| ObjectivesThe aim of this study was to observe the effect of ultrasound-guided unilateral stellate ganglion block combined with Dexmedetomidine on sleep quality in patients with chronic insomnia.MethodsIn this study,70 patients with chronic insomnia who were hospitalized in the pain department sleep center from October 2020 to September 2022 and met the inclusion and exclusion criteria were selected.Among them,2 patients withdrew from the treatment because of personal reasons,3 patients refused to complete the sleep assessment scale and follow-up,1 invalid scale,the dropout rate was 8.5%.Finally,64 patients with chronic insomnia were included.Aged between 18 and 65 years old,ASA Ⅰ or Ⅱ,were divided into two groups by random number table method,with 32 patients in each group,including Dextrometomidine treatment group(Dex group,n=32)and Dextrmetomidine combined with ultrasound-guided stellate ganglion block treatment group(S group,n=32).Dex group:Dex group received Dexm-edetomidine to induce sleep at 21:30～22:30 every night.Before treatment,2 mg of midazolam was injected intravenously.The blood pressure and heart rate were maintained at±20%of the preoperative value,and Dexmedetomidine was diluted to 4ug/ml,the induction dose was 0.6 ug/(kg·h),after 10 minutes,the adjustment rate was 0.2 ug/(kg·h)for 1 hour,and the treatment lasted for 5 days.Group S:unilateral stellate ganglion block under the guidance of B-ultrasound was performed at 8 a.m.every day,and 4 ml of 0.2%ropivacaine was injected.U-SGB was performed once a day,alternately left and right.T’hen use the same method to induce sleep treatment from 21:30 to 22:30 in the evening.Both groups of patients prepped for the venous sampling before and 1 day after treatment to detect the level of serum cortisol and observe the effect of different treatment methods on the level of serum cortisol;After admission,all patients were evaluated for their sleep status through the PSQI score table,and their anxiety and depression status through the HAMD score table and HAMA evaluation table.The above indicators were retested one day after treatment to compare the differences in sleep quality and anxiety and depression status before and after treatment,and the PSQI scores of 1 week,4 weeks and 12 weeks after treatment were followed up to observe whether the efficacy of sleep treatment remained over time.The incidence of adverse reactions such as hypotension,hypoxemia,nausea and vomiting during the treatment was recorded.ResultsThere was no significant difference in general data between the two groups(P>0.05).Before treatment(T1 time point),there was no statistically significant difference between the two groups in the total score of PSQI and the score of each dimension of PSQI(daytime function,sleep quality,hypnotic drugs,sleep efficiency,sleep disorders and sleep time);After treatment,the scores of insomnia patients at 1 day.1 week.1 month and 3 months after treatment were significantly lower than those before treatment,with a statistically significant difference(P<0.01):Among them,the total PSQI score of patients in group S was significantly lower than that in group Dex at the time point T2 to T5(P<0.01).The total effective rate of treatment in group S was significantly higher than that in group Dex at the time of 1 day.1 week.4 weeks and 12 weeks after treatment(P<0.01).There was no statistically significant difference in serum cortisol level between the two groups before treatment,and there was a baseline comparability.On the first day after treatment,the serum cortisol level of patients in group S was significantly lower than that in group Dex,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the HAMD score and HAMA score of the two groups before treatment.On the first day after treatment,the HAMD and HAMA scores of the two groups were lower than those before treatment,with a statistically significant difference(p<0.05).The HAMA and HAMD scores of the S group were lower than those of the Dex group,with a statistically significant difference(p<0.05).Conclusions1.Ultrasound-guided stellate ganglion block combined with dexmedetomidine can rapidly relieve the symptoms of patients with chronic insomnia in a short time,and the efficacy is significantly better than the treatment group of dexmedetomidine,improving the quality of life,and the efficacy lasts for at least 3 months,which is worthy of clinical promotion.2.Dextrmetomidine combined with ultrasound-guided stellate ganglion block in the treatment of chronic insomnia disorder can significantly improve the stress state caused by insomnia,reduce the serum cortisol of patients,and relieve the depression and anxiety state of patients. |
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