以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (4): 42-47.doi: 10.16460/j.issn1008-9969.2020.04.042

• 调查研究 • 上一篇    下一篇

术前睡眠质量对全膝关节表面置换患者术后早期康复及生活质量的影响

李寅翠1, 刘云2a, 李莹2b, 韩雪3, 孟嘉2b   

  1. 1.贵州中医药大学 护理学院,贵州 贵阳 550025;
    2.东部战区总医院（原南京军区南京总医院）a.干部训练中心;b.骨科,江苏 南京 210000;
    3.南京中医药大学 护理学院,江苏 南京 210000
  • 收稿日期:2019-09-06 出版日期:2020-02-25 发布日期:2020-07-14
  • 通讯作者: 刘云（1963-）,女,山东临邑人,硕士,主任护师,硕士研究生导师。
  • 作者简介:李寅翠（1994-）,女,贵州遵义人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    江苏省科技厅社会发展-面上项目（BE2015686）

Effect of Preoperative Sleep Quality on Early Recovery and Quality of Life after Total Knee Arthroplasty

LI Yin-cui1, LIU Yun2a, LI Yin2b, HAN Xue3, MENG Jia2b   

  1. 1. School of Nursing, Guizhou University of Chinese Medicine, Guiyang 550025, China;
    2a. Cadre Training Center;2b. Dept. of Orthopedics, General Hospital of Eastern Theater Command Nanjing General Hospital of Nanjing Military Command,Nanjing 210000, China;
    3. School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210000, China
  • Received:2019-09-06 Online:2020-02-25 Published:2020-07-14

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摘要： 目的 探讨术前睡眠质量对全膝关节表面置换术后早期康复和生活质量的影响。方法 采用便利抽样法,选取南京某三级甲等医院诊断为膝骨关节炎患者,拟行单侧全膝关节表面置换术的196例患者,术前采用匹兹堡睡眠质量指数量表进行睡眠质量调查,得分<7分（n=79）纳入高睡眠质量组,得分≥7分（n=117）纳入低睡眠质量组。2组均评估术后第1、第2、第3 d视觉模拟疼痛评分、术后首次下床活动时间、术后1个月西安大略省和麦克马斯特大学骨关节炎指数评分和生活质量评分。结果 重复测量方差分析结果显示,2组全膝关节置换患者术后第1~第3天视觉模似疼痛评分评分比较,差异具有有统计学意义（P<0.05）。高睡眠质量组术后首次下床活动时间、术后1个月西安大略省和麦克马斯特大学骨关节炎指数总分和功能评分低于低睡眠质量组（P<0.05）;术后1个月高睡眠质量组生活质量评分高于低睡眠质量组（P<0.05）。结论 膝骨关节炎患者术前良好的睡眠质量能缓解全膝关节置换患者术后早期疼痛,可促进患者早期下床活动,有利于改善早期生活质量。建议骨科医护人员重视全膝关节置换患者术前睡眠质量质量对术后情况的影响,重点关注术前睡眠质量差的患者,根据患者特点采取针对性的护理措施,改善其睡眠质量,优化术前状态。

关键词: 膝关节炎, 膝关节置换术, 睡眠质量, 生活质量, 疼痛, 膝关节功能

Abstract: Objective To investigate the effect of preoperative sleep quality on early rehabilitation and quality of life after total knee arthroplasty. Methods With convenience sampling method, 196 patients with knee osteoarthritis who planned unilateral total knee arthroplasty from one tertiary grade A hospital were investiagted by using Pittsburgh Sleep Quality Index Scale. Then patients were divided into group A (high quality of sleep group, PSQI<7, n=79) and group B (PSQI≥7, n=117, low quality of sleep group). Prospective cohort study was used. VAS score 1, 2 and 3 days after the surgery, time of first postoperative activity out of bed, Western Ontario and McMaster Universities Index (WOMAC) and MOS12-item Short Form Health Survey (SF-12 )were evaluated in both groups. Results Repeated measures analysis of variance revealed that VAS scores 3 days after the surgery showed statistically significant difference between the two groups (P<0.05).The first time of getting out of bed activity, WOMAC total score and function score of group A were lower than those of group B (P<0.05). SF-12 score of group A was higher than that of group B one month after the operation (P<0.05). Conclusion Good sleep quality before the operation can accelerate postoperative rehabilitation process and improve the quality of life in early postoperative period. It is suggested that orthopedic medical staff should pay attention to the influence of preoperative sleep quality of patients with total knee replacement, particularly to the patients with poor preoperative sleep quality. Targeted nursing measures according to the characteristics of patients is conducive to the improvement of their sleep quality, thus to optimize their preoperative status.

