Effect Of Melatonin On Immune Function And Sleep Quality In Patients Undergoing

Objective:This prospective randomized, placebo controlled and double blinded clinical study was designed to observe the analgesic effect of melatonin and the influence of melatonin on the stress response, immunological competence, sleep quality of gynaecological patients undergoing hypogastric operations under epidural anaesthesia.Methods:12 gynaecological patients undergoing hypogastric operations were selected and allocated randomly into 2 groups: group P and group M with 6 cases in each group, group M patients took 6mg melatonin orally and those in group P took placebo at 20:50 of preoperative day, the day of surgery and postoperative day; another 6 patients with similar surgical conditions were selected as group C; epidural infusion was applied as anaesthetic method, patient controlled epidural analgesia (PCEA) was selected as postoperative analgesic method; in the day of surgery and postoperative day, urine samples were collected at 10: 00, 14: 00, 16: 00,18: 00, 20: 00, 22: 00, 0: 00, 3: 00, 6: 00 (in preoperative day, at 10: 00, 14: 00, 16: 00, 17: 00, 18: 00, 19: 00, 20: 00, 21: 00, 6: 00) to determine the concentrations of melatonin by radioimmunoassay; in preoperative and postoperative day, peripheral venous blood was collected at 10:00 (in the day of surgery, at the very ending moment of operation) to determine the levels of cortisol, ACTH, IL1- β , TNF by radioimmunoassay and to measure the numbers of CD4, CD8, CD3 cell by flow cytometry; polysomnography was recorded and analysed; subjective sleep status, morning blood pressure, morning body temperature and visual analogue scale were noted too.Results:1. Compared with the day before operation, the average blood cortisol concentration of group C, P in the day of surgery was elevated significantly, while that of group M was not; compared with the preoperarive day and the day of surgery, ACTH levels of group C, P were not changed while that of group M of the postoperative day was enhanced significantly; both concentrations of IL1- β and TNF did not alter before and after operation; the secretion of melatonin after operation was delayed, level of which declined significantly, compared with that of the preoperarive day and the day of surgery;2. There were no differences between groups, as far as CD4, CD8 and CD3 cell number were concerned; compared with the day before operation, both CD3, CD4 cell numbers of group C and P were decreased significantly after operation, CD8 cell number and CD4/CD8 were not of difference; CD3 cell number of group M remained stable, but both CD4 cell number and CD4/CD8 were reduced significantly; CD4, CD8, CD3 cell numbers were correlated with sleep time and melatonin concentrations;3. Compared with group C and P, stage I, IV, SWS and REM sleep time of group M were all increased significantly in different degrees and different days, with higher satisfaction of self-estimation of sleep status; the wake times of group C and P of the operation day were augmented significantly compared with that of the preoperative day, while group M remained unchanged; increased sleep time was correlated with the in time introduction of melatonin and the elevated blood concentrations of melatonin;...