«СПОКОЙНЫЙ, СОЗНАТЕЛЬНЫЙ И СОТРУДНИЧАЮЩИЙ» ПАЦИЕНТ В РЕАНИМАЦИИ КАК СТРАТЕГИЯ ФАРМАКОЛОГИЧЕСКОЙ РЕГУЛЯЦИИ ЦИРКАДНОГО РИТМА (обзор литературы)

  • А. Н. Колесников ГОО ВПО «Донецкий национальный медицинский университет имени М. Горького», Донецк
  • Л. И. Ахильгова ГБУ Ингушская республиканская клиническая больница имени А.О. Ахушкова, Назрань, Россия
  • В. Д. Слепушкин ФГБОУ ВО «Северо-Осетинская государственная медицинская академия» МЗ РФ, Владикавказ
  • Е. А. Кучеренко ГОО ВПО «Донецкий национальный медицинский университет имени М. Горького», Донецк
  • Е. И. Гридасова ГОО ВПО «Донецкий национальный медицинский университет имени М. Горького», Донецк
  • Л. Г. Кварцхелия ГОО ВПО «Донецкий национальный медицинский университет имени М. Горького», Донецк

Аннотация

В статье освещены  современные взгляды на роль мелатонина в регуляции циркадных циклов человека, а также указаны его основные метаболические эффекты – антиоксидантный, противовоспалительный, анальгезирующий, иммуномодулирующий,  которые могут использоваться в лечении  взрослых и детей с различной патологией.
Приведены сведения о возможной причинно-следственной связи десинхронизации секреции мелатонина и развития делирия и послеоперационных когнитивных расстройств у пациентов  в критическом состоянии. Рассмотрена проблема глубокой седации больных в отделениях интенсивной терапии, предложены пути достижения уровня «минимально глубокой»  эффективной седации больных с использованием парентерального и энтерального введения препаратов.

Литература

1. Barr J., Fraser G.L., Puntillo K., Ely E.W., Gelinas C., Dasta J.F., Davidson J.E., Devlin J.W., Kress J.P., Joffe A.M. [et al.] Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41 (1): 263-306.
2. Nseir S., Makris D., Mathieu D., Durocher A., Marquette C.H. Intensive care unit-acquired infection as a side effect of sedation. Crit Care. 2010; 14 (2): R30. doi: 10.1186/cc8907
3. Reade M.C., Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014; 370: 444-454.
4. Kondili E., Alexopoulou C., Xirouchaki N., Georgopoulos D. Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study. Intensive Care Med. 2012; 38: 1640-1646.
5. Pandharipande P., Ely E.W. Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Crit Care Clin. 2006; 22 (2): 313-327.
6. Inouye S.K. Delirium in older persons. N Engl J Med 2006; 354: 1157-1165.
7. Ely E.W., Gautam S., Margolin R. [et al.] The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001; 27 (12): 1892-1900.
8. Barr J., Fraser G.L., Puntillo K. [et al.] American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41: 263-306.
9. Shehabi Y., Riker R.R., Bokesch P.M. [et al.] SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group: Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med. 2010; 38: 2311-2318.
10. Pisani M.A., Kong S.Y., Kasl S.V. [et al.] Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009; 180: 1092-1097.
11. Milbrandt E.B., Deppen S., Harrison P.L. [et al.] Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004; 32: 955-962.
12. Pandharipande P., Shintani A., Peterson J. [et al.] Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006; 104: 21-26.
13. Benedetti F., Pontiggia A., Bernasconi A., Colombo C., Florita M., Smeraldi E. Lormetazepam in depressive insomnia: new evidence of phase-response effects of benzodiazepines. Int Clin Psychopharmacol. 2004; 19: 311-317.
14. Dessap A.M., Roche-Campo F., Launay J.M. [et al.] Delirium and circadian rhythm of melatonin during weaning from mechanical ventilation: an ancillary study of a weaning trial. Chest. 2015; 148: 1231-1241.
15. Eckle T. Delirium-a dysfunctional circadian rhythm. Int J Anesth Res. 2016; 4: 1-3.
16. Olofsson K., Alling C., Lundberg D., Malmros C. Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients. Acta Anaesthesiol Scand. 2004; 48: 679-684.
17. Arendt J. Melatonin and the pineal gland: influence on mammalian seasonal and circadian physiology. Rev Reprod. 1998; 3: 13-22.
18. Walker C.K., Gales M.A. Melatonin receptor agonists for delirium prevention. Ann Pharmacother. 2017; 51: 72-78.
19. Tsuda A., Nishimura K., Naganawa E. [et al.] Ramelteon for the treatment of delirium in elderly patients: A consecutive case series study. Int J Psychiatry Med. 2014; 47: 97-104.
