| Objective:1.By investigating the perioperative sleep quality of orthopedic patients,comparing the perioperative sleep quality and its dynamic changes of patients with different orthopedic diseases,and analyzing whether the influencing factors leading to the decline of perioperative sleep quality are the same,to provide a basis for selecting scientific and personalized prevention and treatment programs in the future,improving the sleep quality of orthopedic patients and promoting their rehabilitation.2.Under the concept of treatment without disease,acupoint stimulation regulation method was applied to orthopedic patients during perioperative period,and compared with routine nursing measures,in order to evaluate the effect of this method in the prevention and treatment of perioperative sleep disorder in orthopedic patients.The purpose of this study is to explore a safe and effective way to improve the sleep quality of orthopedic patients during perioperative period and promote the rehabilitation of orthopedic patients.Methods:Part one: a total of 345 adult patients undergoing orthopedic surgery from March to June 2019 were selected as subjects.Pittsburgh Sleep quality Index(PSQI)and Athens Insomnia scale(AIS)were used to evaluate the overall and daily sleep quality during the perioperative period.General data questionnaire,Chinese version of Ford stress Insomnia scale(FIRST-C),self-rating anxiety scale(SAS)and pain rating scale were used to collect other data.The sleep quality of all orthopedic patients before admission and duringperioperative period were compared.Binary Logistic stepwise regression analysis was used to analyze the influencing factors of perioperative sleep quality.In addition,after classifying orthopedic patients according to diseases,the similarities and differences of perioperative sleep quality and its influencing factors in patients with different kinds of orthopedic diseases were compared.The second part: this study is a quasi-experimental study.From December 2019 to January 2020,71 patients who received elective surgery in a third-class hospital in Shanxi Province who met the inclusion and exclusion criteria and signed informed consent to complete the trial were selected,including 35 patients in the intervention group and 36 patients in the control group.The patients in the intervention group were treated with acupoint stimulation from the date of admission to the day of discharge on the basis of routine nursing care in the department,while the patients in the control group only received routine nursing measures in the department.PSQI score and SAS score were evaluated at admission and discharge,saliva samples were taken to determine the concentration of salivary cortisol(SC)on the second day after admission,operation day,first day and second day after operation,and AIS score and pain score were evaluated from15:00 to 17:00 on the second day after admission,operation day,the first day after operation and the second day after operation,and the AIS score and pain score were evaluated from 15:00 to 17:00 on the second day after admission,the day after operation,the first day after operation and the second day after operation.The adverse reactions related to this study in the two groups were observed and recorded.Results:Part one: based on the PSQI score,the perioperative sleep quality score of orthopedic patients was higher than that before admission(P<0.05).59.42% of the patients had varying degrees of sleep disorders.The results of univariate analysis showed that there were significant differences in 13 factors.After Logistic stepwise regression analysis,the main influencing factors of sleep quality included the use of sleep aids(OR=12.829),anxiety(OR=9.107),the influence of roommatesand their families(OR=4.043),physical discomfort(OR=3.423);Other influencing factors(P<0.05)included female,marital statusand type of disease.After classifying patients according to diseases,based on PSQI score,71.43%,60.98%,57.14% and 46.15% of patients with lumbar spine disease,joint disease,limb fracture and cervical vertebra disease respectively had sleep disorders in different degrees during the perioperative period.Combined with PSQI score and AIS score,the sleep quality of perioperative patients with lumbar spine disease was the worst,while that of patients with cervical spondylosis was relatively good.There were dynamic changes in sleep quality of the four groups of patients during the perioperative period.Logistic stepwise regression analysis showed that severe pain was the main influencing factor of perioperative sleep quality of patients with lumbar disease,and anxiety was the main influencing factor of perioperative sleep quality of patients with limb fracture and joint disease.The second part:1.PSQI score.1.1 the score of seven dimensions and the total score of PSQI.The results of two-factor repeated measurement analysis of variance showed that there were significant differences in other dimensions and total scores at different time points except hypnotic scores(P<0.05).With the extension of time,the patients' scores tended to increase during the perioperative period.There was no significant difference in the time and group interaction of sleep quality,sleep disorder,hypnotic drugs and daytime dysfunction(P>0.05),indicating that the change trend of patient score was the same in the two groups.The main effect analysis of the sleep quality dimension of the group showed that the difference was statistically significant(F=4.522,P=0.043),indicating that the sleep quality score of the intervention group was lower than that of the control group.The main effects of sleep disorders,hypnotic drugs and daytime dysfunction were analyzed,and there was no significant difference between the intervention group and the control group(F=1.638,P=0.212;F=0.014,P=0.905;F=1.300,P=0.265).The results showed that there was no significant difference in the score between the intervention group and the control group.The interaction of falling asleep time,sleep time,sleep efficiency dimension and PSQI total score time and group was statistically significant(P<0.05),indicating that the change trend of patient score with time