腹腔镜妇科手术全身麻醉患者围手术期睡眠障碍对麻醉苏醒和术后疼痛的影响

doi:10.3969/j.issn.1006-5725.2025.24.006

Abstract

Abstract:

Objective To analyze the influence of perioperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia. Methods A total of 160 patients who underwent laparoscopic gynecological surgery at the hospital from March 2024 to March 2025 were retrospectively selected as research subjects. According to the preoperative Pittsburgh Sleep Quality Index （PSQI）， they were divided into the non-sleep-disorder （NSD） group （PSQI ≤ 5 points， n = 80） and the sleep-disorder （SD） group （PSQI > 5 points， n = 80）.The following aspects were compared between the two groups： anesthesia recovery indicators ［recovery time， modified Aldrete score， orientation recovery time， adverse reactions during the recovery period， total dosage of remifentanil， total dosage of propofol， minimum alveolar concentration （MAC） value of sevoflurane， time from drug discontinuation to extubation， intraoperative mean arterial pressure （MAP）， intraoperative heart rate （HR）， and rescue analgesia utilization rate］； pain indicators ［Visual Analogue Scale （VAS） score， opioid dosage， and number of patient-controlled analgesia （PCA） presses］. Moreover， multivariate linear regression， decision tree modeling， and mediation effect analysis were employed to explore the relationships among sleep quality， anesthesia recovery， and postoperative pain. Results The recovery time and orientation recovery time in the NSD group were shorter than those in the SD group （P < 0.05）， and the modified Aldrete score was higher （P < 0.05）. The total propofol dosage， intraoperative HR， and rescue analgesia utilization rate in the SD group were higher than those in the NSD group （P < 0.05）. The incidence of adverse reactions， VAS scores at various postoperative time points， opioid dosage， and number of PCA presses in the NSD group were all lower than those in the SD group （P < 0.05）. Multivariate regression analysis indicated that for every 1-point increase in PSQI， recovery time was prolonged by 0.63 minutes， orientation recovery time was delayed by 0.55 minutes， the modified Aldrete score decreased by 0.05 points， postoperative VAS score increased by 0.20 ~ 0.22 points， opioid dosage increased by 0.87 mg， and the number of PCA presses increased by 0.98 （P < 0.05）. The extended model demonstrated that after incorporating intraoperative factors， the predictive performance for recovery time （R² = 0.456） and postoperative pain （R² = 0.524） was significantly enhanced. Time from drug discontinuation to extubation， remifentanil dosage， and bispectral index （BIS） value were key predictive factors for recovery time； sevoflurane MAC value and MAP fluctuations made significant contributions to postoperative pain prediction. PSQI score maintained an independent predictive role in both models （β = 0.421/0.312）. Decision tree analysis confirmed that PSQI was the core factor for predicting anesthesia recovery and postoperative pain （importance： 51%）. Recovery time in patients with PSQI < 5.5 was significantly shorter than in those with PSQI ≥ 5.5 （18.68 minutes vs. 23.29 minutes）. The pain prediction model incorporating anesthesia recovery indicators exhibited better performance than the model without such indicators （R² = 0.391 vs. 0.336）.Mediation effect analysis revealed that the modified Aldrete score exerted a mild mediating effect between PSQI and postoperative pain （mediation proportion： 5.98%）. The direct effect of PSQI on pain accounted for 93.8% of the total effect， suggesting that sleep disorders mainly affect postoperative pain through other mechanisms. Conclusions Sleep disorders affect postoperative pain experience by prolonging anesthesia recovery time and reducing the modified Aldrete score. The direct effect is dominant， indicating that clinical practice should focus on sleep quality assessment and intervention to improve postoperative pain management.

Key words: sleep disorders, general anesthesia, laparoscopic gynecological surgery, anesthesia recovery, pain

CLC Number:

R614

Lina MIAO,Gongyao LIU,Haitao HOU,Xing. LIU. The impact of perioperative sleep disorders in patients undergoing laparoscopic gynecological surgery under general anesthesia on anesthesia recovery and postoperative pain[J]. The Journal of Practical Medicine, 2025, 41(24): 3833-3841.

Figures/Tables 5

Tab.1

Comparison of baseline data， anesthesia recovery， and pain between the two groups"

