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大手术后褪黑素、皮质醇和核心体温节律的紊乱。

Disturbances in melatonin, cortisol and core body temperature rhythms after major surgery.

作者信息

Gögenur Ismail, Ocak Ubbat, Altunpinar Omer, Middleton Benita, Skene Debra J, Rosenberg Jacob

机构信息

Department of Surgical Gastroenterology, University Hospital of Copenhagen, Gentofte, Niels Andersens vej 65, DK-2900, Hellerup, Denmark.

出版信息

World J Surg. 2007 Feb;31(2):290-8. doi: 10.1007/s00268-006-0256-5.

Abstract

BACKGROUND

It has been suggested that circadian rhythm disturbances are present after major surgery and that this may play a role in the development of postoperative sleep disturbances, fatigue, cognitive dysfunction and cardiovascular morbidity. The objective of this study was to examine the profile of melatonin, cortisol and core body temperature rhythms before and after major surgery.

METHODS

Blood samples (melatonin and cortisol) and core body temperature readings were collected every hour in the 24-h period prior to surgery and the 48 h after surgery from 11 patients undergoing major abdominal surgery. All patients had private rooms. Light exposure was controlled and monitored. Phase markers [50% dim light melatonin onset (DLMO 50%) and offset (DLMOff 50%), cortisol and core body temperature acrophase] for the three circadian rhythm profiles were calculated before and after surgery. The correlation between the melatonin rhythm and time of surgery, duration of surgery and opioid use was examined.

RESULTS

A median delay in the onset of melatonin was seen on the first postoperative day [median DLMO 50% 22:46 hours (range: 21:15-01:08 hours) on the preoperative day compared with 23:54 hours (range: 19:09-02:46 hours) on the first postoperative day; P </= 0.05] . A significant positive correlation existed between the duration of surgery and the time of melatonin onset (r = 0.67, P </= 0.05) . There was a significantly reduced basal secretion of melatonin immediately after surgery, with a subsequent significant increase in maximum melatonin values on the second postoperative night. A median delay of up to 4 h was seen in the timing of the peak of the temperature rhythm on the second postoperative day. Both cortisol secretion and core body temperature were increased after surgery and did not return to preoperative values in the 48 h of the postoperative study period. No significant correlation between opioid dose and the basal or maximum melatonin levels or the time of melatonin onset was found.

CONCLUSION

We found disturbances in three circadian markers after major surgery. The clinical consequences of postoperative circadian disturbances should be investigated further in the future.

摘要

背景

有研究表明,大手术后会出现昼夜节律紊乱,这可能在术后睡眠障碍、疲劳、认知功能障碍和心血管疾病的发生中起作用。本研究的目的是检查大手术前后褪黑素、皮质醇和核心体温节律的变化情况。

方法

对11例接受腹部大手术的患者,在手术前24小时及术后48小时内每小时采集血样(检测褪黑素和皮质醇)并测量核心体温。所有患者均住单人病房。控制并监测光照情况。计算手术前后三种昼夜节律的相位标记[50%暗光褪黑素起始(DLMO 50%)和偏移(DLMOff 50%)、皮质醇和核心体温峰值相位]。研究褪黑素节律与手术时间、手术时长及阿片类药物使用之间的相关性。

结果

术后第一天观察到褪黑素起始时间出现中位数延迟[术前日DLMO 50%中位数为22:46小时(范围:21:15 - 01:08小时),术后第一天为23:54小时(范围:19:09 - 02:46小时);P≤0.05]。手术时长与褪黑素起始时间之间存在显著正相关(r = 0.67,P≤0.05)。术后立即出现褪黑素基础分泌显著减少,随后在术后第二晚褪黑素最大值显著增加。术后第二天体温节律峰值时间出现长达4小时的中位数延迟。术后皮质醇分泌和核心体温均升高,且在术后研究期的48小时内未恢复到术前值。未发现阿片类药物剂量与褪黑素基础水平或最大值水平及褪黑素起始时间之间存在显著相关性。

结论

我们发现大手术后三种昼夜节律标记物出现紊乱。术后昼夜节律紊乱的临床后果未来应进一步研究。

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