Lanuza D M
Department of Medical-Surgical Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Ill, USA.
Am J Crit Care. 1995 May;4(3):212-20.
Although endocrine stress responses of coronary artery bypass patients have been reported, similar studies have not been conducted in patients undergoing implantation of an automatic cardioverter/defibrillator device.
To compare patterns and magnitudes of intra- and postoperative cortisol stress responses in patients undergoing two types of surgery; rate at which postoperative cortisol levels return to presurgical levels; and whether stressors associated with these two procedures affect postoperative circadian rhythms of cortisol, heart rate, and body temperature.
A time-series, small-group design was used to investigate 16 coronary artery bypass graft and 9 automatic cardioverter defibrillator patients. For the cortisol stress study, blood samples were obtained pre-, intra-, and postoperatively until day 6. For the circadian rhythm aspect, cortisol circadian rhythm aspect, cortisol levels, heart rate, and oral temperatures were measured every 2 hours for 24 hours beginning on postoperative day 1.
Plasma cortisol levels increased significantly toward the latter part of surgery. Generally, no significant group differences were found in cortisol magnitude during and after surgery. Postoperative cortisol levels were significantly elevated from preoperative levels for both groups; however, the automatic cardioverter defibrillator group's cortisol levels declined at a slower rate. The stressors associated with these surgeries were sufficient to disrupt or abolish circadian rhythms for the measured variables.
The elevated postoperative cortisol levels and altered circadian rhythms may contribute to increased vulnerability by dampening patients' anti-inflammatory and immunologic responses and adversely affecting their sense of well-being. The clinical significance of these findings is yet to be determined; more research is warranted.
虽然已有关于冠状动脉搭桥患者内分泌应激反应的报道，但尚未对接受自动心脏复律除颤器植入术的患者进行类似研究。
比较接受两种手术的患者术中和术后皮质醇应激反应的模式和程度；术后皮质醇水平恢复到术前水平的速率；以及与这两种手术相关的应激源是否会影响术后皮质醇、心率和体温的昼夜节律。
采用时间序列、小样本组设计，对16例冠状动脉搭桥患者和9例自动心脏复律除颤器患者进行研究。对于皮质醇应激研究，在术前、术中和术后直至第6天采集血样。对于昼夜节律方面，从术后第1天开始，每2小时测量一次皮质醇昼夜节律方面、皮质醇水平、心率和口腔温度，持续24小时。
手术后期血浆皮质醇水平显著升高。一般来说，手术期间和术后两组皮质醇水平差异无统计学意义。两组术后皮质醇水平均显著高于术前水平；然而，自动心脏复律除颤器组的皮质醇水平下降速度较慢。与这些手术相关的应激源足以扰乱或消除所测量变量的昼夜节律。
术后皮质醇水平升高和昼夜节律改变可能会通过抑制患者的抗炎和免疫反应并对其幸福感产生不利影响，从而增加患者的易感性。这些发现的临床意义尚待确定；有必要进行更多研究。
