儿童皮质醇分泌规律和依托咪酯对其影响的研究

发布时间：2018-09-08 09:49

【摘要】：【目的】本研究拟通过动态测定正常儿童、围手术期儿童唾液皮质醇分泌规律以及静脉全麻诱导使用依托咪酯、丙泊酚对儿童围手术期唾液皮质醇分泌规律影响的比较研究,探讨国内儿童皮质醇分泌规律和特征,明确临床常规诱导剂量的依托咪酯是否影响儿童皮质醇的分泌规律。【方法】招募健康儿童和新华医院住院拟行选择性中小型泌尿外科手术儿童共20例,在排除应激刺激下于日间每隔1小时收集唾液,使用ELISA检测唾液皮质醇浓度,观察健康儿童日间皮质醇分泌规律,并比较健康儿童和拟行手术儿童皮质醇昼夜节律的差异;招募健康儿童和新华医院住院拟行手术儿童共20例,于晨间清醒时、清醒后30min、以及清醒后60min分别收集唾液,比较健康儿童和拟行手术儿童晨起皮质醇觉醒反应差异;招募新华医院拟行选择性尿道成形术和肾盂成形术患儿,随机分为麻醉诱导依托咪酯组(38例)和丙泊酚组(39例),麻醉诱导分别使用依托咪酯(0.3mg/kg)和丙泊酚(2mg/kg),于手术日以及术后两日连续多时点采集唾液测定唾液皮质醇浓度,比较两组的皮质醇浓度差异,并比较术后非预防性抗生素使用、住院天数、尿道瘘形成、伤口愈合情况的差异。【结果】健康儿童和拟行手术儿童术前日间皮质醇分泌具有晨高晚低的昼夜节律,二者唾液皮质醇水平比较没有显著差异(P0.05);健康儿童和拟行手术儿童术前均表现出晨起后的皮质醇觉醒反应,二者唾液皮质醇水平比较也没有显著差异(P0.05);与丙泊酚组相比较,依托咪酯组儿童皮质醇水平从手术日离开苏醒室(约14:00)起显著降低直至术后第1日晨8:00(F=14.703,P0.01),与术前相应时间点相比也显著降低(F=55.496,P0.01)。丙泊酚组儿童皮质醇水平与术前相比没有显著差异(F=13.176,P0.01).依托咪酯组和丙泊酚组儿童在非预防性抗生素使用、术后住院天数、伤口愈合和尿道瘘的发生率等方面没有显著差异(P0.01).【结论】健康儿童和拟行泌尿外科中小手术患儿的皮质醇分泌具有晨高晚低的昼夜节律和晨起皮质醇觉醒反应,两组儿童皮质醇分泌的节律和HPA轴功能没有显著差异;使用动态连续监测皮质醇变化的方法研究发现,诱导时单次使用依托咪酯可显著降低患儿术后皮质醇水平,但皮质醇水平的降低是短时现象,持续不超过24h,且对患儿术后感染、伤口愈合和住院时间等临床表现没有显著影响,可以安全使用于行中小型泌尿外科手术儿童。
[Abstract]:[objective] to study the effect of intravenous general anesthesia induced by etomidate and propofol on salivary cortisol secretion in normal children and perioperative children by means of dynamic determination of salivary cortisol secretion in normal children and perioperative children, and to compare the effects of etomidate and propofol on salivary cortisol secretion in children during perioperative period. To explore the rules and characteristics of cortisol secretion in children in China. To determine whether the routine dose of etomidate affects the secretion of cortisol in children. [methods] A total of 20 children with selective small and medium-sized urological surgery were recruited from healthy children and hospitalized in Xinhua Hospital. Saliva was collected every 1 hour every day after excluding stress stimulation. The concentration of cortisol in saliva was measured by ELISA, and the rules of cortisol secretion in healthy children were observed, and the circadian rhythm of cortisol was compared between healthy children and children scheduled for operation. A total of 20 healthy children and 20 hospitalized children were recruited. Saliva was collected 30 minutes after waking and 30 minutes after waking, and 60min was collected after waking to compare the morning cortisol arousal reaction between healthy children and children who planned to undergo surgery. To recruit children with selective urethroplasty and pyeloplasty in Xinhua Hospital. Etomidate group (n = 38) and propofol group (n = 39) were randomly divided into two groups. 0.3mg/kg and 2mg/kg were used to determine salivary cortisol concentration in saliva on the day of operation and two days after operation. The difference of cortisol concentration between the two groups was compared, and the use of non-prophylactic antibiotics, the length of stay in hospital and the formation of urethral fistula were compared. The difference of wound healing. [results] the circadian rhythm of cortisol secretion before operation in healthy children and operative children was high, late and low. There was no significant difference in salivary cortisol levels between the two groups (P0.05); healthy children and children who planned to undergo surgery showed cortisol arousal reaction before operation, and there was no significant difference in salivary cortisol levels between them (P0.05); compared with propofol group, there was no significant difference in salivary cortisol level between them. The level of cortisol in etomidate group decreased significantly from the day of operation to 8:00 (F _ (14.703) P _ (0.01) from the day of operation to 8:00 (F _ (14.703) P _ (0.01), and also significantly decreased compared with the corresponding time point before operation (F _ (55.496) P _ (0.01). There was no significant difference in cortisol level between propofol group and preoperation group (F = 13.176, P 0.01). Children in etomidate group and propofol group were treated with non-prophylactic antibiotics and hospitalized days after operation. There was no significant difference in wound healing and the incidence of urethral fistula (P0.01). [conclusion] cortisol secretion in healthy children and children undergoing minor surgery in urology has a circadian rhythm of high and late morning and early morning cortisol arousal. There was no significant difference between the rhythm of cortisol secretion and the function of HPA axis in the two groups. However, the decrease of cortisol level is a short-term phenomenon, lasting no more than 24 hours, and has no significant effect on the postoperative infection, wound healing and hospital stay in children, so it can be safely used in children undergoing small and medium-sized urological surgery.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R726.1

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