Low melatonin excretion during mechanical ventilation in the intensive care unit
Low melatonin excretion during mechanical ventilation in the intensive care unit
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DOI：
10.1042/cs20030374
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发表时间：
2004-07-01
期刊：
影响因子：
6
通讯作者：
Hahn, RG
中科院分区：
文献类型：
--
作者：
Frisk, U;Olsson, J;Hahn, RG
在两个地区医院的ICU（重症监护室）接受治疗的患者中研究了昼夜节律的生化标志物。正常节律的特征是在夜间分泌相对较高的褪黑激素和较低的皮质醇。干扰会影响睡眠、情绪和认知能力。在整个ICU期间（中位数，10天），收集16例患者在07：00至22：00（白天）和22：00至07：00（夜间）之间排泄的所有尿液，并对其进行采样，以测定6-SMT（6-硫酸氧褪黑激素）（褪黑激素的代谢产物）和游离皮质醇的排泄。6-SMT的总排泄量略低，皮质醇排泄量高于健康参考人群的报告。机械通气组6-SMT排泄量（中位数为198 ng/h）显著低于无机械通气组（555 ng/h; P < 0.0001），而肾上腺素能药物输注组6-SMT排泄量增加（P < 0.01）。五名患者（31%）表现出几乎没有褪黑激素排泄24小时或更长时间。65%和75%的患者昼夜节律持续或周期性紊乱。这些变化不能用夜间过度暴露于光线来解释。总之，在两个ICU部门治疗的大多数患者中，机械通气期间褪黑激素分泌不足，皮质醇排泄量总体较高，这两种激素的昼夜节律紊乱。
Biochemical markers for the circadian rhythm were studied in patients treated at the ICU (intensive care unit) of two regional hospitals. A normal rhythm is characterized by a relatively higher melatonin and a lower cortisol excretion at night. Disturbances affect sleep, mood and cognitive performance. All urine excreted between 07:00 and 22:00 hours (day) and between 22:00 and 07:00 hours (night) was collected and sampled throughout the entire ICU period (median, 10 days) in 16 patients for the excretion of 6-SMT (6-sulphatoxymelatonin), which is a metabolite of melatonin, and free cortisol. The overall excretion of 6-SMT was slightly lower and the cortisol excretion higher than reported for healthy reference populations. Mechanical ventilation was associated with a markedly lower 6-SMT excretion (median, 198 ng/h) compared with periods without such help (555 ng/h; P < 0.0001), whereas infusion of adrenergic drugs increased the 6-SMT excretion (P < 0.01). Five patients (31%) showed a virtually absent melatonin excretion for 24 h or more. The diurnal rhythms were consistently or periodically disturbed in 65% and 75% of the patients. These alterations cannot be explained by excessive exposure to light at night. In conclusion, there was hyposecretion of melatonin during mechanical ventilation, an overall high cortisol excretion and a disturbed diurnal rhythm of both of these hormones in most patients treated in two ICU departments.