Altered Circadian Rhythmicity in Patients in the ICU

Altered Circadian Rhythmicity in Patients in the ICU
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DOI：
10.1378/chest.12-2405
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发表时间：
2013-08-01
期刊：
CHEST
影响因子：
9.6
通讯作者：
Schwab, Richard J.
Schwab, Richard J.
中科院分区：
医学1区
文献类型：
--
作者：
Gazendam, Joost A. C.;Van Dongen, Hans P. A.;Schwab, Richard J.

文献摘要

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背景资料：ICU患者被认为有异常的昼夜节律，但缺乏定量数据。方法：为了研究ICU患者的昼夜节律，我们研究了21名患者48小时内的核心体温（59 - 11岁; 8名男性和13名女性）。21名患者中有17名患者的昼夜节律相位位置超出了与早晨/晚上相关的公布范围，其确定了健康正常受试者中变异性的标准范围。在10例患者中，昼夜相位位置早于正常范围;在7例患者中，昼夜相位位置晚于正常范围。任一方向（提前或延迟）的昼夜节律位移的平均值± SD为4.44 ± 3.54 h。每位患者的24小时体温曲线没有明显的逐日变化。进行逐步线性回归以确定年龄、性别、APACHE（急性生理学和慢性健康评估）III评分或在ICU的天数是否可以预测患者特定的昼夜节律移位幅度。APACHE III评分被认为是显着的昼夜节律displacement.Conclusions预测：研究结果表明，昼夜节律存在，但在ICU的患者改变，昼夜节律异常的程度与疾病的严重程度。
Background: Patients in the ICU are thought to have abnormal circadian rhythms, but quantitative data are lacking.Methods: To investigate circadian rhythms in the ICU, we studied core body temperatures over a 48-h period in 21 patients (59 11 years of age; eight men and 13 women).Results: The circadian phase position for 17 of the 21 patients fell outside the published range associated with morningness/eveningness, which determines the normative range for variability among healthy normal subjects. In 10 patients, the circadian phase position fell earlier than the normative range; in seven patients, the circadian phase position fell later than the normative range. The mean +/- SD of circadian displacement in either direction (advance or delay) was 4.44 +/- 3.54 h. There was no significant day-to-day variation of the 24-h temperature profile within each patient. Stepwise linear regression was performed to determine if age, sex, APACHE (Acute Physiology and Chronic Health Evaluation) III score, or day in the ICU could predict the patient-specific magnitude of circadian displacement. The APACHE III score was found to be significantly predictive of circadian displacement.Conclusions: The findings indicate that circadian rhythms are present but altered in patients in the ICU, with the degree of circadian abnormality correlating with severity of illness.