唾液皮质醇水平在患儿医源性戒断反应评估中的临床意义

Clinical significance of salivary cortisol levels in the assessment of iatrogenic withdrawal responses in children

目的探讨唾液皮质醇水平在儿童重症监护室(PICU)患儿医源性戒断反应(IWS)评估中的临床意义。方法选取温州医科大学附属第二医院育英儿童医院2018年10月至2020年10月收治的40例接受芬太尼连续使用天数≥10 d的PICU患儿作为研究对象,根据索菲亚戒断症状量表(SOS)评分分为有IWS组(SOS≥4)14例与无IWS组(SOS≤3)26例,检测两组患儿停药前后的唾液皮质醇水平,比较两组唾液皮质醇变化水平。结果有IWS组在停药后3 d 8~10点唾液皮质醇浓度均值为(4.18±1.53)ng/ml,高于无IWS组停药后3 d 8~10点唾液皮质醇浓度均值(3.89±0.90)ng/ml,差异有统计学意义(P<0.05),其他时间段比较,差异均无统计学意义(P>0.05)。结论有IWS组患儿停药后唾液皮质醇浓度高于无IWS组,运用唾液皮质醇水平来评估IWS可能存在一定的临床意义,有待以后更大样本量的进一步研究。

Objective To explore the clinical significance of salivary cortisol levels in the assessment of iatrogenic withdrawal symptoms(IWS)in children in the pediatric intensive care unit(PICU).Methods A total of 40 children in PICU admitted to the 2nd Affiliated Hospital and Yuying Children′s Hospital of WMU from October 2018 to October 2020 who received fentanyl for≥10 d of continuous use were selected as the study subjects.According to the score of the Sophia Observation withdrawal Symptoms scale(SOS),they were divided into the group with IWS group(SOS≥4,n=14)and the group without IWS group(SOS≤3,n=26).The salivary cortisol levels of children in the two groups were measured before and after drug withdrawal,and the changes in salivary cortisol levels in the two groups were compared.Results The average salivary cortisol concentration in the with IWS group was(4.18±1.53)ng/ml,higher than that in without IWS group(3.89±0.90)ng/ml at 8:00-10:00 p.m.three days after drug withdrawal,with statistically significant difference(P<0.05).However,there were no statistically significant differences in the other times results(P>0.05).Conclusion The salivary cortisol concentration in the children with IWS group is higher than that in the children without IWS group after drug withdrawal.The application of salivary cortisol level to assess IWS may have some clinical significance,but it needs to be confirmed by further studies with larger sample size in the future.