20. Sultan S.S. Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly. Saudi J Anaesth. 2010; 4: 169-173.
21. Hatta K., Kishi Y., Wada K. [et al.] DELIRIA-J Group: Preventive effects of ramelteon on delirium: A randomized placebo-controlled trial. JAMA Psychiatry. 2014; 71: 397-403.
22. Al-Aama T., Brymer C., Gutmanis I. [et al.] Melatonin decreases delirium in elderly patients: A randomized, placebo-controlled trial. Int J Geriatr Psychiatry. 2011; 26: 687-694.
23. Baron R., Binder A., Biniek R., Braune S., Buerkle H., Dall P., Demirakca S., Eckardt R., Eggers V., Eichler I. [et al.] Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci. 2015; 13: Doc19. doi: 10.3205/000223
24. Celis-Rodriguez E., Birchenall C., de la Cal M.A., Castorena Arellano G., Hernandez A., Ceraso D., Diaz Cortes J.C., Duenas Castell C., Jimenez E.J., Meza J.C. [et al.] Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. Med Int. 2013; 37 (8): 519-593.
25. Shehabi Y., Bellomo R., Reade M.C., Bailey M., Bass F., Howe B., McArthur C., Seppelt I.M., Webb S., Weisbrodt L. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med. 2012; 186 (8): 724-731.
26. Balzer F., Weiss B., Kumpf O., Treskatsch S., Spies C., Wernecke K.D., Krannich A., Kastrup M. Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Crit Care. 2015; 19: 197. DOI: 10.1186/s13054-015-0929-2
27. Shah F.A., Girard T.D., Yende S. Limiting sedation for patients with acute respiratory distress syndrome – time to wake up. Curr Opin Crit Care. 2017; 23 (1): 45-51.
28. Oddo M., Crippa I.A., Mehta S., Menon D., Payen J.F., Taccone F.S., Citerio G. Optimizing sedation in patients with acute brain injury. Crit Care. 2016; 20 (1): 128. doi:10.1186/s13054-016-1294-5
29. Martin J., Franck M., Fischer M., Spies C. Sedation and analgesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation. Intensive Care Med. 2006; 32 (8): 1137-1142.
30. Vincent J.L. Give your patient a fast hug (at least) once a day. Crit Care Med. 2005; 33 (6): 1225-1229.
31. Cigada M., Corbella D., Mistraletti G., Forster C.R., Tommasino C., Morabito A., Iapichino G. Conscious sedation in the critically ill ventilated patient. J Crit Care. 2008; 23 (3): 349-353.
32. Vincent J.L., Shehabi Y., Walsh T.S., Pandharipande P.P., Ball J.A., Spronk P., Longrois D., Strom T., Conti G., Funk G.C. [et al.] Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016; 42 (6): 962-971.
33. Walsh T.S., Kydonaki K., Antonelli J., Stephen J., Lee R.J., Everingham K., Hanley J., Phillips E.C., Uutela K., Peltola P. [et al.] Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial. Lancet Respir Med. 2016; 4 (10): 807-817.
34. Girard T.D., Kress J.P., Fuchs B.D., Thomason J.W., Schweickert W.D., Pun B.T., Taichman D.B., Dunn J.G., Pohlman A.S., Kinniry P.A. [et al.] Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008; 371 (9607): 126-134.
35. Sessler C.N., Gosnell M.S., Grap M.J., Brophy G.M., O’Neal P.V., Keane K.A., Tesoro E.P., Elswick R.K. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166 (10): 1338-1344.
36. Tanaka L.M., Azevedo L.C., Park M., Schettino G., Nassar A.P., Rea-Neto A., Tannous L., de Souza-Dantas V.C., Torelly A., Lisboa T. [et al.] Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care. 2014; 18 (4): R156. doi:10.1186/cc13995
37. Devlin J.W. The pharmacology of oversedation in mechanically ventilated adults. Curr Opin Crit Care. 2008; 14 (4): 403-407.
38. Svenningsen H., Egerod I., Videbech P., Christensen D., Frydenberg M., Tonnesen E.K. Fluctuations in sedation levels may contribute to delirium in ICU patients. Acta Anaesthesiol Scand. 2013; 57 (3): 288-293.
39. Porhomayon J., El-Solh A.A., Adlparvar G., Jaoude P., Nader N.D. Impact of sedation on cognitive function in mechanically ventilated patients. Lung. 2016; 194 (1): 43-52.
40. Wanzuita R., Poli-de-Figueiredo L.F., Pfuetzenreiter F., Cavalcanti A.B., Westphal G.A. Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care. 2012; 16 (2): R49. doi:10.1186/cc11250
41. Umbrello M., Mistraletti G., Corbella D., Cigada M., Salini S., Morabito A., Iapichino G. Bias reduction in repeated-measures observational studies by the use of propensity score: the case of enteral sedation for critically ill patients. J Crit Care. 2012; 27 (6): 662-672.
