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肩关节手术后使用褪黑素

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为何我们在肩关节手术后处方褪黑素、试验证据显示了什么、我们使用的剂量,以及可以期待的效果。

Illustration: 肩关节手术后使用褪黑素

本页面由机器翻译,尚未经临床医生审核。英文版本为权威版本。

如果您曾在我处接受过肩部手术,或即将接受手术,您可能会在服用止痛药的同时被开具褪黑素的处方。本页将解释我们为何开具此药、其作用与局限性,以及服用方法。

为何给您开具褪黑素

肩关节手术后的最初几周,睡眠往往是最难熬的部分。平躺时肩部疼痛加剧,您无法保持惯常的睡姿,而悬吊带也让入睡变得别扭。睡眠中断又会导致次日疼痛感加重。我们关于睡眠、疼痛与恢复的页面涵盖了这方面的实用建议:体位摆放、镇痛药服用时机以及睡眠习惯。

我们现在在肩关节手术后常规开具褪黑素,因为一项针对关节镜下肩袖修复的高质量试验发现,它能改善早期几周的睡眠质量,且服用该药的患者在随后几个月内报告肩关节功能更好,并使用了较少的强效镇痛药。褪黑素性质温和,不会成瘾,且不像传统安眠药那样与镇痛药物发生相互作用。对于一个有明确终点的暂时性问题而言,这是一个合理的权衡。

褪黑素是什么

褪黑素是您的身体在夜间自行合成的一种激素,当天色变暗时,由大脑中的一颗小腺体释放。它是向身体其他部位发出“现在是夜间”这一信号的激素。该药片是这种激素的合成仿制品。

它并非镇静剂。安眠药会强制您入睡;而褪黑素则是调节生物钟,使入睡和维持睡眠变得更加容易。因此,它通常建议在睡前一小时左右服用,而非在您希望入睡的那一刻服用,并且作为规律就寝程序的一部分时效果最佳。

证据显示的内容

肩部试验。 2024年,位于费城的罗思曼骨科研究所发表了一项涉及80名接受微创(关节镜)肩袖修复术患者的随机对照试验。其中一半患者从手术当天起,每晚睡前一小时服用5毫克褪黑素,持续六周;另一半患者则遵循标准的睡眠卫生建议。服用褪黑素的患者在六周时睡眠改善具有可测量的显著性,在长达六个月期间对睡眠质量的评价更高,在第四和第六个月的标准肩部功能问卷中得分更高,且在第四个月时使用的阿片类止痛药更少。两组均未报告副作用。

这是一项来自单一中心的试验,且患者知晓自己所在的分组,因此该结果应被视为具有鼓励意义而非定论性的。然而,对于您目前所处的具体情况,这是目前可获得的最佳证据。

其他手术。 褪黑素已在多种手术后进行过测试。汇总十项试验和725名患者的数据,结果显示术后整体睡眠质量有小幅改善。在髋关节和膝关节置换术后,多项安慰剂对照试验发现,在最初几晚之后,褪黑素几乎没有或没有额外益处。因此,褪黑素并非万能解决方案,我们也不声称它是。肩部手术的结果最具说服力,这就是我们在该领域使用它的原因。

睡眠自然会改善。 了解自然病程是有帮助的。肩袖修复术后,睡眠通常在两周左右达到最差状态,到六周至三个月时明显好转,大多数人在六个月内恢复正常,且多年后仍保持这种状态。褪黑素旨在让最初几周变得更加容易。它不是长期治疗药物,一旦肩部恢复稳定,您就不再需要它。

我们的处方方式

  • 剂量: 2 毫克至 5 毫克,视您的具体情况而定;您的处方上会注明具体剂量。
  • 时间: 在您通常的睡前约一小时,每晚大致在同一时间服用。
  • 时长: 从手术当晚或您回家的第一晚开始,持续约六周,这也是试验所涵盖的时期。之后只需直接停药;无需逐渐减量。
  • 为何需要处方: 在澳大利亚,褪黑素对大多数成年人而言属于处方药。唯一非处方形式是药剂师提供的 2 毫克缓释片,仅批准用于 55 岁及以上伴有失眠的人群。由于手术后的剂量和原因不同,我们开具处方以确保您获得正确的剂型。

请将其与其他有助于恢复的措施配合使用,而非替代:前几周睡觉时保持抬高姿势,按指示在夜间佩戴悬吊带,按时服用常规止痛药以确保在您躺下前药物已起效,以及晚间冰敷。

副作用与注意事项

大多数人对褪黑素耐受性良好。最常见的不适包括:早晨略有昏沉感、梦境生动、头痛或轻度恶心。早晨的昏沉感通常可通过将服药时间提前至傍晚早些时候,或降低剂量来缓解。该药不具有成瘾性,停药后也无戒断反应。

肩关节手术后的最初几周,您本就不应驾驶;一旦获准恢复驾驶,请注意在重新驾车后的最初几天内可能出现的晨间嗜睡。在服用该药的夜晚请避免饮酒。

如果存在以下任何情况,请告知我们,以便我们调整方案:

  • 您正在服用华法林或其他抗凝药物,因为褪黑素可能影响凝血功能检测
  • 您患有癫痫或自身免疫性疾病
  • 您处于妊娠期或哺乳期
  • 您已在服用安眠药或抗抑郁药

预期效果

请勿指望第一晚就能安然入睡。试验中的益处是在数周内逐渐显现的,随着睡眠逐步巩固而改善,而非在第一晚就出现戏剧性的变化。如果疼痛是导致您醒来的原因,首要措施是疼痛控制和体位调整;褪黑素无法克服一个不适的肩膀带来的影响。

如果您觉得它没有帮助,或者您不想服用,这都没关系。它是您康复过程中的一个可选部分,而非必需部分。请在复诊时告知我们,我们会将其从您的清单中移除。

核心要点

肩关节手术后睡眠不佳很常见,通常是暂时性的,且值得治疗。一项高质量的试验发现,服用六周的褪黑素可使术后早期几周的情况得到改善,并可能在后期带来功能上的益处;该药物温和且无成瘾性。这就是它出现在您的处方中的原因。

何时联系我们

  • 疼痛持续加重而非缓解,或您的药物无法控制疼痛
  • 白天嗜睡或意识模糊,且程度超过轻微
  • 服药后出现皮疹、面部或嘴唇肿胀,或呼吸困难:立即停药并前往急诊科
  • 在睡眠、疼痛与恢复页面上列出的常规伤口及一般警示征象

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