口腔癌患者术后睡眠状况调查与相关因素分析
摘要
目的:了解口腔癌患者术后的睡眠状况,分析影响术后睡眠的相关因素,探讨评价睡眠紊乱程度的方法。
方法:对41例住院手术的口腔癌患者,术前采用抑郁自评量表(SDS)、焦虑自评量表(SAS)进行心理调查,在出院前一、二天采用匹兹堡睡眠质量指数(PSQI)进行调查术后的睡眠状况,收集手术时间和一般资料。另外对10例患者分别于术前、术后第一天、术后第四天抽血查血清皮质醇浓度。
结果:
1口腔癌患者术后睡眠障碍的发生率92.7%。口腔癌患者术前抑郁的发生率为43.90%,焦虑的发生率为24.39%。
2焦虑与PSQI因子睡眠质量、入睡时间存在显著正相关(p＜0.05);手术时间与PSQI因子入睡时间、睡眠障碍及总分存在显著正相关(p＜0.05)。
3术后使用镇痛泵组与无使用镇痛泵组在PSQI因子睡眠时间、睡眠效率及总分存在显著差别(p＜0.05)。术后气管切开组与无气管切开组在PSQI各因子及总分均无显著差别(p＞0.05)。单人间组与三人间组在PSQI各因子及总分均无显著差别(p＞0.05)。
4在性别上,男女PSQI总分上无差别,在PSQI因子睡眠障碍、药物催眠在统计上存在显著差别。在年龄上,30～49岁患者与60岁以上患者在PSQI因子睡眠时间、睡眠效率存在显著差别。
5术前与术后第一天的皮质醇浓度之差绝对值(X)与PSQI因子睡眠时间、药物催眠及总分存在显著负相关,即X越小,患者术后睡眠紊乱程度越严重。
结论:
1口腔癌患者术后普遍存在睡眠紊乱。睡眠紊乱发生率为92.7%。
2手术的复杂程度和时间长短、心理因素及疼痛是影响患者术后睡眠主要原因。
3术后镇痛有助于改善患者的睡眠。
4术后血清皮质醇浓度的变化有可能是术后睡眠紊乱严重程度的一个客观指标。
Objective:
The object of this study to explore the sleep status of the patients with oral cancer and analyse on difference of sleep status after operation,find a way in evaluating the degree of sleep disorders.
Methods:
The subjects of this study consisted of forty-one inpatients with oral cancer.The survey parameters used the Self-Rating Depression Scale (SDS)and the Self-Rating anxiety Scale(SAS)to determine psychical health before operation,the Pittsburgh Sleep Quality Index(PSQI)to evaluate sleeping status after operation,surgical time and detect the serum concentration of cortisol in ten patients before and after operation. After calculating descriptive statistics using these variables,T-test,χ~2-test and correlation coefficients were calculated by SPSS 10.0.
Results:
1 Sleep disorders were occurred in 92.7%of the patients.43.90%of the patients with oral cancer had the symptom depression.24.39%of the patients with oral cancer had the symptom anxiety.
2 Calculation of correlation coefficients between anxiety and PSQI, revealed a significant correlation between anxiety and sleep quality, fall-asleep time.Calculation of correlation coefficients between surgical time and PSQI,revealed a significant correlation between surgical time, fall-asleep time,sleep obstruction,and total score.
3 Sleep obstruction,and sleep medication in the female patients were significantly more than the male patients(p＜0.05).Sleep time,and sleep efficiency in the patients aging more than sixty were significantly more than the patients aging from thirty to forty-nine(p＜0.05).
4 Sleep time,sleep efficiency,and total score in the patient with PCA (patients controlled analgesia)pump were significantly more than the non-PCA pump(p＜0.05).The factors of PSQI and total score were no significantly different between the patients with tracheotomy and the patients without tracheotomy.The same result also took place between the patients in single-person room and the patients in three-person room.
5 Linear regression analysis showed a significant negative correlation between the degree of sleep disorders and absolute value of cortisol minus between preoperative day and postoperative first day.
Conclusion:
1 Sleep disorders was observed in 92.7%of patients with oral cancer after operation.
2The complexity and the time of the operation were the major influence on sleep in patients with oral cancer after operation.Psychical health and pain also affected the sleep.
3 Analgesia was benefit to improve the sleep of the patient after operation.
4 The change in serum concentration of cortisol may be an objective indicator in valuating the degree of sleep disorders.
