生物节律与围术期并发症
Circadian Rhythms and Perioperative Complications
摘要: 生物节律调控着机体激素分泌、体温、心率、血压、代谢和免疫功能等多种生理过程。围术期并发症是影响手术患者预后的关键因素。近年来,随着生物节律的深入研究,其与手术预后的关系正成为围术期医学的研究热点。本文旨在归纳生物节律对围术期并发症的影响及临床证据,为改善患者预后、加速术后康复提出新思路。
Abstract: Circadian Rhythms regulate various physiological processes in the body, including hormone secretion, body temperature, heart rate, blood pressure, metabolism, and immune function. Perioperative complications are critical factors influencing the prognosis of surgical patients. In recent years, with in-depth research on biological rhythms, their relationship with surgical outcomes has become a hotspot in perioperative medicine. This article aims to summarize the impact of biological rhythms on perioperative complications and the clinical evidence, providing new insights for improving patient outcomes and accelerating postoperative recovery.
文章引用:黄灿, 段光友, 黄河. 生物节律与围术期并发症[J]. 临床医学进展, 2026, 16(1): 1341-1353. https://doi.org/10.12677/acm.2026.161173

参考文献

[1] Gulland, A. (2017) Sixty Seconds on...the Circadian Rhythm. BMJ, 359, j5243. [Google Scholar] [CrossRef] [PubMed]
[2] Montaigne, D., Marechal, X., Modine, T., Coisne, A., Mouton, S., Fayad, G., et al. (2018) Daytime Variation of Perioperative Myocardial Injury in Cardiac Surgery and Its Prevention by Rev-Erbα Antagonism: A Single-Centre Propensity-Matched Cohort Study and a Randomised Study. The Lancet, 391, 59-69. [Google Scholar] [CrossRef] [PubMed]
[3] Smolensky, M.H., Hermida, R.C., Reinberg, A., Sackett-Lundeen, L. and Portaluppi, F. (2016) Circadian Disruption: New Clinical Perspective of Disease Pathology and Basis for Chronotherapeutic Intervention. Chronobiology International, 33, 1101-1119. [Google Scholar] [CrossRef] [PubMed]
[4] Kim, S.J., Walsh, J., Tunkel, D.E., Boss, E.F., Ryan, M. and Lee, A.H. (2020) Frequency of Post‐Tonsillectomy Hemorrhage Relative to Time of Day. The Laryngoscope, 130, 1823-1827. [Google Scholar] [CrossRef] [PubMed]
[5] Nemeth, S., Schnell, S., Argenziano, M., Ning, Y. and Kurlansky, P. (2021) Daytime Variation Does Not Impact Outcome of Cardiac Surgery: Results from a Diverse, Multi-Institutional Cardiac Surgery Network. The Journal of Thoracic and Cardiovascular Surgery, 162, 56-67.e44. [Google Scholar] [CrossRef] [PubMed]
[6] Guidry, C.A., Davies, S.W., Willis, R.N., Dietch, Z.C., Shah, P.M. and Sawyer, R.G. (2016) Operative Start Time Does Not Affect Post-Operative Infection Risk. Surgical Infections, 17, 547-551. [Google Scholar] [CrossRef] [PubMed]
[7] Lineaweaver, W.C. (2020) Sleep Deprivation Studies and Their Culture of Overstatement. Annals of Plastic Surgery, 84, 251-252. [Google Scholar] [CrossRef] [PubMed]
[8] Chen, C., Zhai, R., Lan, X., Yang, S., Tang, S., Xiong, X., et al. (2024) The Influence of Sleep Disorders on Perioperative Neurocognitive Disorders among the Elderly: A Narrative Review. Ibrain, 10, 197-216. [Google Scholar] [CrossRef] [PubMed]
[9] Ren, S., Xu, L., Wang, P., Li, L., Hu, Y., Xu, M., et al. (2019) Circadian Rhythms Have Effects on Surgical Outcomes of Liver Transplantation for Patients with Hepatocellular Carcinoma: A Retrospective Analysis of 147 Cases in a Single Center. Transplantation Proceedings, 51, 1913-1919. [Google Scholar] [CrossRef] [PubMed]
[10] Tamimi, Z., Abusamak, M., Al-Waeli, H., Al-Tamimi, M., Al Habashneh, R., Ghanim, M., et al. (2022) NSAID Chronotherapy after Impacted Third Molar Extraction: A Randomized Controlled Trial. Oral and Maxillofacial Surgery, 26, 663-672. [Google Scholar] [CrossRef] [PubMed]
[11] Al-Waeli, H., Nicolau, B., Stone, L., Abu Nada, L., Gao, Q., Abdallah, M., et al. (2020) Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery. Scientific Reports, 10, Article No. 468. [Google Scholar] [CrossRef] [PubMed]