项目	NSD组（n = 80）	SD组（n = 80）	t/x²/Z值	P值
年龄（x ± s）/岁	42.39 ± 8.04	44.20 ± 8.76	1.364	0.175
BMI			0.230	0.631
< 24 kg/m2	48（60.00）	44（55.00）
≥ 24 kg/m2	32（40.00）	36（45.00）
学历			0.101	0.751
高中及以下	35（43.75）	38（47.50）
大专及以上	45（56.25）	42（52.50）
手术类型			0.240	0.624
子宫切除术	28（35.00）	32（40.00）
非子宫切除术	52（65.00）	48（60.00）
手术时间			0.025	0.873
< 90 min	46（57.50）	44（55.00）
≥ 90 min	34（42.50）	36（45.00）
ASA分级			0.000	1.000
Ⅰ—Ⅱ级	72（90.00）	71（88.75）
Ⅲ级	8（10.00）	9（11.25）
高血压	12（15.00）	15（18.75）	0.178	0.673
糖尿病	6（7.50）	7（8.75）	0.000	1.000
PSQI评分［M（Q₁，Q₃ ）］/分	3.00（2.00，4.00）	9.00（7.00，10.00）	10.987	< 0.001
BIS［M（Q₁，Q₃ ）］
T0	94.0（92，96）	93.5（91，95）	-0.856	0.392
T1	45.0（42，48）	46.0（43，49）	-1.234	0.217
T2	52.0（48，55）	51.0（47，56）	-0.678	0.498
T3	50.0（46，53）	51.5（48，55）	-1.456	0.145
T4	48.0（45，51）	49.0（46，53）	-1.123	0.261
苏醒时间（x ± s）/min	18.68 ± 4.30	23.29 ± 4.95	6.290	< 0.001
改良Aldrete评分［M（Q₁，Q₃ ）］/分	9.00（9.00，10.00）	9.00（8.00，9.00）	2.655	0.008
定向力恢复时间（x ± s）/min	8.96 ± 2.43	12.83 ± 4.10	7.248	< 0.001
总不良反应	18（22.50）	48（60.00）	23.211	< 0.001
恶心呕吐	8（10.00）	18（22.50）	4.592	0.032
苏醒期躁动	4（5.00）	14（17.50）	6.260	0.012
寒战	6（7.50）	16（20.00）	5.270	0.022
瑞芬太尼总量（x ± s）/μg	458.04 ± 106.43	486.76 ± 110.79	-1.672	0.096
丙泊酚总量（x ± s）/mg	673.96 ± 123.2	723.89 ± 148.29	-2.316	0.022
七氟醚MAC值（x ± s）	0.79 ± 0.18	0.75 ± 0.18	1.455	0.148
停药至拔管时间（x ± s）/min	12.04 ± 3.37	16.3 ± 4.75	-6.551	< 0.001
术中MAP（x ± s）/mmHg	79.5 ± 8.21	77.36 ± 8.96	1.573	0.118
术中HR（x ± s）/（次/min）	71.24 ± 9.52	76.03 ± 12.08	-2.785	0.006
补救镇痛使用率	14（17.50）	43（53.75）	21.366	< 0.001
VAS评分［M（Q₁，Q₃ ）］/分
术后即刻	3.00（2.00，4.00）	5.00（3.00，6.00）	-5.349	< 0.001
术后6 h	3.00（2.75，5.00）	5.00（4.00，7.00）	-5.161	< 0.001
术后24 h	2.00（1.00，3.00）	4.00（3.00，5.00）	-6.047	< 0.001

Tab.1

Tab.2

Fig.1

Tab.3

Fig.2

References 29

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结局变量	β系数	95%置信区间	P值	R²	调整R²
麻醉苏醒指标	-	-	-	-	-
苏醒时间	0.631	0.410 ~ 0.851	< 0.001	0.187	0.161
定向力恢复时间	0.548	0.389 ~ 0.707	< 0.001	0.249	0.225
改良Aldrete评分	-0.054	-0.088 ~ -0.020	0.002	0.092	0.062
疼痛指标	-	-	-	-	-
术后即刻VAS评分	0.197	0.121 ~ 0.273	< 0.001	0.149	0.127
术后6 h VAS评分	0.221	0.133 ~ 0.309	< 0.001	0.152	0.131
术后24 h VAS评分	0.207	0.139 ~ 0.275	< 0.001	0.222	0.202
阿片类药物用量	0.865	0.616 ~ 1.113	< 0.001	0.234	0.215
PCA按压次数	0.979	0.756 ~ 1.201	< 0.001	0.338	0.320

结局变量	自变量	β系数	95% CI	P值	VIF
苏醒时间	PSQI评分	0.421	0.298 ~ 0.544	??< 0.001?	1.34
	停药至拔管时间	0.342	0.215 ~ 0.469	??< 0.001?	1.89
	瑞芬太尼总用量	0.234	0.089 ~ 0.379	?0.002?	2.12
	术中平均BIS值	-0.189	-0.334 ~ -0.044	?0.012?	1.56
	年龄	0.156	0.032 ~ 0.280	?0.014?	1.43
	模型拟合度	?R2 = 0.456，调整R2 = 0.428，F = 24.67，P < 0.001
术后24 h VAS?	PSQI评分	0.312	0.189 ~ 0.435	??< 0.001?	1.42
	七氟醚MAC值	0.267	0.156 ~ 0.378	??< 0.001?	1.67
	术中MAP波动	0.198	0.058 ~ 0.338	?0.006?	1.54
	瑞芬太尼总用量	0.187	0.063 ~ 0.311	?0.003?	2.08
	定向力恢复时间	0.165	0.041 ~ 0.289	?0.009?	1.78
	模型拟合度	?R2 = 0.524，调整R2 = 0.496，F = 32.45，P < 0.001

The impact of perioperative sleep disorders in patients undergoing laparoscopic gynecological surgery under general anesthesia on anesthesia recovery and postoperative pain

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