【作者】 陈伟程；

【导师】 吴汉江；

【作者基本信息】 中南大学 ， 口腔医学， 2008， 硕士

【摘要】 目的:了解口腔癌患者术后的睡眠状况,分析影响术后睡眠的相关因素,探讨评价睡眠紊乱程度的方法。方法:对41例住院手术的口腔癌患者,术前采用抑郁自评量表(SDS)、焦虑自评量表(SAS)进行心理调查,在出院前一、二天采用匹兹堡睡眠质量指数(PSQI)进行调查术后的睡眠状况,收集手术时间和一般资料。另外对10例患者分别于术前、术后第一天、术后第四天抽血查血清皮质醇浓度。结果:1口腔癌患者术后睡眠障碍的发生率92.7%。口腔癌患者术前抑郁的发生率为43.90%,焦虑的发生率为24.39%。2焦虑与PSQI因子睡眠质量、入睡时间存在显著正相关(p＜0.05);手术时间与PSQI因子入睡时间、睡眠障碍及总分存在显著正相关(p＜0.05)。3术后使用镇痛泵组与无使用镇痛泵组在PSQI因子睡眠时间、睡眠效率及总分存在显著差别(p＜0.05)。术后气管切开组与无气管切开组在PSQI各因子及总分均无显著差别(p＞0.05)。单人间组与三人间组在PSQI各因子及总分均无显著差别(p＞0.05)。4在性别上,男女PSQI总分上无差别,在PSQI因子睡眠障碍、药物催眠在统计上存在显著差别。在年龄上,30～49岁患者与60岁以上患者在PSQI因子睡眠时间、睡眠效率存在显著差别。5术前与术后第一天的皮质醇浓度之差绝对值(X)与PSQI因子睡眠时间、药物催眠及总分存在显著负相关,即X越小,患者术后睡眠紊乱程度越严重。结论:1口腔癌患者术后普遍存在睡眠紊乱。睡眠紊乱发生率为92.7%。2手术的复杂程度和时间长短、心理因素及疼痛是影响患者术后睡眠主要原因。3术后镇痛有助于改善患者的睡眠。4术后血清皮质醇浓度的变化有可能是术后睡眠紊乱严重程度的一个客观指标。更多还原

【Abstract】 Objective:The object of this study to explore the sleep status of the patients with oral cancer and analyse on difference of sleep status after operation,find a way in evaluating the degree of sleep disorders.Methods:The subjects of this study consisted of forty-one inpatients with oral cancer.The survey parameters used the Self-Rating Depression Scale (SDS)and the Self-Rating anxiety Scale(SAS)to determine psychical health before operation,the Pittsburgh Sleep Quality Index(PSQI)to evaluate sleeping status after operation,surgical time and detect the serum concentration of cortisol in ten patients before and after operation. After calculating descriptive statistics using these variables,T-test,χ~2-test and correlation coefficients were calculated by SPSS 10.0.Results:1 Sleep disorders were occurred in 92.7%of the patients.43.90%of the patients with oral cancer had the symptom depression.24.39%of the patients with oral cancer had the symptom anxiety.2 Calculation of correlation coefficients between anxiety and PSQI, revealed a significant correlation between anxiety and sleep quality, fall-asleep time.Calculation of correlation coefficients between surgical time and PSQI,revealed a significant correlation between surgical time, fall-asleep time,sleep obstruction,and total score.3 Sleep obstruction,and sleep medication in the female patients were significantly more than the male patients(p＜0.05).Sleep time,and sleep efficiency in the patients aging more than sixty were significantly more than the patients aging from thirty to forty-nine(p＜0.05).4 Sleep time,sleep efficiency,and total score in the patient with PCA (patients controlled analgesia)pump were significantly more than the non-PCA pump(p＜0.05).The factors of PSQI and total score were no significantly different between the patients with tracheotomy and the patients without tracheotomy.The same result also took place between the patients in single-person room and the patients in three-person room.5 Linear regression analysis showed a significant negative correlation between the degree of sleep disorders and absolute value of cortisol minus between preoperative day and postoperative first day.Conclusion:1 Sleep disorders was observed in 92.7%of patients with oral cancer after operation.2The complexity and the time of the operation were the major influence on sleep in patients with oral cancer after operation.Psychical health and pain also affected the sleep.3 Analgesia was benefit to improve the sleep of the patient after operation.4 The change in serum concentration of cortisol may be an objective indicator in valuating the degree of sleep disorders.更多还原