
[9]Bantu Samridhi C,Roehrs TA,Harris EJ,et al. Pain sensitivity in sleepy pain-free normals[J]. Sleep,2009,32(8):1011-1017.
[10]李凌江,马辛.中国抑郁障碍防治指南(第二版)解读:概述[J].中华精神科杂志,2017,50(3):21.
[11]Gong L,Wang ZH. Sleep Quality Effects Recovery after Total Knee Arthroplasty(TKA)–A randomized,double-blind,controlled study[J]. J Arthroplasty,2015,30(11):1897-1901.
[12]Lene K,Poul J,Henrik K. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement[J]. J Clin Sleep Med,2014,10(3):321-326.
[13]Carpenter JS,Andrykowski MA. Psychometric evaluation of the pittsburgh sleep quality index[J]. J Psychosom Res,1998,45(1):5-13.
[14]中华医学会骨科学分会.骨科常见疼痛的处理专家建议[J].中华骨科杂志,2008,28(1):78-81.
[15]王征宇.症状自评量表(SCL-90)[J].上海精神医学,1984,2(2):68-70.
[16]Sullivan GM,Artino AR Jr. Analyzing and interpreting data from likert-type scales[J]. J Grad Med Educ,2013,5(4):541-542.
[17]Büyükyilmaz FE,Sendir M,Acaro Evaluation of night-time pain characteristics and quality of sleep in postoperative Turkish orthopedic patients[J]. Clin Nurs Res,2011,20(3):326-342.
[18]Rojkovich B,Gibson T. Day and night pain measurement in rheumatoid arthritis[J]. Ann Rheum Dis,1998,57(7):434-436.
[19]Cremeans-Smith JK,Millington K,Sledjeski E,et al. Sleep Disruptions Mediate the Relationship Between Early Postoperative Pain and Later Functioning Following Total Knee Replacement Surgery[J]. J Behav Med,2006,29(2):215-222.
[20]Affleck G,Urrows S,Tennen H,et al. Sequential daily relations of sleep,pain intensity,and attention to pain among women with fibromyalgia[J]. Pain,1996,68(2/3):363-368.
[21]Gore M,Brandenburg NA,Dukes E,et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning,symptom levels of anxiety and depression,and sleep[J]. J Pain Symptom Manage,2005,30(4):374-385.