Key words: knee arthritis, knee replacement, sleep quality, quality of life, pain, knee function

中图分类号: 

  • R473.6
[1] 戴尅戎,李慧武,严孟宁. 我国人工关节加速发展的二十年[J].中华关节外科杂志(电子版),2015,9(6):691-694. DOI:10.3877/cma.j.issn.1674-134X.2015.06.001.
[2] Bourne RB, Chesworth BM, Davis AM, et al.Patient Satisfaction after Total Knee Arthroplasty: Who Is Satisfied and Who Is Not[J]. Clin Orthop Relat Res,2010, 468(1):57-63. DOI:10.4103/1117-6806.253792.
[3] Herrero-Sánchez MD, García-Iñigo Mdel C, Nuño-Beato-Redondo B S, et al. Association Between Ongoing Pain Intensity, Health-related Quality of Life, Disability and Quality of Sleep in Elderly People with Total Knee Arthroplasty[J]. Cien Saude Colet,2014, 19(6):1881-1888.DOI:10.1590/1413-81232014196.04632013.
[4] 沈彬,翁习生,廖刃,等. 中国髋、膝关节置换术加速康复--围术期疼痛与睡眠管理专家共识[J]. 中华骨与关节外科杂志, 2016,9(2):91-97.DOI:10.3969/j.issn.2095-9958.2016.02-01.
[5] Krenk L, Jennum P, Kehlet H.Activity, Sleep and Cognition after Fast-track Hip or Knee Arthroplasty[J]. J Arthroplasty, 2013, 28(8):1265-1269. DOI:10.1016/j.arth.2013.02.013.
[6] Gong L, Wang Z, Fan D.Sleep Quality Effects Recovery after Total Knee Arthroplasty (TKA) - A Randomized, Double-blind, Controlled Study[J]. J Arthroplasty, 2015,30(11):1897-1901.DOI:10.1016/j.arth.2015.02.020.
[7] Taylor SS, Hughes JM, Coffman CJ, et al.Prevalence of and Characteristics Associated with Insomnia and Obstructive Sleep Apnea Among Veterans with Knee and Hip Osteoarthritis[J]. BMC Musculoskelet Disord, 2018, 19(1):79. DOI:10.1186/s12891-018-1993-y.
[8] 胡容,王卫红,何彩云,等. 104例膝关节置换患者睡眠质量现状及其影响因素分析[J]. 护理学报, 2016, 23(14):12-15. DOI:10.16460/j.issn1008-9969.2016.14.012.
[9] 李东文,徐燕. 全膝关节置换术后疼痛、睡眠型态紊乱与关节功能关系的研究[J].护理研究,2007,21(11C):3037-3038. DOI:10.3969/j.issn.1009-6493.2007.33.016.
[10] 方英磊,陆鸣,黄斐,等. 术前睡眠质量对膝关节置换术后早期康复的影响[J]. 广东医学, 2019,40(1):91-94. DOI:10.13820/j.cnki.gdyx.20183346.
[11] 雷光华,王坤正. 骨关节炎诊疗指南(2018年版)解读[J].中华骨科杂志,2018,38(12):716-717.DOI:10.3760/cma.j.issn.0253-2352.2018.12.002.
[12] 刘贤臣,唐茂芹,胡蕾,等. 匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志, 1996, 29(2):103-107. DOI:10.1007/BF02951625.
[13] Hooper GJ, Rothwell AG, Hooper NM, et al.The Relationship Between the American Society of Anesthesiologists Physical Rating and Outcome Following Total Hip and Knee Arthroplasty: An Analysis of the New Zealand Joint Registry[J]. J Bone Joint Surg Am, 2012,94(12):1065-1070.DOI:10.2106/JBJS.J.01681.
[14] Buysse DJ, Reynolds CF, Monk TH, et al.Quantification of Subjective Sleep Quality in Healthy Elderly Men and Women Using the Pittsburgh Sleep Quality Index(PSQI)[J]. Sleep, 1991, 14(4):331-338. DOI:10.1016/0304-3959(91)90086-D.
[15] 路桃影,李艳,夏萍,等. 匹兹堡睡眠质量指数的信度及效度分析[J].重庆医学,2014,43(3):260-263. DOI:10.3969/j.issn.1671-8348.2014.03.002.
[16] Stubbs DF.Visual Analogue Scales[J]. Br J Clin Pharmacol,1979, 7(1):124.DOI:10.3969/j.issn.1671-8348.2014.03.002.
[17] 中华医学会骨科学分会. 骨科常见疼痛的处理专家建议[J]. 中华骨科杂志,2008, 28(1):78-81. DOI:10.3321/j.issn:0253-2352.2008.01.018.
[18] Bellamy N, Buchanan WW, Goldsmith CH, et al.Validation study of WOMAC: A Health Status Instrument for Measuring Clinically Important Patient Relevant Outcomes to Antirheumatic Drug Therapy in Patients with Osteoarthritis of the Hip or Knee[J]. J Rheumatol, 1988, 15(12):1833-1840.
