全身麻醉影响4~6岁鼾症儿童术后首夜褪黑素的分泌但不造成抑制

Effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring

目的评价全身麻醉对4~6岁鼾症儿童术后褪黑素分泌的影响。方法选择4~6岁拟行腺样体切除术的鼾症儿童20例,性别不限,ASA分级I或II级。通过术前、术中、术后3 d共11个相对应时间点(T1~T11)测量唾液褪黑素,测量相同时间点的光照度和患儿体温情况,记录患儿3 d夜晚睡眠时长及术后疼痛评分(FLACC)、镇静躁动评分(Riker)和康复质量评分量表-15(QoR-15),随访术前和术后28 d儿童睡眠呼吸障碍生活质量评价调查表(OSA-18)观察康复情况,并观察患儿住院期间主要不良事件的发生情况。结果20名患儿唾液褪黑素基线值(T1)差异无统计学意义,术后早7时(T8)比术前7 h(T4)降低(P<0.05),术后第2日早7时(T11)恢复,3 d(T4、T8、T11)早7时的唾液褪黑素均数超过3 pg/mL。测量3 d相对应的褪黑素时室内光照度和患儿体表温度无差异。FLACC评分、Riker评分和QoR-15评分差异无统计学意义。术后28 d随访OSA-18评分低于术前(P<0.05)。20名患儿均无出现呼吸抑制、窦性心动过缓、窦性心动过速、高血压、低血压和恶心呕吐等不良事件。结论全身麻醉影响鼾症儿童术后首夜褪黑素的分泌,但不造成抑制,学龄前儿童在上午进行全身麻醉行短小手术不显著干扰褪黑素的分泌而造成昼夜节律紊乱。

Objective To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring.Methods Twenty children with snoring aged 4-6 years of either gender(ASA grade I and II)were selected for adenoidectomy.Before,during and 3 days after the operation,salivary melatonin levels of the children were measured at 11 selected time points(T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded,and postoperative pain scores(FLACC)and Riker and Rehabilitation Quality Rating Scale-15(QoR-15)scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire(OSA-18)was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded.Results No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation(T8)was significantly lowered as compared with that before the surgery(T4)(P<0.05)but recovered at 7 am on the second day after the surgery(T11);salivary melatonin levels at T4,T8,and T11 exceeded 3 pg/mL on the third day.No significant difference was found in illumination intensity or body temperature across the time points when melatonin level was measured.The children showed no significant changes in FLACC score,Riker score or QOR-15 score after the operation,but the OSA-18 score was significantly lowered after the operation(P<0.05).None of the 20 children had such adverse events as respiratory depression,sinus bradycardia,sinus tachycardia,hypertension,hypotension,nausea or vomiting during hospitalization.Conclusion In preschool children with snoring,general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery,and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.