方法:对41例住院手术的口腔癌患者,术前采用抑郁自评量表(SDS)、焦虑自评量表(SAS)进行心理调查,在出院前一、二天采用匹兹堡睡眠质量指数(PSQI)进行调查术后的睡眠状况,收集手术时间和一般资料。另外对10例患者分别于术前、术后第一天、术后第四天抽血查血清皮质醇浓度。
结果:
1口腔癌患者术后睡眠障碍的发生率92.7%。口腔癌患者术前抑郁的发生率为43.90%,焦虑的发生率为24.39%。
2焦虑与PSQI因子睡眠质量、入睡时间存在显著正相关(p＜0.05);手术时间与PSQI因子入睡时间、睡眠障碍及总分存在显著正相关(p＜0.05)。
3术后使用镇痛泵组与无使用镇痛泵组在PSQI因子睡眠时间、睡眠效率及总分存在显著差别(p＜0.05)。术后气管切开组与无气管切开组在PSQI各因子及总分均无显著差别(p＞0.05)。单人间组与三人间组在PSQI各因子及总分均无显著差别(p＞0.05)。
4在性别上,男女PSQI总分上无差别,在PSQI因子睡眠障碍、药物催眠在统计上存在显著差别。在年龄上,30～49岁患者与60岁以上患者在PSQI因子睡眠时间、睡眠效率存在显著差别。
5术前与术后第一天的皮质醇浓度之差绝对值(X)与PSQI因子睡眠时间、药物催眠及总分存在显著负相关,即X越小,患者术后睡眠紊乱程度越严重。
结论:
1口腔癌患者术后普遍存在睡眠紊乱。睡眠紊乱发生率为92.7%。
2手术的复杂程度和时间长短、心理因素及疼痛是影响患者术后睡眠主要原因。
3术后镇痛有助于改善患者的睡眠。
4术后血清皮质醇浓度的变化有可能是术后睡眠紊乱严重程度的一个客观指标。
Objective:
The object of this study to explore the sleep status of the patients with oral cancer and analyse on difference of sleep status after operation,find a way in evaluating the degree of sleep disorders.
Methods:
The subjects of this study consisted of forty-one inpatients with oral cancer.The survey parameters used the Self-Rating Depression Scale (SDS)and the Self-Rating anxiety Scale(SAS)to determine psychical health before operation,the Pittsburgh Sleep Quality Index(PSQI)to evaluate sleeping status after operation,surgical time and detect the serum concentration of cortisol in ten patients before and after operation. After calculating descriptive statistics using these variables,T-test,χ~2-test and correlation coefficients were calculated by SPSS 10.0.
Results:
1 Sleep disorders were occurred in 92.7%of the patients.43.90%of the patients with oral cancer had the symptom depression.24.39%of the patients with oral cancer had the symptom anxiety.
2 Calculation of correlation coefficients between anxiety and PSQI, revealed a significant correlation between anxiety and sleep quality, fall-asleep time.Calculation of correlation coefficients between surgical time and PSQI,revealed a significant correlation between surgical time, fall-asleep time,sleep obstruction,and total score.
3 Sleep obstruction,and sleep medication in the female patients were significantly more than the male patients(p＜0.05).Sleep time,and sleep efficiency in the patients aging more than sixty were significantly more than the patients aging from thirty to forty-nine(p＜0.05).
4 Sleep time,sleep efficiency,and total score in the patient with PCA (patients controlled analgesia)pump were significantly more than the non-PCA pump(p＜0.05).The factors of PSQI and total score were no significantly different between the patients with tracheotomy and the patients without tracheotomy.The same result also took place between the patients in single-person room and the patients in three-person room.
5 Linear regression analysis showed a significant negative correlation between the degree of sleep disorders and absolute value of cortisol minus between preoperative day and postoperative first day.
Conclusion:
1 Sleep disorders was observed in 92.7%of patients with oral cancer after operation.
2The complexity and the time of the operation were the major influence on sleep in patients with oral cancer after operation.Psychical health and pain also affected the sleep.
3 Analgesia was benefit to improve the sleep of the patient after operation.
4 The change in serum concentration of cortisol may be an objective indicator in valuating the degree of sleep disorders.
引文
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1 范利锋,王平仁,兰培敏.睡眠机制的研究Clin Intern Med,2005,22(10):662-664.
2 王振英,汤淑芬,梁位流.外科住院病人手术前后睡眠状况调查与干预.MedicalJournal of Chinese People'Health,2006,18(7):567-568.
3 王晓华.癌症患者睡眠质量与心理健康状况调查分析.Chin J Rehabil TheoryPractice,2005,11(9):737-739.