42. Mistraletti G., Sabbatini G., Taverna M., Figini M.A., Umbrello M., Magni P., Ruscica M., Dozio E., Esposti R., DeMartini G. [et al.] Pharmacokinetics of orally administered melatonin in critically ill patients. J Pineal Res. 2010; 48 (2): 142-147.
43. Rodriguez C., Mayo J.C., Sainz R.M., Antolin I., Herrera F., Martin V., Reiter R.J. Regulation of antioxidant enzymes: a significant role for melatonin. J Pineal Res. 2004; 36: 1-9.
44. Galano A., Tan D.X., Reiter R.J. On the free radical scavenging activities of melatonin’s metabolites. AFMK and AMK J Pineal Res. 2013; 54: 245-257.
45. Zhang H.M., Zhang Y. Melatonin: a well-documented antioxidant with conditional pro-oxidant actions. J Pineal Res. 2014; 57: 131-146.
46. Reiter R.J., Mayo J.C., Tan D.X., Sainz R.M., Alatorre-Jimenez M., Qin L. Melatonin as an antioxidant: under promises but over delivers. J Pineal Res. 2016; 61: 253-278.
47. Mistraletti G., Umbrello M., Sabbatini G., Miori S., Taverna M., Cerri B., Mantovani E.S., Formenti P., Spanu P., D’Agostino A. [et al.] Melatonin reduces the need for sedation in ICU patients: a randomized controlled trial. Minerva Anestesiol. 2015; 81 (12): 1298-1310.
48. Bourne R.S., Mills G.H. Melatonin: possible implications for the postoperative and critically ill patient. Intensive Care Med. 2006; 32 (3): 371-9. 2012; 108 (4): 572-580.
49. Gitto E., Romeo C., Reiter R.J. Melatonin reduces oxidative stress in surgical neonates. J Pediatr Surg. 2004; 39: 184-189.
50. Chen Y., Xu DX, Wang J.P. Melatonin protects against lipopolysaccharide-induced intrauterine fetal death and growth retardation in mice. J Pineal Res. 2006; 40: 40-47.
51. Gitto E., Pellegrino S., Gitto P., Barberi I., Reiter R.J. Oxidative stress of the newborn in the pre- and postnatal period and the clinical utility of melatonin. J Pineal Res. 2009; 46: 128-139.
52. Gitto E., Aversa S., Reiter R.J., Barberi I., Pellegrino S. Update on the use of melatonin in pediatrics. J Pineal Res. 2011; 50: 21-28.
53. Sanchez-barcelo EJ, Mediavilla M.D., Reiter R.J. Clinical uses of melatonin in pediatrics. Int J Pediatr. 2011; 892624. doi:10.1155/2011/8982624
54. Yon J., Carter L., Reiter R.J., Jevtovic-todorovic V. Melatonin reduces the severity of anesthesia-induced apoptotic neurodegeneration in the developing rat brain. Neurobiol Dis. 2006; 21: 522-530.
55. Wong C.S., Jow G.M., Kaizaki A., Fan L.W., Tien L.T. Melatonin ameliorates brain injury induced by systemic lipopolysaccharide in neonatal rats. Neuroscince. 2014; 267: 147-156.
56. Nagai R., Watanabe K., Wakatsuki A.H.amada F, Shinohara K., Hayashi Y., Imamura R., Fukaya T. Melatonin preserves fetal growth in rats by protecting against ischemia/reperfusion-induced oxidative/nitrosative mitochondrial damage in the placenta. J Pineal Res. 2008; 45: 271-276.
57. Richter H.G., Hansell J.A., Raut S., Giussani D.A. Melatonin improves placental efficiency and birth weight and increases the placental expression of antioxidant enzymes in under nourished pregnancy. J Pineal Res. 2009; 46: 357-364.
