| Objective: to investigate efficacy and safety of Dexmedetomidin nasal spray for perioperative sleep intervention to improve the postoperative rehabilitation in aged colorectal cancer patients.Method: 64 aged patients intending to undergo selective laparoscopic surgery for rectal cancer were randomized into an Intervention Group(n=32)and a Control Group(n=31).Nasal spray of Dexmedetomidin 1.5ug/kg was given to each patient in the Intervention Group during 21:00-21:30 pm per night from the day of admission until the day before discharge,while normal saline was given to patients in the Control with the same method in the same speed.Peri-operative treatment for both groups was carried out while ERAS concept was applied properly.Post-operative data during hospital stay was recorded,including sleep quality score and the occurrence of delirium;the occurrence of untoward effects such as hypertension,hypotension,tachycardia,bradycardia and respiratory depression;levels of stress hormones on the next day of admission and the day of surgery such as angiotensin II(Ang-II),noradrenaline(NE)and corticosteroids(Cor);number of add-on pressing and add-on intravenous analgesics due to pain during 48 hours;postoperative gastrointestinal recovery such as anus exhausting time and anus defecation time;the occurrence of postoperative complications such as pulmonary infection,intestinal obstruction,postoperative hemorrhage and intestinal fistula;and postoperative hospital stay(day),hospitalization cost(Yuan)and sleep satisfaction.Results: Pittsburgh Sleep Quality Index(PSQI)was 8.0(5.0,10.0)and 7(5.5,9.5)respectively for the two groups on admission day without significant difference(P>0.05).Significant intergroup difference was observed for components or total score of Pittsburgh Sleep Quality Index(PSQI)(P<0.05)on the day of discharge.Incidence rate of delirium was 15.6% and 37.5% respectively for the Intervention Group and the Control,with a statistically significant difference(P<0.05).No tachycardia or respiratory depression occurred in either group.There was no statistical significance in the intergroup difference concerning hypertension,hypotension or bradycardia(P>0.05).No significant difference was observed between the two groups for stress hormones on the next day of admission including Ang-II,NE and Cor(P>0.05),while the significant difference existed on the day of surgery for these parameters(P<0.05).Satisfactory analgesia was reported for both groups.An intergroup difference with statistical significance was found on add-on pressing number,total number of injection with flurbiprofen axetil and cases injected with oxycodone hydrochloride.For anus exhausting time and anus defecation time,statistical significance was noticed in the difference between the two groups(P<0.05).No statistical significance was observed in the intergroup difference concerning incidence rate of postoperative complications including pulmonary infection,postoperative hemorrhage,intestinal obstruction,intestinal fistula and infection of incision wound(P>0.05),while a significant difference was found when total incidence of complications was compared(P<0.05).Statistical significance existed in the intergroup difference on postoperative hospital stay,total expense or sleep satisfaction(P<0.05).Conclusion: Nasal spray of Dexmedetomidin seems capable of relieving dyssomnia in aged perioperative rectal cancer patients,improving their sleep satisfaction degree;decreasing stress,postoperative delirium and untoward effects;enhancing the recovery of gastrointestinal functions,and facilitating their fast rehabilitation. |
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