| Objective: To observe the postoperative sleep quality,hemodynamic changes and adverse reactions of patients with different doses of dexmedetomidine combined with fentanyl and trama used in intravenous controlled analgesia after total hip arthroplasty,and to explore the effects of dexmedetomidine used in total hip arthroplasty on postoperative sleep and the recommended dosage.Methods: A total of 80 patients with elective unilateral total hip arthroplasty admitted to the First Affiliated Hospital of Guangxi Medical University from June 2020 to December 2020 were selected and divided into group C,group D1,group D2 and group D3 according to random number table method,with 20 patients in each group.Anesthesia method: All patients in the four groups were treated with intravenous general anesthesia combined with peripheral nerve block(improved iliac fascia block on the inguinal ligament on the affected side under ultrasound guidance),and PCIA was used for postoperative analgesia.PCIA formula: control group(group C)fentanyl0.5mg+ tramadol 500mg+ tolisetron 10mg;The experimental groups were(D1group)fentanyl 0.5mg+ tramadol 500mg+ tolansetron 10mg+ dexmedetomidine50μg(the dose of dexmedetomidine was 1μg/h),respectively;(D2 group)Fentanyl 0.5mg+ tramadol 500mg+ tolansetron 10mg+ dexmedetomidine 100μg(the dose of dexmedetomidine was 2μg/h);(D3 group)Fentanyl 0.5mg+tramadol 500mg+ tolansetron 10 mg + dexmedetomidine 150μg(the dose of dexmedetomidine was 3μg/h),followed by 0.9% sodium chloride injection diluted to 150 ml.PCIA parameter setting: background dose 3ml/h,single additional dose 3ml/time,locking time 30 min.The morning urine 2ml of the patients on the day before surgery,the first day after surgery,the second day after surgery,and the third day after surgery were collected.The 6-hydroxysulphate melatonin(6-HMS)concentration was detected and recorded,and the Athens Insomnia Scale(AIS)score and Pittsburgh Sleep Quality Index(PSQI)score were performed at the same corresponding time points.Sleep scores of patients were recorded by smart bracelet(Huawei Honor Band 5).In addition,seven observation time points were set: before anesthesia induction(T0),30 min after surgery(T1),3h after surgery(T2),6h after surgery(T3),12 h after surgery(T4),24 h after surgery(T5)and 48 h after surgery(T6).Heart rate and blood pressure from T0 to T6 were recorded.Subjective sleep quality satisfaction and adverse reactions were collected in each group.Results:(1)General demographic data of the four groups: gender,age,ASA classification,Height mass index;General information of operation:operation time,blood loss,resuscitation time,extubation time;Preoperative vital signs: there was no statistical significance in mean arterial pressure,heart rate and respiratory rate(P>0.05).(2)Postoperative vital signs at different time points: at T3,the mean arterial pressure in group D1 and D2 was decreased compared with that in group C(P<0.05),and that in group D3 was decreased compared with that in group D2(P<0.05).At T4,the mean arterial pressure in D3 group was higher than that in D2 group(P<0.05).There was no significant difference in heart rate among the four groups(P>0.05).(3)Postoperative sleep quality:(1)AIS score: the AIS score of the first,second and third days after surgery in D1,D2 and D3 groups was significantly lower than that in C group;Compared with the day before surgery,the AIS scores of group C on the first,second and third days after surgery were significantly increased,and the AIS scores of group D1 on the third day after surgery were significantly increased.Compared with the first day after surgery,the AIS score of group C on the second day after surgery decreased significantly,and the difference was statistically significant(P<0.05).There was no significant difference at other time points(P>0.05).On the first day after operation,the rate of insomnia in D1,D2 and D3 groups was significantly higher than that in C group.The proportion of people without sleep disorder on the first day after surgery in D1,D2 and D3 groups was significantly lower than that in C group,with statistical significance(P<0.05).(2)PSQI score: The PSQI score of D1 group on the first day after surgery was significantly lower than that of C group;The PSQI scores of the first,second and third days after operation in D2 and D3 groups were significantly lower than those in C group.Compared with the day before surgery,the PSQI scores of group C were significantly increased in the first,second and third days after surgery,and those of group D1 were significantly increased in the first and third days after surgery.Compared with the first day after surgery,the PSQI score of group C on the second day after surgery was significantly lower;Compared with the second day after surgery,the PSQI score of D1 group on the third day after surgery was significantly increased,with statistical significance(P<0.05).There was no significant difference at other time points(P>0.05).On the first day after surgery,the scores of subjective sleep,sleep time,sleep time and sleep efficiency in D1,D2 and D3 groups were significantly lower than those in C group.The scores of sleep disorders in D2 group were significantly decreased,and the difference was statistically significant(P<0.05).There was no significant difference between hypnotic drugs and daytime functional items(P>0.05).(3)EIA score of smart bracelet: the sleep score of smart bracelet in the first,second and third days after surgery in group D2 was significantly higher than that in group C;The sleep score of smart bracelet on the second and third days after operation in group D3 was significantly higher than that in group C.Compared with the day before surgery,the sleep score of smart bracelet in group C on the third day after surgery was significantly lower,with statistical significance(P<0.05).There was no significant difference at other time points(P>0.05).(4)6-HMS concentration: On the first,second and third day after surgery,6-HMS concentration in D2 and D3 group was significantly higher than that in C group;On the second day after surgery,the concentration of 6-HMS in D2 group was higher than that in D1 group.Compared with the day before surgery,the concentration of 6-HMS in group C during the first,second and third days after surgery was significantly decreased,and that in group D1 during the first and third days after surgery was significantly decreased.Compared with the second day after surgery,the concentration of 6-HMS in groups C,D1 and D2 on the third day after surgery was significantly decreased,with statistical significance(P<0.05).There was no significant difference at other time points(P>0.05).(4)Adverse reactions and patients’ satisfaction with postoperative subjective sleep quality: the incidence of postoperative total adverse reactions in D1,D2 and D3 groups was significantly lower than that in C group;Postoperative subjective sleep quality satisfaction in D1,D2 and D3 groups was higher than that in C group,and the difference was statistically significant(P<0.05).Conclusion:(1)Dexmedetomidine combined with Fentanyl and tramadol intravenous analgesia can effectively improve postoperative sleep quality of patients undergoing total hip arthroplasty,and at the same time,hemodynamics is stable,the incidence of adverse reactions can be reduced,and sleep satisfaction of patients can be improved.(2)According to the observation results,the recommended dosage of dexmedetomidine for postoperative analgesia in adults is 2μg/h. |
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