58. Liu S., Guo Y., Yuan Q., Pan Y., Wang L., Liu Q., Wang F., Wang J., Hao A. Melatonin prevents neural tube defects in the offspring of diabetic pregnancy. J Pineal Res. 2015; 59: 508-517. doi:10.1111/JPI.12282
59. Maqbool A., Lattke M., Wirth T., Baumann B. Sustained, neuron-specific IKK/NF-KB activation generates a selective neuroinflammatory response promoting local neurodegeneration with aging. Mol Neurodegener. 2013; 8: 40. doi:10.1186/1750-1326-8-40
60. Brazao V., Santello F.H., Filipin Model V., Azevedo A.P., Toldo M.P., de Morais F.R., do Prado J.C. Jr. Immunoregulatory actions of melatonin and zinc during chronic Trypanosoma cruzi infection. J Pineal Res. 2015; 58: 210-218. doi:10.1111/JPI.12207
61. Xu S, Pi H, Zhang L., Zhang N., Li Y, Zhang H., Tang J., Li H, Feng M., Deng P., Guo P., Tian L., Xie J., He M, Lu Y, Zhong M., Zhang Y., Wang W., Reiter R.J., Yu Z, Zhou Z. Melatonin prevents abnormal mitochondrial dynamics resulting from the neurotoxicity of cadmium by blocking calcium-dependent translocation of Drp1 to the mitochondria. J Pineal Res. 2016; 60: 291-302. doi:10.1111/JPI.12310
62. Gandhi A.V., Mosser E.A., Oikonomou G., Prober D.A. Melatonin is required for the circadian regulation of sleep. Neuron. 2015; 85: 1193-1199.
63. Garfinkel D., Laudon M., Nof D., Zisapel N. Improvement of sleep quality in elderly people by controlled-release melatonin. Lancet. 1995; 346: 541-544.
64. Herxheimer A., Petrie K.J. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2001; (1): CD001520.
65. Mo Y, Scheer C.E., Abdallah G.T. Emerging role of melatonin and melatonin receptor agonists in sleep and delirium in intensive care unit patients. J Intensive Care Med. 2016; 31: 451-455.
66. Ibrahim M.G., Bellomo R., Hart G.K. [et al.] A double-blind placebo-controlled randomised pilot study of nocturnal melatonin in tracheostomised patients. Crit Care Resusc. 2006; 8: 187-191.
67. Bourne R.S., Mills G.H., Minelli C. Melatonin therapy to improve nocturnal sleep in critically ill patients: encouraging results from a small randomised controlled trial. Crit Care. 2008; 12: R52. doi:10.1186/cc6871
68. Vijayakumar H.N., Ramya K., Duggappa D.R. [et al.] Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: a double-blind randomised placebo controlled trial. Indian J Anaesth. 2016; 60: 814-820.
69. Bily B., Sabol F., Török P., Artemiou P., Bilecova-Rabajdova M., Kolarcik P. Influence of prophylactic melatonin administration on the incidence of early postoperative delirium in cardiac surgery patients. Anesteziol Intenzivni Med. 2015; 26: 319-327.
70. Umbrello M., Mistraletti G., Corbella D., Cigada M., Salini S., Morabito A., Iapichino G. Bias reduction in repeated-measures observational studies by the use of propensity score: the case of enteral sedation for critically ill patients. J Crit Care. 2012; 27 (6): 662-672.
71. Cigada M., Corbella D., Mistraletti G., Forster C.R., Tommasino C., Morabito A., Iapichino G. Conscious sedation in the critically ill ventilated patient. J Crit Care. 2008; 23 (3): 349-353.
72. Mistraletti G., Umbrello M., Salini S., Cadringher P., Formenti P. [et al.] Enteral versus intravenous approach for the sedation of critically ill patients: a randomized and controlled trial// Critical Care (2019) 23: 3. doi:10.1186/s13054-018-2280-x
73. Nishikimi M., Numaguchi A., Takahashi K., Miyagawa Y., Matsui K. [et al.] Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial. Crit Care Med. 2018; 46 (7): 1099-1105.
74. Слепушкин В.Д., Пашинский В.Г. Эпифиз и адаптация организма. Издательство Томского университета. Томск; 1982. 210.
75. Слепушкин В.Д. Нарушение суточного биоритма у больных в отделении реанимации: причины, пути устранения. Материалы 1 Российского съезда по хронобиологии и хрономедицине. Владикавказ; 2008: 91-92.
76. Слепушкин В.Д., Женило В.М., Осканова М.Ю., Женило М.В. Мониторинг церебральных функций в анестезиологии и интенсивной терапии. Владикавказ–Ростов-на-Дону–Назрань, 2014. 202.
Опубликована
2019-03-01
Как цитировать
КОЛЕСНИКОВ, А. Н. et al. «СПОКОЙНЫЙ, СОЗНАТЕЛЬНЫЙ И СОТРУДНИЧАЮЩИЙ» ПАЦИЕНТ В РЕАНИМАЦИИ КАК СТРАТЕГИЯ ФАРМАКОЛОГИЧЕСКОЙ РЕГУЛЯЦИИ ЦИРКАДНОГО РИТМА (обзор литературы). Университетская клиника, [S.l.], n. 1(30), p. 72-79, март 2019. ISSN 1819-0464. Доступно на: <http://journal.dnmu.ru/index.php/UC/article/view/287>. Дата доступа: 29 март 2024 doi: https://doi.org/10.26435/uc.v0i1(30).287.