不同麻醉开始时间对机器人辅助下前列腺癌根治术患者术后昼夜节律的影响

Effect of different anesthesia onset time on postoperative circadian rhythm in patients undergoing robot-assisted radical prostatectomy

中文关键词: 昼夜节律  麻醉  睡眠障碍  术后疼痛  前列腺切除术

英文关键词: Circadian rhythm  Anaesthesia  Dyssomnia  Postoperative pain  Prostatectomy

中文摘要:

      
目的 分析不同麻醉开始时间对机器人辅助下前列腺癌根治术患者术后昼夜节律的影响。
方法 选择2022年1—10月行机器人辅助下前列腺癌根治术患者103例，年龄50～85岁，BMI 18～30 kg/m²，ASAⅠ—Ⅲ级。根据麻醉开始时间将患者分为两组：上午8∶00—11∶59组（M组，n=53）和下午12∶00—18∶00组（A组，n=50）。记录前列腺癌D'Amico危险分级、麻醉时间、镇痛泵有效按压次数（D1）和实际按压次数（D2），计算 D1/D2。记录入室后5 min（T0）、麻醉诱导后5 min（T1）、手术开始后5 min（T2）、手术开始后60 min（T3）、手术结束时（T4）、拔管后5 min（T5）的HR、MAP、SpO₂，T1—T4时BIS。通过阿森斯失眠量表（AIS）评估术前1 d、术后1和3 d的睡眠状态，使用数字评定量表（NRS）评估术后1和3 d的疼痛程度。根据术前1 d和术后3 d慕尼黑大学睡眠类型测量表（MEQ-SA）的结果判断患者昼夜节律时型有无改变。
结果 两组D'Amico分级、麻醉时间、D1/D2差异无统计学意义，不同时点HR、MAP、SpO₂、BIS，术前1 d、术后1、3 d AIS评分，术后1、3 d NRS评分差异无统计学意义。M组昼夜节律时型改变的有11例（21%），其中5例的昼夜节律时型分型向更“晚”转变，6例向更“早”转变。A组昼夜节律时型改变的有3例（6%），其中1例的昼夜节律时型分型向更“晚”转变，2例向更“早”转变。M组昼夜节律时型改变率明显高于A组（P＜0.05）。
结论 麻醉开始于上午的机器人辅助下前列腺癌根治术患者术后昼夜节律时型改变发生率高于开始于下午的患者。

英文摘要:

      
Objective To analyze the effect of different anesthesia induction time on postoperative circadian rhythm in patients undergoing robot-assisted radical prostatectomy.
Methods A total of 103 patients, aged 50-85 years, BMI 18-30 kg/m², ASA physical status Ⅰ—Ⅲ, undergoing robot-assisted radical prostatectomy from January 2022 to October 2022 were recruited. The patients were grouped according to the induction time: the morning 8∶00-11∶59 group (group M, n = 53) and the afternoon 12∶00-18∶00 group (group A, n = 50). D'Amico risk grade, duration of anesthesia, number of effective compressions of analgesic pump (D1) and actual compressions (D2) were recorded, D1/D2 were calculated. HR, MAP, SpO₂ were recorded at 5 minutes after entrying the operation room (T0), 5 minutes after anesthesia induction (T1), 5 minutes after the surgery start (T2), 60 minutes after the surgery start (T3), at the end of surgery (T4) and 5 minutes after extubation (T5). BIS at T1-T4 were recorded. Sleeping status was assessed by the Athens insomnia scale (AIS) 1 day before surgery, 1 day and 3 days after surgery, and pain level was assessed 1 and 3 days after surgery using the digital rating scale (NRS). According to the results of the morningness-eveningness questionnaire of sleep-wake assessment (MEQ-SA) 1 day before surgery and 3 days after surgery, the patients' circadian rhythm was determined.
Results There were no statistically significant differences in D'Amico risk grade, duration of anesthesia, D1/D2, HR, MAP, SpO₂ and BIS at different time point, AIS scores 1 day before surgery, 1 day and 3 days after surgery, and NRS scores 1 day and 3 days after surgery between the two groups. In group M, there were 11 cases (21%) of circadian rhythm changes, of which 5 people's circadian rhythm changed to “later” and 6 people's circadian rhythm changed to “earlier”. In group A, there were 3 cases (6%) of circadian rhythm changes, of which 1 person's circadian rhythm changed to “later” and 2 people's circadian rhythm changed to “earlier”. The rate of circadian rhythm change in group M was significantly higher than that in group A (P < 0.05).
Conclusion The incidence of perioperative circadian rhythm alteration is significantly higher in patients undergoing robot-assisted radical prostatectomy who starts anesthesia in the morning than those in the afternoon.