Paul Torsten, Lemmer Björn
Institute of Pharmacology and Toxicology, University of Heidelberg, Mannheim, Germany.
Chronobiol Int. 2007;24(1):45-61. doi: 10.1080/07420520601142569.
Melatonin, cortisol, heart rate, blood pressure, spontaneous motor activity, and body temperature follow stable circadian rhythms in healthy individuals. These circadian rhythms may be influenced or impaired by the loss of external zeitgebers during analgosedation, critical illness, continuous therapeutic intervention in the intensive care unit (ICU), and cerebral injury. This prospective, observational, clinical study examined 24 critically ill analgo-sedated patients, 13 patients following surgery, trauma, or acute respiratory distress (ICU), and 11 patients with acute severe brain injury following trauma or cerebral hemorrhage (CCI). Blood samples for the determination of melatonin and cortisol were obtained from each patient at 2 h intervals for 24 h beginning at 18:00 h on day 1 and ending 16:00 h on day 2. Blood pressure, heart rate, body temperature, and spontaneous motor activity were monitored continuously. Level of sedation was assessed using the Ramsey Sedation Scale. The severity of illness was assessed using the APACHE-II-score. The time series data were analyzed by rhythm analysis with the Chronos-Fit program, using partial Fourier series with up to six harmonics. The 24 h profiles of all parameters from both groups of patients were greatly disturbed/abolished compared to the well-known rhythmic 24 h patterns in healthy controls. These rhythm disturbances were more pronounced in patients with brain injury. The results of this study provide evidence for a pronounced disturbance of the physiological temporal organization in ICU patients. The relative contribution of analgosedation and/or brain injury, however, is a point of future investigation.
在健康个体中，褪黑素、皮质醇、心率、血压、自发运动活动和体温遵循稳定的昼夜节律。在镇痛镇静、危重病、重症监护病房（ICU）的持续治疗干预以及脑损伤期间，外部时间线索的丧失可能会影响或损害这些昼夜节律。这项前瞻性、观察性临床研究对24例接受镇痛镇静的危重病患者、13例接受手术、创伤或急性呼吸窘迫（ICU）的患者以及11例创伤或脑出血后急性重度脑损伤（CCI）的患者进行了研究。从第1天18:00开始至第2天16:00结束，每隔2小时从每位患者采集血样以测定褪黑素和皮质醇。持续监测血压、心率、体温和自发运动活动。使用拉姆齐镇静评分评估镇静水平。使用急性生理与慢性健康状况评分系统II（APACHE-II评分）评估疾病严重程度。使用Chronos-Fit程序通过节律分析对时间序列数据进行分析，使用高达六个谐波的部分傅里叶级数。与健康对照中众所周知的有节律的24小时模式相比，两组患者所有参数的24小时曲线均受到极大干扰/消失。这些节律紊乱在脑损伤患者中更为明显。本研究结果为ICU患者生理时间组织的明显紊乱提供了证据。然而，镇痛镇静和/或脑损伤的相对作用是未来研究的一个重点。
