广东医学2026，Vol.47Issue(3)：331-336,6.DOI:10.13820/j.cnki.gdyx.20252000
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
Effects of different doses of dexmedetomidine-induced sleep combined with stellate ganglion block on patients with refractory insomnia
摘要
Abstract
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.关键词
右美托咪定/星状神经节阻滞/顽固性失眠/褪黑素/皮质醇Key words
dexmedetomidine/stellate ganglion block/refractory insomnia/melatonin/cortisol分类
医药卫生引用本文复制引用
邓铭锋,刘光华,徐德敏,陈添辉,张奕文..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[J].广东医学,2026,47(3):331-336,6.基金项目
国家卫生健康委医药卫生科技发展研究中心"创新药物上市后临床研究科研专项"(卫科成果函[2024]333号) （卫科成果函[2024]333号）
广东省"十四五"临床重点专科建设项目(粤卫办函[2025]6号) （粤卫办函[2025]6号）
佛山市自筹经费类科技创新项目入库培育项目(2220001005072) （2220001005072）
