摘要目的：动态监测及分析重症监护病房（ICU）谵妄患者睡眠特点和褪黑素水平的变化。方法采用前瞻性观察性研究方法，对2013年12月至2014年4月滨州医学院附属医院ICU住院超过72 h的患者采用ICU意识模糊评估法（CAM-ICU）进行评估，根据有无谵妄序贯收集患者并分为谵妄组及非谵妄组。入组后所有患者采用多导睡眠仪连续24 h动态监测睡眠状况；监测期间每4 h留取1次静脉血，采用酶联免疫吸附试验（ELISA）检测血浆褪黑素水平。结果共收入ICU住院患者18例，其中谵妄患者9例。多导睡眠监测分析显示，所有患者均存在睡眠障碍，表现为快动眼期（REM期）睡眠减少〔为（5.91±5.26）%〕，觉醒频繁〔觉醒指数为（15.40±12.79）次/h〕，而3期睡眠处于低限水平〔为（14.67±11.10）%〕。与非谵妄组相比，谵妄组患者REM期缺失差异有统计学意义〔（0.10±0.20）%比（8.83±3.81）%，t＝4.782，P＝0.001〕。动态检测褪黑素的结果显示，所有患者褪黑素水平昼低夜高的分泌节律性均丧失，谵妄组与非谵妄组各时间点褪黑素水平差异无统计学意义（时间效应F＝1.370、P＝0.287，组间效应F＝1.646、P＝0.250，交互效应F＝1.558、P＝0.247）。谵妄组褪黑素水平在06：00及14：00时出现两个高峰，分别为（137.84±62.21）ng/L和（148.24±58.87）ng/L，最低值出现在22：00，为（64.47±26.97）ng/L；而非谵妄组褪黑素峰浓度出现在02：00，为（63.52±39.75）ng/L，最低值出现在10：00，为（44.87±11.19）ng/L。结论 ICU患者存在睡眠障碍，谵妄患者REM期缺失较非谵妄患者明显。ICU患者褪黑素分泌均失去正常昼低夜高的节律性变化，谵妄患者褪黑素峰值移至日间出现。

abstractsObjective To dynamic monitor and analyze the characteristic of polysomnography (PSG)and melatonin levels of delirium patients in intensive care unit (ICU). Methods A prospective observational study was performed from December 2013 to April 2014. The patients admitted to ICU of Affiliated Hospital of Binzhou Medical College for more than 72 hours were evaluated with confusion assessment method for the ICU (CAM-ICU),and were divided into delirium group and non-delirium group. Sleep patterns of all the patients underwent continuous PSG for up to 24 hours were evaluated. Melatonin levels were determined every 4 hours with enzyme linked immunosorbent assay (ELISA)duration sleep monitoring. Results Eighteen patients were enrolled,and 9 were delirium patients. All the patients had sleep disorders:a decrease in rapid eye movement (REM)sleep 〔(5.91±5.26)%〕,an increase in the sleep fragmentations 〔arousal index was (15.40 ±12.79)times/h〕,and the N3 sleep stage was on the lower limit of normal 〔(14.67 ±11.10)%〕. Compared with non-delirium group,the REM sleep was significantly decreased in delirium group〔(0.10±0.20)%vs.(8.83±3.81)%,t=4.782,P=0.001〕. Melatonin levels lost rhythm between day and night,and there was no difference in melatonin between delirium group and non-delirium group (time effect:F=1.370,P=0.287;between-group effect:F=1.646,P=0.250;interaction effect:F=1.558,P=0.247). The peak of melatonin levels of delirium group appeared on 06:00 〔(137.84±62.21)ng/L〕and 14:00 〔(148.24±58.8)ng/L〕, the minimum value on 22:00 〔(64.47 ±26.97) ng/L〕. But in non-delirium group,the peak of melatonin levels appeared on 02:00 〔(63.52 ±39.75)ng/L〕,the minimum value on 10:00 〔(44.87 ±11.19)ng/L〕. Conclusions ICU patients have sleep disorders,and the delirium patients have less REM stage. Normal rhythmic melatonin secretion changes of ICU patients were lost. The delirium peak of patients appears in the daytime.