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ICU患者的晝夜節(jié)律紊亂和譫妄：一項(xiàng)前瞻性隊(duì)列研究

貴州醫(yī)科大學(xué)    麻醉與心臟電生理課題組

翻譯：宋雨婷

編輯：宋雨婷 

審校：曹瑩

背景

在重癥監(jiān)護(hù)病房 （ICU） 接受治療的患者可能會(huì)經(jīng)歷晝夜顛倒，使其晝夜節(jié)律可能會(huì)受到干擾。

方法

該前瞻性隊(duì)列研究試驗(yàn)于某三級(jí)教學(xué)醫(yī)院的外科ICU進(jìn)行，目的為探討ICU患者譫妄與褪黑素、皮質(zhì)醇和睡眠的晝夜節(jié)律之間的關(guān)系。納入術(shù)后在ICU住院期間意識(shí)清醒并計(jì)劃在ICU停留超過24小時(shí)的患者。在ICU的前三天，通過抽取動(dòng)脈血，每天測(cè)量三次血漿褪黑素和皮質(zhì)醇水平。每日睡眠質(zhì)量通過理查茲-坎貝爾睡眠量問卷（RCSQ）進(jìn)行評(píng)估，通過重癥監(jiān)護(hù)病房意識(shí)模糊評(píng)估法（CAM-ICU）進(jìn)行每日兩次的評(píng)估，以篩查ICU譫妄。

結(jié)果

本研究共納入76名患者，17名患者在ICU住院期間出現(xiàn)譫妄。譫妄患者和非譫妄患者褪黑素水平在第1天08:00（P =0.048）、第2天03:00（P = 0.002）和08: 00（P = 0.009）以及第3天的三個(gè)時(shí)間點(diǎn)（3:00，P = 0.032；08:00，P =0.014；16:00，P =0.047）均不同。第1天16:00譫妄患者血漿皮質(zhì)醇水平顯著低于非譫妄患者（P =0.025）。褪黑素和皮質(zhì)醇分泌水平的變化在非譫妄患者中表現(xiàn)出明顯的生物節(jié)律性（褪黑素P < 0.001，皮質(zhì)醇P = 0.026），而譫妄患者褪黑素和皮質(zhì)醇分泌水平無(wú)節(jié)律性（褪黑激素P = 0.064，皮質(zhì)醇P = 0.454）。兩組患者前三天的RCSQ評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義。

結(jié)論

褪黑素和皮質(zhì)醇分泌的晝夜節(jié)律紊亂與ICU患者譫妄的發(fā)展有關(guān)。臨床工作人員應(yīng)更加重視在ICU中維持患者正常的晝夜節(jié)律。

原始文獻(xiàn)來(lái)源：

Li, J., Cai, S., Liu, X. et al. Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study. BMC Anesthesiol 23, 203 (2023).

英文原文：

Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study

Background: Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed.

Methods: To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective cohort study was carried out in a surgical ICU of a tertiary teaching hospital. Patients who were conscious during the ICU stay after surgery and were scheduled to stay in the ICU for more than 24 h were enrolled. Serum melatonin and plasma cortisol levels were measured three times a day by drawing arterial blood on the first three days after ICU admission. Daily sleep quality was assessed by the Richard-Campbell Sleep Questionnaire (RCSQ). The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was performed twice a day to screen for ICU delirium.

Results: A total of 76 patients were included in this study, and 17 patients developed delirium during their ICU stay. Melatonin levels were different at 8:00 (p?=?0.048) on day 1, at 3:00 (p?=?0.002) and at 8:00 (p?=?0.009) on day 2, and at all three time points on day 3 (p?=?0.032, 0.014, 0.047) between delirium and non-delirium patients. The plasma cortisol level in the delirium patients was significantly lower than that in the non-delirium patients at 16:00 on day 1 (p?=?0.025). The changes in melatonin and cortisol secretion levels exhibited obvious biological rhythmicity in non-delirium patients (p?<?0.001 for melatonin, p?=?0.026 for cortisol), while no rhythmicity was found in melatonin and cortisol secretion levels in the delirium group (p?=?0.064 for melatonin, p?=?0.454 for cortisol). There was no significant difference in RCSQ scores in the first three days between the two groups.

Conclusions: The disturbance of the circadian rhythm of melatonin and cortisol secretion was associated with the development of delirium in ICU patients. Clinical staff should pay more attention to the importance of maintaining patients’ normal circadian rhythms in the ICU.

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編輯：MiLu.米鷺

校對(duì)：Michel.米萱  

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