was different between the two groups,and the increase was small in the intervention group and large in the control group.A simple effect analysis was conducted on the dimensions of falling asleep time,sleep time,sleep efficiency and the total score of PSQI.There was no significant difference in the scores between the two groups before admission(F=1.000,P=0.327;F=1.000,P=0.327;F=2.080,P=0.161;F=0.667,P=0.421);during the perioperative period,there was a significant difference between the two groups(F=5.200,P=0.031;F=4.522,P=0.043,F=5.200,P=0.031;F=12.960,P=0.001).The score of intervention group was lower than that of control group.1.2.Based on the PSQI score,the sleep quality levels of the two groups were compared after intervention.The results of Wilcoxon rank sum test compared with two independent samples showed that there was significant difference in sleep quality between the two groups after intervention.In the intervention group,one patient in the < 7 group entered the 7-15 group,and one patient in the 7-15 group entered the > 15 group,while in the control group,6patients in the < 7 group entered the 7-15 group and 4 patients in the 7-15 group entered the > 15 group.2.AIS score.The results of two-factor repeated measurement analysis of variance showed that there were significant differences in AIS scores at different time points(F=8.218,P=0.001).With the extension of time,the AIS scores of patients increased at first and then decreased.The interaction between time and group was statistically significant(F=4.084,P=0.022),indicating that the change trend of AIS score of the two groups was different with time.The change range of the control group was larger than that of the intervention group.The comparison of AIS scores between the two groups at each time point showed that there was no significant difference in AIS scores between the two groups on the evening of admission and the evening of preoperation(F=3.240,P=0.083;F=3.198,P=0.085),but there was significant difference in AIS scores between the two groups on the evening of operation and the night of 1 day after operation(F=9.897,P=0.004;F=4.399,P=0.045),and the score of the intervention group was lower than that of the control group.3.Salivary cortisol(SC)concentration.The results of analysis of variance of repeated measurements of two factors showed that there was significant difference in SC concentration at different time points(F=3.846,P=0.025).With the extension of time,the concentration of SC increased at first and then decreased.The interaction between time and group was statistically significant(F=3.694,P=0.028),indicating that the change trend of SC concentration in the two groups was different with time.The change range of the control group was larger than that of the intervention group.The comparison of the concentration of SC between the two groups at each time point showed that there was no significant difference in the concentration of SC between the two groups on the second day of admission,the day of operation and the first day after operation,and there was no significant difference between the two groups(F=2.823,P=0.104;F=1.981,P=0.171;F=3.720,P=0.064).The concentration of SC in the intervention group was lower than that in the control group(F=5.974,P=0.021).The concentration of SC in the intervention group was lower than that in the control group.4.Anxiety score.The results of analysis of variance of repeated measurements of two factors showed that there were significant differences in anxiety scores at different time points(F=22.431,P < 0.001).With the extension of time,the anxiety scores of patients increased.The interaction between time and group was statistically significant(F=5.991,P=0.021),indicating that the anxiety score of the two groups changed differently with time.The increase of anxiety score in the control group was larger than that in the intervention group.The comparison of anxiety score between the two groups at each time point showed that there was no significant difference in anxiety score between the two groups on the day of admission(F=2.842,P=0.103),but there was significant difference in anxiety score between the two groups on the day of discharge(F=4.411,P=0.045),and the score in the intervention group was lower than that in the control group.5.Pain score.The results of variance analysis of repeated measurements showed that there weresignificant differences in pain scores at different time points(F=4.371,P=0.011).With the extension of time,the pain scores of patients increased at first and then decreased.There was no significant difference in the interaction between time and group(F=1.322,P=0.285),indicating that the change trend of anxiety score was the same between the two groups.According to the main effect analysis,there was no significant difference in pain score between the two groups(F=0.327,P=0.571).6.Incidence of adverse reactions.There were no adverse reactions in both groups during the study.Conclusion:The first part: the sleep quality of orthopedic patients during the perioperative period was significantly lower than that before admission,and the perioperative sleep quality was affected by many factors.According to the disease,orthopedic patients were divided into four categories.Further analysis showed that the perioperative sleep quality of patients with different diseases was different and there were dynamic changes with time.The main influencing factors of sleep quality are also different in patients with different types of diseases.Orthopedic doctors and nurses should combine the changing characteristics of sleep quality of various diseases and their main influencing factors,formulate personalized prevention and treatment measures to improve patients' sleep quality and promote patients' rapid recovery.The second part: the acupoint stimulation regulation method based on the concept of treatment without disease can effectively prevent and cure the subjective sleep disorders in patients with lumbar vertebrae and joint diseases during the perioperative period.This method is safe,feasible and easy to operate,and is suitable for clinical application. |
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