4 沈晓红,姜乾金.术前焦虑与术后心身康复的相关性及其心理社会影响因素.Chinese Journal of Clinical Psychology,2003,11(3):200-201.
5 蔡长华,陈阳.术后睡眠障碍的发生机制及临床意义.《国外医学》麻醉学与复苏分册,1998,19(1):51-53.
6 厉宵燕.术后患者睡眠质量的调查.解放军护理杂志,2006,23(12):28-29。
7 郭琴,张丽萍,廖佳.胸外科肿瘤病人睡眠状况调查及影响因素分析.四川肿瘤防治,2007,20(1):45-47.
8 赵东芳,穆红,刘均娥.骨科患者睡眠状况调查及影响因素分析.中华护理教育,2007,4(2):85-87.
9 王蓓,蔡立春,孙桂兰,李英.普外科患者手术前后睡眠状况的调查与分析.护士进修杂志,2003,18(5):417-418.
10 秦丽敏.乳腺癌患者手术前后睡眠状况的调查与分析.吉林医学,2007,28(2):193-195.
11 谢兆媛,李岩,孙延菊.泌尿外科住院病人睡眠质量调查及影响因素分析.CHINESE NURSING RESEARCH December,2004,.18(12):2110-2111.
12 潘集阳,马萍,梁华君,张继辉.肿瘤患者主观睡眠质量与心身状况相关分析.Chin J of BehavioralMed Sci,2006,15(4):316-317.
13 王雪笠,贺银方,冯连元.多道睡眠图对睡眠功能障碍患者的评估作用.中国临床康复),2004,8(24):5130.
14 王雪笠,贺银方,冯连元等.慢性失眠者多道睡眠图的观察和定量分析.临床神经电生理学杂志,2001,10(2):92-95.
15 姜乾金.医学心理学.北京:人民卫生出版社,2002.
16 吴洁兰,许丽云,颜木容,张华凌.肿瘤病人术后睡眠状况调查及护理CHINESE NURSING RESEARCH,2005 19(11):2454-2455.
17 王丽,于雁.癌症患者睡眠障碍原因调查与护理对策.齐鲁护理杂志,2005,11(1):11-13.
18 林泳琴,陈秀杰,宋凤娇,曾宪玲.影响老年喉癌病人睡眠的相关因素及护理对策.护理研究,2005,19(9):1739-1740.
19 刘谦,侯晓华.睡眠剥夺对机体影响的研究.临床内科杂志,2005,22(10):664-666。
20 毛洪祥,杨碧秀.抑郁症相关睡眠障碍.国际精神病学杂志,2007,34(3):129-132
21 Ward,CF.M.D.Propofoland Sleep:An Attractive Connection Anesthesi -ology,2005,102(2):481.
22 Ekstedt,Mirjam BNSci;Akerstedt,Torbjorn PhO;Soderstrom,Marie MSci Microarousals During Sleep Are Associated With Increased Levels of Lipids,Cortisol,and Blood Pressure.Psychosomatic Medicine,2004,66(6):925-931.
23 Gur,A1;Cevik,R1;Sarac,AJ1;Colpan,L2;Em,S3 Hypothalamic-pituitarygonadal axis and cortisol in young women with primary fibromyalgia:the potential roles of depression,fatigue,and sleep disturbance in the occurrence of hypocortisolism.Annals of the Rheumatic Diseases,2004.63(11):1504-1506.
24 Wu,Aihua M.D.;Drummond Gordon B.F.R.C.A.Sleep Arousal after Lower Abdominal Surgery and Relation to Recovery from Respiratory Obstruction.Anesthesiology,200399(6):1295-1302.
25 Germain,Anne PhD;Buysse,Daniel J.MD;Ombao,Hernando PhD;Kupfer,David J.MO,Hall,Martica PhD.Psychophysiological Reactivity and Coping Styles Influence the Effects of Acute Stress Exposure on Rapid Eye Movement Sleep.Psychosomatic Medicine,2003,65(5):857-864.
26 Bonafide,Christopher P.M.D.,Aucutt-Walter,Natalie M.D.,Divittore, Nicole B.A.,King,Tonya Ph.D.,Bixler,Edward O.Ph.D.,Cronin,Arthur J.M.D.Remifentanil Inhibits Rapid Eye Movement Sleep but Not the Nocturnal Melatonin Surge in Humans.Anesthesiology,2008,108(4):627-633.