[19] Xie F, Li SC, Goeree R, et al.Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Patients Scheduled for Total Knee Replacement[J]. Qual Life Res, 2008,17(4):595-601. DOI:10.1007/s11136-008-9340-7.
[20] Hagell P, Westergren A, Årestedt K.Beware of the origin of numbers: Standard scoring of the SF-12 and SF-36 Summary Measures Distorts Measurement and Score Interpretations[J]. Res Nurs Health, 2017,40(4):378-386. DOI: 10.1002/nur.21806.
[21] Fong DY, Lam CL, Mak KK, et al.The Short Form-12 Health Survey was a Valid Instrument in Chinese Adolescents[J]. J Clin Epidemiol, 2010, 63(9):1020-1029. DOI: 10.1016/j.jclinepi.2009.11.011.
[22] 肖惠敏,邝惠容. SF-12量表评价中国老年人生存质量的信度和效度分析[J].中国老年学杂志,2014,34(4):1018-1020. DOI:10.3969/j.issn.1005-9202.2014.04.073.
[23] Hawker GA, French MR, Waugh EJ, et al.The Multidimensionality of Sleep Quality and its Relationship to Fatigue in Older aDults with Painful Osteoarthritis[J]. Osteoarthritis Cartilage, 2010,18(11):1365-1371.DOI:10.1016/j.joca.2010.08.002.
[24] Ziętek P, Ziętek J, Szczypiór K.Anxiety in Patients Undergoing Fast-Track Knee Arthroplasty in the Light of Recent Literature[J]. Psychiatr Pol, 2014,48(5):1015-1024. DOI: 10.12740/PP/27173.
[25] Chan EY, Blyth FM, Nairn L, et al.Acute Postoperative Pain Following Hospital Discharge after Total Knee Arthroplasty[J]. Osteoarthritis Cartilage, 2013,21(9):1257-1263. DOI:10.1016/j.joca.2013.06.011.
[26] Lavigne G, Zucconi M, Castronovo C, et al.Sleep Arousal Response to Experimental Thermal Stimulation During Sleep in Human Subjects Free of Pain and Sleep Problems[J]. Pain, 2000,84(2):283-290.DOI:10.1016/S0304-3959(99)00213-4.
[27] Cremeans-Smith JK, Millington K, Sledjeski E, et al.Sleep Disruptions Mediate the Relationship Between Early Postoperative Pain and Later Functioning Following Total Knee Replacement Surgery[J]. J Behav Med, 2006,29(2):215-222. DOI:10.1007/s10865-005-9045-0.
[28] Wu CL, Naqibuddin M, Rowlingson AJ, et al.Fleisher LA. The Effect of Pain on Health-related Quality of Life in the Immediate Postoperative Period[J]. Anesthesia Analgesia, 2003, 97(4):1078. DOI:10.1213/01.ane.0000081722.09164.d5.
[29] 杨会,李继华,钟碧芳. 全程疼痛护理对膝关节置换术患者焦虑及睡眠质量的影响[J]. 中国继续医学教育,2018,10(35):169-171.DOI:10.3969/j.issn.1674-9308.2018.35.071.
[30] 吴炜炜,兰秀燕,邝惠容,等. 传统健身运动对老年人睡眠质量影响的Meta分析[J].中华护理杂志,2016,51(2):216-224. DOI:10.3761/j.issn.0254-1769.2016.02.016.
[31] Mesci E, Icagasioglu A, Mesci N, et al.Relation of Physical Activity Level with Quality of Life, Sleep and Depression in Patients with Knee Osteoarthritis[J]. North Clin Istanb, 2015, 2(3):215-221.DOI:10.14744/nci.2015.95867.
[32] Hakkou J, Rostom S, Mengat M, et al.Sleep Disturbance in Moroccan Patients with Ankylosing Spondylitis: Prevalence and Relationships with Disease-Specific Variables, Psychological Status and Quality of Life[J]. Rheumatol Int, 2013,33(2):285-290. DOI:10.1007/s00296-012-2376-6.
[33] Reis C,Dias S,Rodrigues AM,et al.Sleep Duration, Lifestyles and Chronic Diseases: A Cross-sectional Population-based Study[J].Sleep Sci, 2018, 11(4):217-230. DOI:10.5935/1984-0063.20180036.
[34] 季艳萍,杨威,刘继兰,等. 人工全膝关节置换术后患者生活质量及其影响因素[J].解放军护理杂志,2014,31(3):1-4. DOI:10.3969/j.issn.1008-9993.2014.03.001.
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