异丙酚与七氟醚麻醉对老年腹部大手术患者术后睡眠质量的影响：一项随机临床试验

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-06-02 DOI:10.1016/j.jclinane.2025.111875

Na-Ping Chen M.D., Ph.D. , Pei Sun M.D. , Chun-Jing Li M.D. , Xi-Xi Xing MBBS. , Mo Li M.D., Ph.D , Zhu-Jun Sun MBBS. , Huai-Jin Li M.D. , Dong-Liang Mu M.D. , Dong-Xin Wang M.D., Ph.D.

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引用次数: 0

摘要

研究目的大手术后老年患者的睡眠障碍很常见。异丙酚和七氟醚都是常用的麻醉剂。在这项研究中，我们比较了异丙酚与七氟醚麻醉对该患者术后睡眠质量的影响。设计随机临床试验。大学医院。患者年龄65 ~ 90岁，计划择期腹部大手术的患者。干预组患者随机接受以异丙酚为基础的静脉麻醉或以七氟醚为基础的吸入麻醉。主要终点是术后第一个晚上用活动描记术监测的总睡眠时间。次要终点包括从基线（麻醉前）到术后第二天早上各时间点的血浆食欲素- a浓度。主要结果2022年5月23日至2023年4月3日，144例患者(平均年龄72.9岁；58.3%的男性)被纳入并随机分配。术后第一个晚上，异丙酚麻醉的总睡眠时间（中位150分钟[四分位数范围99 ~ 200]）比七氟醚麻醉的总睡眠时间（111分钟[80 ~ 160]）更长；中位差29分钟[95% CI 4 ~ 53]；p = 0.025)。麻醉诱导后1 h，异丙酚组血浆orexin-A浓度较低(中位数差值为- 31.3 pg/mL [95% CI - 58.1 ~ - 2.2]；P = 0.033)和术后第一天早上6:00(中位差为- 29.8 pg/mL [95% CI -58.3 ~ - 2.3]；p = 0.036)。结论在接受腹部大手术的老年患者中，与七氟醚麻醉相比，异丙酚麻醉与术后第一夜总睡眠时间更长有关。这种差异可能部分归因于较低的血浆促食欲素a水平。试验注册：该随机试验于2022年4月26日获得北京大学第一医院生物医学研究伦理委员会（No.2022-155）批准。中国临床试验注册中心ChiCTR2200060120)网址：https://www.chictr.org.cn/showproj.html?proj=169584, 2022年5月19日。

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Propofol versus sevoflurane anesthesia on postoperative sleep quality in older patients after major abdominal surgery: A randomized clinical trial

Study objective

Sleep disturbances are common in older patients following major surgery. Both propofol and sevoflurane are frequently used anesthetics. In this study, we compared the effect of propofol- versus sevoflurane-based anesthesia on postoperative sleep quality in this patient population.

Design

A randomized clinical trial.

Setting

A university hospital.

Patients

Patients aged 65 to 90 years who were scheduled for elective major abdominal surgery.

Interventions

Enrolled patients were randomized to receive either propofol-based intravenous anesthesia or sevoflurane-based inhalational anesthesia.

Measurements

Primary endpoint was total sleep time monitored by actigraphy on the first postoperative night. Secondary endpoints included plasma orexin-A concentrations at various timepoints from baseline (before anesthesia) until the second postoperative morning.

Main results

From May 23, 2022 to April 3, 2023, 144 patients (mean age 72.9 years; 58.3 % male) were enrolled and randomly assigned. Total sleep time on the first postoperative night was longer with propofol anesthesia (median 150 min [interquartile range 99 to 200]) than with sevoflurane anesthesia (111 min [80 to 160]; median difference 29 min [95 % CI 4 to 53]; P = 0.025). Plasma orexin-A concentration was lower in the propofol group at 1 h after anesthesia induction (median difference − 31.3 pg/mL [95 % CI −58.1 to −2.2]; P = 0.033) and 6:00 on the first postoperative morning (median difference − 29.8 pg/mL [95 % CI -58.3 to −2.3]; P = 0.036).

Conclusions

Among older patients undergoing major abdominal surgery, propofol anesthesia, compared with sevoflurane anesthesia, was associated with a longer total sleep time on the first postoperative night. This difference may be partially attributable to lowered plasma orexin-A level.

Trial registration: This randomized trial was approved by Biomedical Research Ethical Committee of Peking University First Hospital (No.2022-155) on April 26, 2022. Chinese Clinical Trial Registry (No. ChiCTR2200060120) URL: https://www.chictr.org.cn/showproj.html?proj=169584, May 19, 2022.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.