【罂粟摘要】ICU患者的昼夜节律紊乱和谵妄：一项前瞻性队列研究

ICU患者的昼夜节律紊乱和谵妄：一项前瞻性队列研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：宋雨婷    编辑：宋雨婷    审校：曹莹

背景

在重症监护病房 （ICU） 接受治疗的患者可能会经历昼夜颠倒，使其昼夜节律可能会受到干扰。

方法

该前瞻性队列研究试验于某三级教学医院的外科ICU进行，目的为探讨ICU患者谵妄与褪黑素、皮质醇和睡眠的昼夜节律之间的关系。纳入术后在ICU住院期间意识清醒并计划在ICU停留超过24小时的患者。在ICU的前三天，通过抽取动脉血，每天测量三次血浆褪黑素和皮质醇水平。每日睡眠质量通过理查兹-坎贝尔睡眠量问卷（RCSQ）进行评估，通过重症监护病房意识模糊评估法（CAM-ICU）进行每日两次的评估，以筛查ICU谵妄。

结果

本研究共纳入76名患者，17名患者在ICU住院期间出现谵妄。谵妄患者和非谵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天的三个时间点（3:00，P = 0.032；08:00，P =0.014；16:00，P =0.047）均不同。第1天16:00谵妄患者血浆皮质醇水平显著低于非谵妄患者（P =0.025）。褪黑素和皮质醇分泌水平的变化在非谵妄患者中表现出明显的生物节律性（褪黑素P < 0.001，皮质醇P = 0.026），而谵妄患者褪黑素和皮质醇分泌水平无节律性（褪黑激素P = 0.064，皮质醇P = 0.454）。两组患者前三天的RCSQ评分差异无统计学意义。

结论

褪黑素和皮质醇分泌的昼夜节律紊乱与ICU患者谵妄的发展有关。临床工作人员应更加重视在ICU中维持患者正常的昼夜节律。

原始文献来源：

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.