不同剂量右美托咪定诱导睡眠联合星状神经节阻滞对顽固性失眠患者治疗作用的影响OA

Objective To compare the clinical efficacy and safety of three different doses of dexmedetomidine-induced sleep combined with stellate ganglion block(SGB)in patients with refractory insomnia.Methods Ninety pa-tients with refractory insomnia admitted to the Department of Anesthesia Sleep Medicine at Sanshui Hospital of Foshan Hospital of Traditional Chinese Medicine between January 2022 and December 2023 were enrolled.According to the in-duction dose of dexmedetomidine,patients were randomly assigned to three groups:dexmedetomidine 0.6 μg/(kg·h)(Group Ⅰ,n=28),0.8 μg/(kg·h)(Group Ⅱ,n=28),and 1.0 μg/(kg·h)(Group Ⅲ,n=27).Beginning the day after admission,ultrasound-guided stellate ganglion block was performed alternately each day at approximately 10:00 AM.At 22:00,patients entered the anesthesia sleep therapy room and underwent continuous electrocardiographic monito-ring.Dexmedetomidine was intravenously infused at the assigned induction dose;after 30 minutes,a maintenance infusion of 0.2 μg/(kg·h)was continued for 6 hours.Vital signs were monitored after cessation of infusion,and patients re-turned to the ward at 08:00.The treatment course lasted 1 week.The Pittsburgh Sleep Quality Index(PSQI)scores were recorded before treatment(T0)and at 1 week(T1),1 month(T2),3 months(T3),and 6 months(T4)after treat-ment.Polysomnography was used to measure sleep latency,total sleep time,sleep efficiency,and the proportions of rapid eye movement(REM)sleep and non-rapid eye movement(NREM)sleep.Venous blood samples were collected to de-termine serum melatonin and cortisol levels.Adverse events during treatment-including dizziness,dry mouth,bradycar-dia,hypoxemia,and hypotension-were also recorded.Results Compared with Group Ⅰ,PSQI scores in Groups Ⅱ and Ⅲ were significantly lower at T1-T4(P＜0.05).Sleep latency was significantly shorter in Groups Ⅱ and Ⅲ at T1-T4 compared with Group Ⅰ.Total sleep time and sleep efficiency were significantly increased in Groups Ⅱ and Ⅲ at T2-T4(P＜0.05).The proportion of REM sleep was significantly reduced in Group Ⅱ at T2-T4 and in Group Ⅲ at T1-T4,whereas the proportion of NREM stage 3 sleep was significantly increased in Groups Ⅱ and Ⅲ at T2-T4(P＜0.05).Compared with Group Ⅰ,serum melatonin levels were significantly higher and cortisol levels significantly lower in Groups Ⅱ and Ⅲ at T1-T4(P＜0.05).However,compared with Group Ⅲ,the incidence of adverse events-inclu-ding dry mouth,dizziness,bradycardia,and hypotension-was significantly lower in Groups Ⅰ and Ⅱ(P＜0.05).Conclusion Compared with dexmedetomidine at 0.6 μg/(kg·h)or 1.0 μg/(kg·h),dexmedetomidine at 0.8 μg/(kg·h)combined with stellate ganglion block more effectively shortens sleep latency,improves sleep architecture,en-hances sleep efficiency,and improves sleep quality in patients with refractory insomnia.These effects may be associated with increased melatonin levels and decreased cortisol levels.