[12] Taccardi, D., Gowdy, H.G.M., Singer Norris, L., Daly-Cyr, J., Zacharias, A.M., Lu, Z., et al. (2024) Longitudinal Multisite Study of the Chronobiological Control of Chronic Pain: The Circahealth Circapain Study Protocol. BMJ Open, 14, e086801. [Google Scholar] [CrossRef] [PubMed]
[13] Radhakrishna, U., Kuracha, M.R., Hamzavi, I., Saiyed, N., Prajapati, J., Rawal, R.M., et al. (2025) Impaired Molecular Mechanisms Contributing to Chronic Pain in Patients with Hidradenitis Suppurativa: Exploring Potential Biomarkers and Therapeutic Targets. International Journal of Molecular Sciences, 26, Article 1039. [Google Scholar] [CrossRef] [PubMed]
[14] Khan, S.A., Lim, H., Harikrishnan, S. and Kothandan, H. (2024) Association between the Time of Surgery and the Incidence of Postoperative Nausea-Vomiting: A Propensity Score Matched Analysis. Cureus, 16, e72737. [Google Scholar] [CrossRef
[15] Wright, M.C. (2006) Time of Day Effects on the Incidence of Anesthetic Adverse Events. Quality and Safety in Health Care, 15, 258-263. [Google Scholar] [CrossRef] [PubMed]
[16] Song, B., Luo, M. and Zhu, J. (2021) The Efficacy of Acupuncture in Postoperative Sleep Quality: A Literature Review. Sleep and Breathing, 25, 571-577. [Google Scholar] [CrossRef] [PubMed]
[17] Fang, Y., Zhang, Y., Wang, G., Guan, J., Wang, H., Shao, M., et al. (2025) Autonomic Function Effects on Postoperative Sleep Disorder: A Prospective Cohort Study. International Journal of Surgery, 111, 7010-7020. [Google Scholar] [CrossRef
[18] Blair, G.J., Mehmood, T., Rudnick, M., Kuschner, W.G. and Barr, J. (2019) Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review. Journal of Intensive Care Medicine, 34, 183-190. [Google Scholar] [CrossRef] [PubMed]
[19] Su, X., Meng, Z., Wu, X., Cui, F., Li, H., Wang, D., et al. (2016) Dexmedetomidine for Prevention of Delirium in Elderly Patients after Non-Cardiac Surgery: A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet, 388, 1893-1902. [Google Scholar] [CrossRef] [PubMed]
[20] Tavares, C., Memória, C.M., da Costa, L.G.V., Quintão, V.C., Antunes, A.A., Teodoro, D., et al. (2025) Effect of Melatonin on Postoperative Cognitive Function in Elderly Patients Submitted to Transurethral Resection of the Prostate under Spinal Anesthesia. Clinics, 80, Article 100562. [Google Scholar] [CrossRef] [PubMed]
[21] Ayuse, T., Ozaki-Honda, Y., Kurata, S., Mishima, G., Kiriishi, K., Magata, N., et al. (2020) Study on the Preventive Effect of Ramelteon on the Onset of Sleep Disorder after General Anesthesia in Patients with Autism Spectrum Disorder: A Study Protocol. Medicine, 99, e22826. [Google Scholar] [CrossRef] [PubMed]
[22] Hou, H., Wu, S., Qiu, Y., Song, F. and Deng, L. (2022) The Effects of Morning/Afternoon Surgeries on the Early Postoperative Sleep Quality of Patients Undergoing General Anesthesia. BMC Anesthesiology, 22, Article No. 286. [Google Scholar] [CrossRef] [PubMed]
[23] Jia, X., Zhang, L., Zhang, W., Zhou, Y., Song, Y., Liu, C., et al. (2021) Melatonin Ameliorates the Sleep Disorder Induced by Surgery under Sevoflurane Anaesthesia in Aged Mice. Basic & Clinical Pharmacology & Toxicology, 128, 256-267. [Google Scholar] [CrossRef] [PubMed]
[24] Simeone, S., Pucciarelli, G., Perrone, M., Teresa, R., Gargiulo, G., Guillari, A., et al. (2018) Delirium in ICU Patients Following Cardiac Surgery: An Observational Study. Journal of Clinical Nursing, 27, 1994-2002. [Google Scholar] [CrossRef] [PubMed]
[25] Scholtens, R.M., de Rooij, S.E.J.A., Vellekoop, A.E., Vrouenraets, B.C. and van Munster, B.C. (2016) Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study. PLOS ONE, 11, e0167621. [Google Scholar] [CrossRef] [PubMed]
[26] Scholtens, R.M., van Munster, B.C., van Faassen, M., van Kempen, M.F., Kema, I.P. and de Rooij, S.E. (2017) Plasma Melatonin Levels in Hip Fracture Patients with and without Delirium: A Confirmation Study. Mechanisms of Ageing and Development, 167, 1-4. [Google Scholar] [CrossRef] [PubMed]
