Gögenur I, Middleton B, Kristiansen V B, Skene D J, Rosenberg J
Department of Surgical Gastroenterology D, University of Copenhagen, Gentofte Hospital, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark.
Acta Anaesthesiol Scand. 2007 Sep;51(8):1099-106. doi: 10.1111/j.1399-6576.2007.01387.x.
Sleep disturbances, fatigue and reduced general well-being frequently occur after minimal invasive surgery. The circadian rhythms of melatonin and core body temperature are central to the regulation of normal sleep. The aim of this study was to assess changes in these circadian rhythms after laparoscopic cholecystectomy.
Twelve women were studied before and after laparoscopic cholecystectomy. The major urinary melatonin metabolite, 6-sulphatoxymelatonin (aMT6s), and the core body temperature were measured for 1 day before and 1 day after surgery. The basal and maximum secretion of aMT6s were determined, as well as the timing and amplitude of aMT6s and the temperature rhythm. The patients' rest-activity and calculated sleep parameters were assessed by actigraphy.
A significant delay in the timing of aMT6s rhythm was observed after surgery [median (range) peak time of aMT6s: after surgery, 05:49 h (02:57-08:23 h); before surgery, 04:32 h (02:18-06:49 h); P< or = 0.05]. The amplitude of the aMT6s rhythm was also significantly decreased after surgery [after surgery, 7.1 ng aMT6s/mg creatinine (1-15.9 ng); before surgery, 13.2 ng aMT6s/mg creatinine (2.9-22.7 ng); P< or = 0.005]. There was almost a 12-h phase delay of the core body temperature rhythm after surgery [peak time: before surgery, 17:39 h (15:17-22:06 h); after surgery, 05:14 h (03:24-21:43 h); P< or = 0.01].
Following laparoscopic cholecystectomy, there was a delay in the timing of the aMT6s rhythm and a decreased evening decline in the temperature rhythm.
微创手术后经常出现睡眠障碍、疲劳和总体幸福感下降。褪黑素和核心体温的昼夜节律是正常睡眠调节的核心。本研究的目的是评估腹腔镜胆囊切除术后这些昼夜节律的变化。
对12名女性在腹腔镜胆囊切除术前和术后进行研究。在手术前1天和手术后1天测量主要尿褪黑素代谢物6-硫酸氧褪黑素（aMT6s）和核心体温。测定aMT6s的基础分泌和最大分泌，以及aMT6s的时间和幅度以及体温节律。通过活动记录仪评估患者的休息-活动情况并计算睡眠参数。
术后观察到aMT6s节律的时间显著延迟[aMT6s的中位数（范围）峰值时间：术后为05:49小时（02:57 - 08:23小时）；术前为04:32小时（02:18 - 06:49小时）；P≤0.05]。术后aMT6s节律的幅度也显著降低[术后为7.1 ng aMT6s/mg肌酐（1 - 15.9 ng）；术前为13.2 ng aMT6s/mg肌酐（2.9 - 22.7 ng）；P≤0.005]。术后核心体温节律几乎有12小时的相位延迟[峰值时间：术前为17:39小时（15:17 - 22:06小时）；术后为05:14小时（03:24 - 21:43小时）；P≤0.01]。
腹腔镜胆囊切除术后，aMT6s节律的时间延迟，体温节律的夜间下降减少。
