Nishiyama Seiya, Sekine Akiko, Masuyama Tomoyuki, Nagatomo Kanae, Kanbayashi Takashi, Sanui Masamitsu
Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama-Shi, Saitama, Japan.
Department of Neurology, Japanese Red Cross Maebashi Hospital, Maebashi-Shi, Gunma, Japan.
Neuropsychopharmacol Rep. 2025 Mar;45(1):e12504. doi: 10.1002/npr2.12504. Epub 2024 Nov 14.
Cerebrospinal fluid (CSF) levels of orexin show a cyclic diurnal variation in healthy subjects, which is diminished in patients with certain diseases. However, possible circadian variations in orexin levels in critically ill patients remain unknown. In this study, we evaluated the orexin concentrations in the CSF and their diurnal variation in patients undergoing thoracic aortic aneurysm repair with lumbar intrathecal catheterization for CSF drainage after non-neurosurgery.
Eligible patients with a lumbar intrathecal catheter placed for CSF drainage following aortic surgery at a single-center ICU between September 2019 and February 2020 were included. Catheters were placed before anesthesia induction, and CSF was collected at the time of catheter placement, ICU admission, and daily at 6:00, 12:00, 18:00, and 24:00 until the catheter was removed or for up to 5 days after admission to the ICU.
Three patients (Patients A, B, and C) who underwent thoracic aortic aneurysm repair were included. Patients B and C received sedatives or hypnotics during the orexin measurement period. The baseline orexin levels for Patients A, B, and C were 219.9, 312.3, and 403.8 pg/mL, while the mean orexin levels were 319.4 ± 82.6, 372.4 ± 56.0, and 306.3 ± 48.3 pg/mL, respectively. For all three patients, orexin levels showed diurnal variations, but no consistent periodic changes.
CSF orexin concentrations for patients undergoing thoracic aortic aneurysm repair in the ICU were within the reported range compared to those of previously reported healthy subjects; however, consistent periodic diurnal variations were not observed.
在健康受试者中，脑脊液中食欲素水平呈现昼夜周期性变化，而在某些疾病患者中这种变化会减弱。然而，重症患者食欲素水平可能存在的昼夜节律变化仍不清楚。在本研究中，我们评估了接受胸主动脉瘤修复术且在非神经外科手术后通过腰椎鞘内置管进行脑脊液引流的患者脑脊液中食欲素的浓度及其昼夜变化。
纳入2019年9月至2020年2月期间在单中心重症监护病房接受主动脉手术后放置腰椎鞘内导管进行脑脊液引流的符合条件的患者。在麻醉诱导前放置导管，并在导管放置时、入住重症监护病房时以及每日6:00、12:00、18:00和24:00收集脑脊液，直至导管拔除或入住重症监护病房后最多5天。
纳入了3例接受胸主动脉瘤修复术的患者（患者A、B和C）。患者B和C在食欲素测量期间接受了镇静剂或催眠药。患者A、B和C的基线食欲素水平分别为219.9、312.3和403.8 pg/mL，而平均食欲素水平分别为319.4±82.6、372.4±56.0和306.3±48.3 pg/mL。对于所有3例患者，食欲素水平均呈现昼夜变化，但无一致的周期性变化。
与先前报道的健康受试者相比，重症监护病房中接受胸主动脉瘤修复术患者的脑脊液食欲素浓度在报告范围内；然而，未观察到一致的周期性昼夜变化。
