| Objective:To evaluate the effects of preoperative sleep quality on early cognitive dysfunction(POCD)in elderly patients after total hip replacement under intraspinal anesthesia.Methods:Patients aged 65-80 years who underwent unilateral total hip arthroplasty under elective intraspinal anesthesia were selected.BMI 18-28kg/m2;,ASA grade II-Ⅲ;The preoperative routine examination and the test results were perfect and basically normal;Ethical;Patients volunteered to be tested and signed the informed consent.The patients who met the criteria were visited 1 day before surgery(T0),and scored by MMSE,and the preoperative sleep quality of the patients was evaluated using PSQI.According to the principle of randomization,30 patients with PSQI >score 7 were included in the preoperative low sleep quality group(group L),and 30 patients with PSQI≤7 score were included in the preoperative high sleep quality group(group H)randomly.After entering the operating room,basic vital signs were monitored and no abnormity was detected.The same anesthesiologist performed intraspinal anesthesia and returned to the ward after the operation.MMSE scores of patients in both groups were recorded 1d(T1),2d(T2)and 7d(T3)after surgery.Serum levels of IL-6 and TNF-α were recorded 1h before surgery(t0),1d after surgery(t1),2d after surgery(t2),and 7d after surgery(t3).Visual analogue scale(VAS)was recorded 1d,2d and 7d after surgery in both groups,and postoperative 2d satisfaction was recorded by VAS score.The recovery scores of Qo R-15 were recorded in both groups 7 days after surgery.Results:Compared with group L,group H had higher MMSE score on postoperative day1(T1),and the difference was statistically significant(P < 0.05).There was no significant difference in MMSE scores between the two groups 1 day before surgery(T0),2 days after surgery(T2)and 7 days after surgery(T3)(P>0.05).Compared with T0,the MMSE score in group L was significantly decreased at T1,and the difference was statistically significant(P<0.05),while there was no significant difference in MMSE score at T2 and T3(P>0.05).There was no significant difference in MMSE scores at T1,T2 and T3 in group H(P>0.05).Before the operation(t0),the contents of IL-6 and TNF-α in serum of two groups were not statistically significant(P>0.05).Compared with t0,the contents of IL-6 and TNF-αin serum of t1、t2 in group L and t1 in group H were increased,and the difference was statistically significant(P < 0.05).There was no statistical significance in t2 of group H and t3 of two groups(P > 0.05).Compared with group L,the contents of IL-6 and TNF-α in serum of group H were lower at t1、t2,and the difference was statistically significant(P<0.05).The contents of IL-6 and TNF-α were not statistically significant at t3(P>0.05).Compared with group L,the VAS score of group H was lower on day 1、day 2after surgery,and the difference was statistically significant(P<0.05).The VAS score on postoperative day 7 was not statistically significant(P>0.05);the postoperative2 d satisfaction score was higher,and the difference was statistically significant(P<0.05).The Qo R-15 recovery quality score was higher on postoperative day 7,but the difference was not statistically significant(P>0.05).Conclusion:Compared with the patients with poor preoperative sleep quality,the elderly patients with high preoperative sleep quality had higher MMSE scores,lower serum IL-6 and TNF-α content,lower incidence of POCD at the early postoperative stage,lower VAS scores at 1d and 2d after surgery,lower pain degree,higher satisfaction,and higher recovery quality scores at 7d after surgery. |
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