27 Rosenberg-Adamsen S,Kehlet H,Dodds C,Rosenberg J.Postoperative sleep disturbances:Mechanisms and clinical implications.Br J Anaesth,1996,76:552 - 9.
28 Cronin AJ,Keifer JC,Davies MF,King TS,Bixler EO.Postoperative sleep disturbance:Influences of opioids and pain in humans.Sleep,2001,24:39 - 44.
29 Roehrs T,Roth T.Sleep and pain:Interaction of two vital functions.Semin Neurol,2005,25:106-16.
30 Richardson GS.The human circadian system in normal and disordered sleep.J Clin Psychiatry,2005,66(suppl):3-9.
31 APPENDIX A.International Classification of Sleep Disorders,International Classification of Diseases,and the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,Text Revision.CONTINUUM:Lifelong Learning in Neurology.Sleep Disorders 2007,13(3):252-255.
32 Rogers,Laura Q.FACSM;Courneya,Kerry S.;Rao,Krishna;Robbins,Tom;Malone,James;Seiz,Alison 1;Reminger,Sheryl.Physical Activity,Sleep,Cognitive Function,and Fatigue in Head and Neck Cancer Survivors.Medicine ＆ Science in Sports ＆ Exercise,2007,39(5)Supplement:S450-S451.
33 Tropeano,Anne-Isabelle a,Roudot-Thoraval,Francoise b,Badoual,Thierry a,Goldenberg,Francoise c,Dolbeau,Guillaume d,Gosse,Philippe e,Macquin-Mavier.Isabelle a Different effects of ambulatory blood pressure monitoring on subjective and objective sleep quality.Blood Pressure Monitoring,200611(6):315-320.
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6 Kawasaki, Takashi MD, Ogata, Masanori MD, Kawasaki, Chika MD,Tomihisa, Tomoko, Okamoto, Kohji MD +,; Shigematsu, Akio MD. Surgical Stress Induces Endotoxin Hyporesponsiveness and an Early Decrease of Monocyte mCD14 and HLA-DR Expression During Surgery. Anesthesia & Analgesia. 92(5):1322-1326, May 2001.
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36 郭琴,张丽萍,廖佳.胸外科肿瘤病人睡眠状况调查及影响因素分析.四川肿瘤防治,2007,20(1):45-47.
37 赵东芳,穆红,刘均娥.骨科患者睡眠状况调查及影响因素分析.中华护理教育,2007,4(2):85-87.
38 王蓓,蔡立春,孙桂兰,李英.普外科患者手术前后睡眠状况的调查与分析.护士进修杂志,2003,18(5):417-418.
39 秦丽敏.乳腺癌患者手术前后睡眠状况的调查与分析.吉林医学,2007,28(2):193-195.
40 谢兆媛,李岩,孙延菊.泌尿外科住院病人睡眠质量调查及影响因素分析.CHINESE NURSING RESEARCH December,2004,.18(12):2110-2111.
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50 王雪笠,贺银方,冯连元等.慢性失眠者多道睡眠图的观察和定量分析.临床神经电生理学杂志,2001,10(2):92-95.
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58 吴洁兰,许丽云,颜木容,张华凌.肿瘤病人术后睡眠状况调查及护理CHINESE NURSING RESEARCH.2005 19(11):2454-2455.
59 王丽,于雁.癌症患者睡眠障碍原因调查与护理对策.齐鲁护理杂志,2005,11(1):11-13.
60 林泳琴,陈秀杰,宋凤娇,曾宪玲.影响老年喉癌病人睡眠的相关因素及护理对策.护理研究,2005,19(9):1739-1740.
1 范利锋,王平仁,兰培敏.睡眠机制的研究Clin Intern Med,2005,22(10):662-664.
2 王振英,汤淑芬,梁位流.外科住院病人手术前后睡眠状况调查与干预.MedicalJournal of Chinese People'Health,2006,18(7):567-568.
3 王晓华.癌症患者睡眠质量与心理健康状况调查分析.Chin J Rehabil TheoryPractice,2005,11(9):737-739.
4 沈晓红,姜乾金.术前焦虑与术后心身康复的相关性及其心理社会影响因素.Chinese Journal of Clinical Psychology,2003,11(3):200-201.
5 蔡长华,陈阳.术后睡眠障碍的发生机制及临床意义.《国外医学》麻醉学与复苏分册,1998,19(1):51-53.
6 厉宵燕.术后患者睡眠质量的调查.解放军护理杂志,2006,23(12):28-29。
7 郭琴,张丽萍,廖佳.胸外科肿瘤病人睡眠状况调查及影响因素分析.四川肿瘤防治,2007,20(1):45-47.
