| 毛姗姗,胡蕊,黄群,等.多模态数字化监测下右美托咪定联合星状神经节阻滞对更年期睡眠障碍病人神经 -免疫轴调控机制研究[J].安徽医药,2026,30(6):1177-1182. |
| 多模态数字化监测下右美托咪定联合星状神经节阻滞对更年期睡眠障碍病人神经 -免疫轴调控机制研究 |
| Multimodal digital monitoring of the synergistic regulatory mechanism of dexmedetomidine combined with stellate ganglion block on the neuro-immune axis in menopausal patients with sleep disorders |
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| DOI：10.3969/j.issn.1009-6469.2026.06.023 |
| 中文关键词: 入睡和睡眠障碍 围绝经期 多模态数字化 右美托咪定 星状神经节阻滞 皮质醇 免疫功能 |
| 英文关键词: Sleep initiation and maintenance disorders Peri-menopausal period Multimodal digital monitoring Dexmedetomidine Stellate ganglion block Cortisol Immune function |
| 基金项目:徐州市卫生健康委科技项目( XWKYHT20240093) |
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| 中文摘要: |
| 目的多模态数字化监测下评估右美托咪定( Dex)鼻喷联合星状神经节阻滞( SGB)对更年期睡眠障碍病人神经 -免疫轴的协同调控作用。方法选取 2023年 12月至 2024年 12月徐州市中医院收治的更年期睡眠障碍病人 60例，采用随机数字表法分为 SGB组( S组， n=30)和 SGB联合 Dex鼻喷组( SD组， n=30)。 S组病人白天进行超声引导下 SGB，左右交替，连续 10 d。 SD组疗程第 1天心电监护及多模态脑电监测仪下进行 Dex滴定，疗程中每晚睡前 Dex鼻喷治疗 20 d，并且白天进行超声引导下 SGB治疗 10 d。比较两组病人干预前和干预后 1、10、30、60 d的改良女性绝经期自测表( Kupperman)、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表( HAMA)评分。使用便携式睡眠监测仪( PSG)记录并比较两组病人干预前后睡眠情况包括入眠时间(SL)、总睡眠时间( TST)、觉醒时间(WASO)、睡眠效率( SE)、快速眼动睡眠(REM)占比、 N3期睡眠比例。比较两组病人干预前后雌激素、卵泡刺激素(FSH)、黄体生成素( LH)、血浆皮质醇含量及免疫功能的变化。结果干预后 1、10、30、60 d，与 S组相比， SD组改良 Kupperman、PSQI［干预后 60 d:(3.82±0.51)分比( 6.94±1.15)分］、 HAMA评分均降低( P<0.05)； S组各项评分在干预后 60 d与干预后 30 d差异无统计学意义( P>0.05)； SD组各项评分在干预后 60 d低于干预后 30 d(P<0.05)。两组病人干预后 SL、WASO均较本组干预前减少(P<0.05)TST、SE、REM占比、 N3期睡眠比例均增加( P<0.05)且 SD组各项睡眠结构及分期参数均较 S组改善明显( P<0.05)。与干预前相，比，干预后两组病人的雌激素、 CD4+/CD8+水平升高(，P<0.05)FSH、LH水平及血浆皮质醇含量下降( P<0.05)；干预后， SD组雌激素、 CD4+/CD8+水平高于 S组( P<0.05)， FSH、LH水平及血，浆皮质醇含量［( 202.16±25.56)μg/L比( 245.45±25.21)μg/L］低于 S组( P<0.05)。结论多模态数字化监测下 Dex鼻喷联合 SGB可有效改善更年期睡眠障碍病人失眠症状，改善睡眠结构及分期，调节神经激素分泌，提高免疫功能。 |
| 英文摘要: |
| Objective To evaluate the synergistic regulatory effect of intranasal dexmedetomidine (Dex) combined with stellate gan.glion block (SGB) on the neuro-immune axis in menopausal patients with sleep disorders under multimodal digital monitoring.Meth. ods Sixty patients with menopausal sleep disorders admitted to Xuzhou Hospital of Traditional Chinese Medicine from December2023 to December 2024 were enrolled and randomly divided into the SGB group (group S, n=30) and the SGB combined with intranasal Dex group (group SD, n=30) using a random number table method. Patients in group S underwent ultrasound-guided SGB during theday, alternating left and right, for 10 consecutive days. In the SD group, Dex administration was performed under electrocardiographic(ECG) monitoring and multimodal electroencephalography (EEG) monitoring on the first day of treatment. During the course of treat.ment, Dex nasal spray was administered every night before bedtime for 20 days, and SGB therapy was performed under ultrasoundguidance during the day for 10 days. The modified Kupperman self-rating scale (Kupperman) scores, Pittsburgh sleep quality index(PSQI) scores, and Hamilton anxiety scale (HAMA) scores of the two groups were recorded before intervention and at 1, 10, 30 and 60days after intervention. Portable sleep monitoring (PSG) was used to record and compare sleep parameters between the two groups be.fore and after treatment, including sleep latency (SL), total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency(SE), percentage of rapid eye movement (REM) sleep, and percentage of N3 sleep. The changes in estrogen, follicle-stimulating hor. mone (FSH), luteinizing hormone (LH), plasma cortisol content, and immune function were compared between the two groups before andafter intervention.Results At 1, 10, 30, and 60 days after intervention, the modified Kupperman scores, PSQI [at 60 days: (3.82±0.51) vs. (6.94±1.15)], and HAMA scores in the SD group were all lower than those in the S group (P<0.05). There was no statistically signifi. cant difference in any scores of the S group between 60 days and 30 days after intervention (P>0.05), whereas all scores in the SD group at 60 days after intervention were lower than those at 30 days (P<0.05). After intervention, SL and WASO in both groups decreased com.pared with those before intervention, while TST, SE, REM percentage, and N3 sleep percentage increased. Moreover, all sleep architec.ture and stage parameters in the SD group improved significantly compared with those in the S group (P<0.05). Compared with before in. tervention, estrogen levels and CD4+/CD8+ ratio increased, while FSH, LH, and plasma cortisol levels decreased after intervention (P< 0.05). After intervention, the SD group had higher estrogen levels and CD4+/CD8+ ratio (P<0.05), and lower FSH, LH, and plasma corti. sol levels [(202.16±25.56) μg/L vs. (245.45±25.21) μg/L] than the S group (P<0.05).Conclusion Under multimodal digital monitoring,intranasal dexmedetomidine combined with stellate ganglion block can effectively alleviate insomnia symptoms in menopausal patientswith sleep disorders, improve sleep architecture and sleep staging, regulate neurohormone secretion, and enhance immune function. |
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