硬膜外麻醉联合全身麻醉对老年胃肠道肿瘤手术患者术后睡眠和疼痛的影响：一项前瞻性随机试验。

Effects of combining epidural with general anesthesia on postoperative sleep and pain in elderly patients undergoing gastrointestinal tumor surgery: a prospective randomized trial.

作者信息

Tang Yanju, Ge Yali

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Anesthesiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou University, 98 Nan Tong Western Road, Yangzhou, Jiangsu 225001, China.

出版信息

BMC Anesthesiol. 2025 Aug 8;25(1):398. doi: 10.1186/s12871-025-03266-w.

DOI:10.1186/s12871-025-03266-w

PMID:40781597

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333111/

Abstract

PURPOSE

Postoperative sleep disturbance is one of the most important factors affecting rapid postoperative recovery. The aim of the present study was to investigate the effects of combined epidural and general anesthesia on postoperative sleep and pain in elderly patients undergoing gastrointestinal tumor surgery.

PATIENTS AND METHODS

Ninety patients who were scheduled to undergo elective gastrointestinal tumor surgery were randomly divided into the general anesthesia (GA) and epidural combined with GA (GEA) groups. A wireless smart bracelet was used to measure objective sleep quality on the night before surgery (Preop 1), and on the first, third, and seventh night after surgery (POD1, POD3, and POD7, respectively). Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Furthermore, the total dose of general anesthetics required and postoperative pain and adverse effects were assessed.

RESULTS

PSQI was higher on postoperative day 1 and day 3 than on preoperative day 1 in both groups. In addition, on postoperative day 1 and postoperative day 3, PSQI scores were lower in the GEA group than in the GA group. On postoperative day 1, the sleep scores, rapid eye movement sleep, and percentage of stable sleep were higher in the GEA group than in the GA group. remifentanil dosage and the incidence of postoperative nausea and vomiting were significantly lower in the GEA group than in the GA group. There was no significant difference in VAS scores at 6, 24, 48 h after operation and total PCA demand attempts within 48 h after operation between the two groups.

CONCLUSION

Elderly patients usually experience considerable sleep disturbances after gastrointestinal tumor surgery. Epidural combined with GA can effectively improve postoperative short-term sleep quality and reduce the incidence of postoperative nausea and vomiting. This may be related to the reduction of intraoperative consumption of remifentanil under epidural anesthesia. However, the pain within 48 h after the operation was not improved in this study.

TRIAL REGISTRATION

The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date 04/04/2021 Trial ID ChiCTR2100045064).

摘要

目的

术后睡眠障碍是影响术后快速康复的最重要因素之一。本研究旨在探讨硬膜外麻醉联合全身麻醉对老年胃肠道肿瘤手术患者术后睡眠和疼痛的影响。

患者与方法

90例计划接受择期胃肠道肿瘤手术的患者被随机分为全身麻醉（GA）组和硬膜外麻醉联合全身麻醉（GEA）组。使用无线智能手环在手术前一晚（术前1天）以及术后第1、3和7晚（分别为术后第1天、术后第3天和术后第7天）测量客观睡眠质量。使用匹兹堡睡眠质量指数（PSQI）量表评估主观睡眠质量。此外，评估所需全身麻醉药的总剂量以及术后疼痛和不良反应。

结果

两组术后第1天和第3天的PSQI均高于术前第1天。此外，术后第1天和第3天，GEA组的PSQI评分低于GA组。术后第1天，GEA组的睡眠评分、快速眼动睡眠和稳定睡眠百分比均高于GA组。GEA组瑞芬太尼用量及术后恶心呕吐发生率明显低于GA组。两组术后6、24、48小时的视觉模拟评分（VAS）及术后48小时内PCA总需求尝试次数无显著差异。