[全身麻醉对4至6岁打鼾儿童术后褪黑素分泌的影响]
[Effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring].
作者信息
Qiu Qianqi, Song Xingrong, Sun Changzhi, Tan Yonghong, Xu Yingyi, Huang Guiliang, Zhang Na, Li Zhengke, Wei Wei
机构信息
Department of Anesthesiology, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou 510623, China.
Department of Otolaryngology, Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou 510623, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Jan 30;41(1):128-134. doi: 10.12122/j.issn.1673-4254.2021.01.19.
OBJECTIVE
To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring.
METHODS
Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded.
RESULTS
No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)( < 0.05) but recovered at 7 am on the second day after the surgery (T11);salivary melatonin levels at T4, T8, and T11 exceeded 3 pg/mL on the third day.No significant difference was found in illumination intensity or body temperature across the time points when melatonin level was measured.The children showed no significant changes in FLACC score, Riker score or QOR- 15 score after the operation, but the OSA-18 score was significantly lowered after the operation ( < 0.05).None of the 20 children had such adverse events as respiratory depression, sinus bradycardia, sinus tachycardia, hypertension, hypotension, nausea or vomiting during hospitalization.
CONCLUSIONS
In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.
目的
评估全身麻醉对4至6岁打鼾儿童术后褪黑素分泌的影响。
方法
选取20例4 - 6岁打鼾儿童（男女不限，ASA分级Ⅰ级和Ⅱ级）行腺样体切除术。在手术前、手术期间及术后3天，于11个选定时间点（T1 - T11）测量患儿唾液褪黑素水平。在每个测量时间点记录患儿的光照强度和体温。记录患儿术后3天的睡眠时间，并评估术后疼痛评分（FLACC）以及里克尔镇静和恢复质量评分量表 - 15（QoR - 15）评分。使用睡眠呼吸暂停生活质量评估问卷（OSA - 18）评估患儿术后28天的恢复情况。记录患儿住院期间主要不良事件的发生率。
结果
20例患儿术前唾液褪黑素基线水平无显著差异。术后上午7点（T8）的唾液褪黑素水平较手术前（T4）显著降低（<0.05），但在术后第二天上午7点（T11）恢复；术后第三天T4、T8和T11的唾液褪黑素水平超过3 pg/mL。在测量褪黑素水平的各个时间点，光照强度或体温无显著差异。患儿术后FLACC评分、里克尔评分或QoR - 15评分无显著变化，但术后OSA - 18评分显著降低（<0.05）。20例患儿住院期间均未发生呼吸抑制、窦性心动过缓、窦性心动过速、高血压、低血压、恶心或呕吐等不良事件。
结论
对于打鼾的学龄前儿童，全身麻醉会影响但不会抑制术后第一晚的褪黑素分泌，且上午进行的全身麻醉小手术不会导致褪黑素分泌发生显著变化而引起这些儿童昼夜节律紊乱。
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