冠状动脉搭桥术病人围术期皮质醇分泌的昼夜节律性

Circadian rhythm of cortisol secretion in patients during coronary artery bypass grafting surgery

观察冠状动脉搭桥术病人围术期皮质醇昼夜分泌节律性的变化。选择在低温体外循环或非体外循环下行冠脉搭桥术的男性病人 4 0例 ,分为体外循环组和非体外循环组 ,每组 2 0例。所有病人均在麻醉诱导前 (基础值 )、气管插管后1 0min、肝素化后 1 0min、转机后 30min(或切皮后 2h)、中和肝素前和术终各时点及术后每 3h抽血 1次持续到术后 2 4h。采用放射免疫方法检测血浆皮质醇的浓度。两组病人术中各时点血浆皮质醇浓度显著低于麻醉诱导前 ,而在术后 2 4h明显升高 ;非体外循环组病人在诱导后和术终时点皮质醇水平高于体外循环组。在术后 2 4h体外循环组与非体外循环组分别有3例和 7例病人的皮质醇分泌表现为昼夜节律性 ,其余病人则无昼夜节律性分泌。体外循环与非体外循环冠状动脉搭桥术后多数病人皮质醇昼夜节律性分泌紊乱 ,但非体外循环冠脉搭桥术病人术后早期有皮质醇昼夜分泌节律性的病例数多于体外循环组 。

To observe the circadian rhythm of cortisol secretion of patients during coronary artery bypass grafting surgery. Forty male patients undergoing coronary artery bypass grafting surgery under hypothermic coronary pulmonary bypass (CPB) or off pump were enrolled in this study. They were allocated into two groups: CPB group (n=20) and off pump group (n=20). Blood samples were withdrawn in all patients at the following time points: immediately before the induction of anesthesia, 10 min after the induction of anesthesia, 10 min after heparinization, 30 min after commencement of CPB (or 2 h after skin incision), before reversal of heparin with protamine and at the end of surgery. In the immediate postoperative period, blood samples were taken every 3 h for twenty four hours. Plasma concentration of cortisol was measured by radioimmunoassay. During the course of surgery the serum cortisol concentrations at all time points were significantly lower than the baseline, and elevated after surgery. The values after induction and at the end of surgery in the off pump group were greater than the corresponding values in the CPB group. During postoperative 24h, circadian secretion patterns were indicated in three patients in the CPB group and seven patients in the off pump group respectively. Circadian rhythms of cortisol disappeared in the remaining patients in both groups. Perioperative secretion rhythms of cortisol in patients undergoing CABG surgery with CPB or off pump were disturbed. however, more patients in the off pump group regained secretion rhythm of cortisol in the immediate postoperative period. So CPB may disturb the perioperative cortisol circadian secretion.