[27] Pérez-Alavéz, J.C., Castañeda-López, J.T., Nieto-Nino, A.G., Rojas-Granados, A. and Angeles-Castellanos, M. (2025) Association between Postoperative Delirium and Loss of Melatonin Rhythm after Hip Arthroplasty: A Pilot Study. Cureus, 17, e86728. [Google Scholar] [CrossRef] [PubMed]
[28] Han, Y., Han, L., Dong, M., Sun, Q., Zhang, Z., Ding, K., et al. (2019) Preoperative Salivary Cortisol AM/PM Ratio Predicts Early Postoperative Cognitive Dysfunction after Noncardiac Surgery in Elderly Patients. Anesthesia & Analgesia, 128, 349-357. [Google Scholar] [CrossRef] [PubMed]
[29] Mahanna-Gabrielli, E., Miano, T.A., Augoustides, J.G., Kim, C., Bavaria, J.E. and Kofke, W.A. (2018) Does the Melatonin Receptor 1B Gene Polymorphism Have a Role in Postoperative Delirium? PLOS ONE, 13, e0207941. [Google Scholar] [CrossRef] [PubMed]
[30] du Fay de Lavallaz, J., Puelacher, C., Lurati Buse, G., Bolliger, D., Germanier, D., Hidvegi, R., et al. (2018) Daytime Variation of Perioperative Myocardial Injury in Non-Cardiac Surgery and Effect on Outcome. Heart, 105, 826-833. [Google Scholar] [CrossRef] [PubMed]
[31] Qian, K., Wu, S., Lee, W., Liu, S., Li, A., Cang, J., et al. (2021) A Model-Based Validation Study of Postoperative Complications with Considerations on Operative Timing. Annals of Translational Medicine, 9, 708-708. [Google Scholar] [CrossRef] [PubMed]
[32] Turan, A., Duncan, A., Leung, S., Karimi, N., Fang, J., Mao, G., et al. (2020) Dexmedetomidine for Reduction of Atrial Fibrillation and Delirium after Cardiac Surgery (DECADE): A Randomised Placebo-Controlled Trial. The Lancet, 396, 177-185. [Google Scholar] [CrossRef] [PubMed]
[33] Li, P., Li, L., Zhao, Z., Xie, J., Zhu, C., Deng, X., et al. (2021) Dexmedetomidine Reduces the Incidence of Postoperative Delirium after Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials. BMC Anesthesiology, 21, Article No. 153. [Google Scholar] [CrossRef] [PubMed]
[34] Ninni, S., Seunes, C., Ortmans, S., Mouton, S., Modine, T., Koussa, M., et al. (2018) Peri-Operative Acute Kidney Injury Upon Cardiac Surgery Time-of-Day. International Journal of Cardiology, 272, 54-59. [Google Scholar] [CrossRef] [PubMed]
[35] Nishida, H., Salerno, C., Onsager, D., Song, T., Nguyen, A., Grinstein, J., et al. (2022) Comparing Short‐Term/Long‐Term Outcomes of Heart Transplants That Occur Inside and Outside of Normal Working Hours. ESC Heart Failure, 9, 2484-2490. [Google Scholar] [CrossRef] [PubMed]
[36] Berhanu, M., Dadi, N., Mengistu, B., Muluken, Z., Tolesa, A., Tageza, T., et al. (2023) Magnitude of Early Postoperative Hypoxemia and Its Associated Factors among Adult Patients Who Undergo Emergency Surgery under General Anesthesia at Jimma Medical Center, Jimma, Southwest Ethiopia, 2021: A Prospective Observational Study. Perioperative Medicine, 12, Article No. 1. [Google Scholar] [CrossRef] [PubMed]
[37] Nassar, J.E., Singh, M., Knebel, A., Daher, M., Alsoof, D., Diebo, B.G., et al. (2025) The Correlation of Sleep Disorders with Postoperative Outcomes in Spine Surgery: A Narrative Review. North American Spine Society Journal (NASSJ), 21, Article 100586. [Google Scholar] [CrossRef] [PubMed]
[38] Imai, R., Makino, H., Katoh, T., Kimura, T., Kurita, T., Hokamura, K., et al. (2020) Desflurane Anesthesia Shifts the Circadian Rhythm Phase Depending on the Time of Day of Anesthesia. Scientific Reports, 10, Article No. 18273. [Google Scholar] [CrossRef] [PubMed]
[39] Lu, H., Huang, A.P. and Kuo, L. (2021) Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage after Surgery. Neurology and Therapy, 10, 1045-1059. [Google Scholar] [CrossRef] [PubMed]
[40] Lewis, A.J., Zhang, X., Griepentrog, J.E., Yuan, D., Collage, R.D., Waltz, P.K., et al. (2018) Blue Light Enhances Bacterial Clearance and Reduces Organ Injury during Sepsis. Critical Care Medicine, 46, e779-e787. [Google Scholar] [CrossRef] [PubMed]