8 赵东芳,穆红,刘均娥.骨科患者睡眠状况调查及影响因素分析.中华护理教育,2007,4(2):85-87.
9 王蓓,蔡立春,孙桂兰,李英.普外科患者手术前后睡眠状况的调查与分析.护士进修杂志,2003,18(5):417-418.
10 秦丽敏.乳腺癌患者手术前后睡眠状况的调查与分析.吉林医学,2007,28(2):193-195.
11 谢兆媛,李岩,孙延菊.泌尿外科住院病人睡眠质量调查及影响因素分析.CHINESE NURSING RESEARCH December,2004,.18(12):2110-2111.
12 潘集阳,马萍,梁华君,张继辉.肿瘤患者主观睡眠质量与心身状况相关分析.Chin J of BehavioralMed Sci,2006,15(4):316-317.
13 王雪笠,贺银方,冯连元.多道睡眠图对睡眠功能障碍患者的评估作用.中国临床康复),2004,8(24):5130.
14 王雪笠,贺银方,冯连元等.慢性失眠者多道睡眠图的观察和定量分析.临床神经电生理学杂志,2001,10(2):92-95.
15 姜乾金.医学心理学.北京:人民卫生出版社,2002.
16 吴洁兰,许丽云,颜木容,张华凌.肿瘤病人术后睡眠状况调查及护理CHINESE NURSING RESEARCH,2005 19(11):2454-2455.
17 王丽,于雁.癌症患者睡眠障碍原因调查与护理对策.齐鲁护理杂志,2005,11(1):11-13.
18 林泳琴,陈秀杰,宋凤娇,曾宪玲.影响老年喉癌病人睡眠的相关因素及护理对策.护理研究,2005,19(9):1739-1740.
19 刘谦,侯晓华.睡眠剥夺对机体影响的研究.临床内科杂志,2005,22(10):664-666。
20 毛洪祥,杨碧秀.抑郁症相关睡眠障碍.国际精神病学杂志,2007,34(3):129-132
21 Ward,CF.M.D.Propofoland Sleep:An Attractive Connection Anesthesi -ology,2005,102(2):481.
22 Ekstedt,Mirjam BNSci;Akerstedt,Torbjorn PhO;Soderstrom,Marie MSci Microarousals During Sleep Are Associated With Increased Levels of Lipids,Cortisol,and Blood Pressure.Psychosomatic Medicine,2004,66(6):925-931.
23 Gur,A1;Cevik,R1;Sarac,AJ1;Colpan,L2;Em,S3 Hypothalamic-pituitarygonadal axis and cortisol in young women with primary fibromyalgia:the potential roles of depression,fatigue,and sleep disturbance in the occurrence of hypocortisolism.Annals of the Rheumatic Diseases,2004.63(11):1504-1506.
24 Wu,Aihua M.D.;Drummond Gordon B.F.R.C.A.Sleep Arousal after Lower Abdominal Surgery and Relation to Recovery from Respiratory Obstruction.Anesthesiology,200399(6):1295-1302.
25 Germain,Anne PhD;Buysse,Daniel J.MD;Ombao,Hernando PhD;Kupfer,David J.MO,Hall,Martica PhD.Psychophysiological Reactivity and Coping Styles Influence the Effects of Acute Stress Exposure on Rapid Eye Movement Sleep.Psychosomatic Medicine,2003,65(5):857-864.
26 Bonafide,Christopher P.M.D.,Aucutt-Walter,Natalie M.D.,Divittore, Nicole B.A.,King,Tonya Ph.D.,Bixler,Edward O.Ph.D.,Cronin,Arthur J.M.D.Remifentanil Inhibits Rapid Eye Movement Sleep but Not the Nocturnal Melatonin Surge in Humans.Anesthesiology,2008,108(4):627-633.
27 Rosenberg-Adamsen S,Kehlet H,Dodds C,Rosenberg J.Postoperative sleep disturbances:Mechanisms and clinical implications.Br J Anaesth,1996,76:552 - 9.
28 Cronin AJ,Keifer JC,Davies MF,King TS,Bixler EO.Postoperative sleep disturbance:Influences of opioids and pain in humans.Sleep,2001,24:39 - 44.
29 Roehrs T,Roth T.Sleep and pain:Interaction of two vital functions.Semin Neurol,2005,25:106-16.
30 Richardson GS.The human circadian system in normal and disordered sleep.J Clin Psychiatry,2005,66(suppl):3-9.
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