Perioperative melatonin secretion in patients undergoing coronary artery bypass grafting
Perioperative melatonin secretion in patients undergoing coronary artery bypass grafting
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DOI：
10.1097/00000539-200205000-00006
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发表时间：
2002-05-01
影响因子：
5.7
通讯作者：
Vuylsteke, A
中科院分区：
文献类型：
--
作者：
Guo, XY;Kuzumi, E;Vuylsteke, A
褪黑素是一种神经荷尔蒙，在调节人类的“生物钟”方面起着重要作用。我们试图描述在体外循环(CPB)下接受冠状动脉旁路移植手术的患者围手术期褪黑激素的分泌模式。在IRB批准和书面知情同意后，12名计划在低温CPB下进行择期冠状动脉搭桥术的男性患者纳入研究。在麻醉过程中，患者的眼睛会被仔细遮盖，以防止光线影响。分别于术中特定时间点、术后即刻每3h采血一次，术后第2天下午6：00至术后第3天下午6：00采血24 h，分别用放射免疫法和酶联免疫吸附试验测定血浆褪黑素和皮质醇浓度。手术期间，血浆褪黑素浓度低于最低敏感浓度，但在术后即刻检测到少量浓度，没有昼夜变化。在术后第2天和第3天，有10例患者存在褪黑激素的昼夜分泌模式，并与光照强度呈负相关(r=0.480；P<；0.01)。术后即刻血浆皮质醇浓度明显高于麻醉诱导前(P<；0.01)。只有3名患者恢复了皮质醇的昼夜分泌。我们的结论是，在体外循环心脏手术期间和术后即刻，褪黑激素和皮质醇的分泌受到干扰。然而，大多数患者从术后第2天开始出现褪黑激素的昼夜节律。只有30%的患者恢复了皮质醇分泌的昼夜节律。
Melatonin, a neurohormone, plays an important role in adjusting the "biological clock" in humans. We sought to describe perioperative patterns of melatonin secretion in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass (CPB). After IRB approval and written informed consent, 12 male patients scheduled for elective coronary artery bypass grafting under hypothermic CPB were enrolled in the study. During anesthesia, patients' eyes were carefully covered to prevent light effects. Blood samples were taken at specific time points during surgery, every 3 h in the immediate postoperative period, and for 24 h from 6:00 Pm of Postoperative Day 2 until 6:00 Pm of Postoperative Day 3. Plasma melatonin and cortisol concentrations were measured by radioimmunoassay and enzyme-linked immunosorbent assay, respectively. During surgery, plasma melatonin concentrations were below the minimum sensitivity concentration, yet small concentrations, without circadian variation, were detected during the immediate postoperative period. During Postoperative Days 2 and 3, circadian secretion patterns of melatonin were present in 10 patients and showed an inverse correlation with light intensity (r = 0.480; P < 0.01). Plasma cortisol concentrations in the immediate postoperative period were significantly larger than those before the induction of anesthesia (P < 0.01). Only three patients regained circadian secretion of cortisol. We concluded that melatonin and cortisol secretion was disrupted during cardiac surgery with CPB and in the immediate postoperative period. However, circadian rhythms of melatonin were present in most patients from Postoperative Day 2. Only 30% of the patients regained circadian rhythm of cortisol secretion.