11月28日,，《兒科學(xué)》雜志在線發(fā)表的一項(xiàng)研究顯示,，預(yù)防性使用對乙酰氨基酚的確會輕微增加?jì)雰航臃N后睡眠時間但并不顯著，解熱藥可能通過抑制機(jī)體自然免疫應(yīng)答而實(shí)際上發(fā)揮對抗睡眠,、甚至降低免疫應(yīng)答水平的作用,。在下午接種疫苗后體溫迅速升高的嬰兒在接種后24 h內(nèi)的睡眠時間,，明顯長于在上午接種的嬰兒以及接種后體溫未升高的嬰兒(Pediatrics 2011 Nov. 28 [doi:10.1542/peds.2011-1712])。
美國加州大學(xué)的Linda Franck博士及其同事從一項(xiàng)產(chǎn)后睡眠障礙研究中采集了預(yù)防性使用對乙酰氨基酚以減少嬰兒接種疫苗后睡眠障礙的相關(guān)信息,。共涉及70名相關(guān)資料齊全的嬰兒,，來自2個隨機(jī)分組：對照組的母親接受標(biāo)準(zhǔn)護(hù)理；強(qiáng)化組的母親在接種前30 min預(yù)防性使用對乙酰氨基酚,，接種后每4 h使用1次對乙酰氨基酚,，共使用5劑。雖然經(jīng)過了隨機(jī)分組,，但入組嬰兒80%在接種時或接種后被使用了對乙酰氨基酚,，不過對照組的使用時間更多在出現(xiàn)發(fā)熱或不適癥狀后。
所有入組嬰兒均佩戴了腳踝活動變化記錄儀,，記錄接種前后24 h的活動數(shù)據(jù),，由此推測睡眠運(yùn)動情況。母親也通過日記記錄嬰兒的睡眠情況,，并在每天早上采用電子溫度計(jì)記錄嬰兒的腋窩溫度,，連續(xù)記錄72 h。母親的平均年齡為27歲,，其中31%為亞裔,，26%為白人，23%為西班牙裔,，11%為黑人,，9%為混血或其他種族；90%的母親讀完了中學(xué),，29%讀完了大學(xué),。嬰兒的平均年齡為9周，平均出生體重為3.4 kg,；80%在入組時已接種了所有推薦接種的疫苗,。
結(jié)果顯示，強(qiáng)化組嬰兒接種后24 h的腋窩溫度顯著高于接種前(平均升高0.23℃),。但組間差異不顯著,。強(qiáng)化組嬰兒的睡眠時間也顯著長于對照組(平均增加69 min)，不過增加的主要是活動睡眠,，而安靜睡眠時間僅略微增加,。研究者發(fā)現(xiàn)，睡眠時間延長與腋窩溫度升高之間存在明顯關(guān)聯(lián),，與接種時間也有顯著相關(guān)性：下午1:30以后接種的嬰兒睡眠時間更長,，而部分較早接種的嬰兒的睡眠時間反而少于接種前。
多變量回歸分析顯示,，只有接種后腋窩溫度升高和下午接種者2個因素可預(yù)測接種后24 h睡眠時間延長,，在后者中占32.5%的比重,。
研究者指出，對照組亦有多數(shù)嬰兒使用了對乙酰氨基酚,，這使得更難發(fā)現(xiàn)組間差異,。入組嬰兒中僅有14名未使用該藥，他們接種后的睡眠時間增加相對更多,。不過,，鑒于對乙酰氨基酚并非顯著預(yù)測因素，研究者認(rèn)為體溫增加才是睡眠時間延長的主要原因,。
研究者總結(jié)認(rèn)為：“體溫升高被認(rèn)為是免疫應(yīng)答的標(biāo)志之一,，而且與T細(xì)胞活性增加、抗原識別和免疫應(yīng)答增強(qiáng)所伴隨的內(nèi)源性致熱源釋放有關(guān),。因此,，接種疫苗后睡眠時間延長和體溫升高可能是抗體應(yīng)答程度的指標(biāo)。”如果上述結(jié)果能得到進(jìn)一步證實(shí),，或許應(yīng)建議在下午對嬰兒接種疫苗,，以幫助嬰兒更好地睡眠。
本項(xiàng)研究獲得了美國國立衛(wèi)生研究院的支持,。研究者均無相關(guān)利益沖突,。（生物谷Bioon.com）
doi:10.1542/peds.2011-1712
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Infant Sleep After Immunization: Randomized Controlled Trial of Prophylactic Acetaminophen
Linda Franck, RN, PhD, Caryl L. Gay, PhD, Mary Lynch, RN, MS, MPH, CPNP, Kathryn A. Lee, RN, PhD
Objective: To determine the effects of acetaminophen and axillary temperature responses on infant sleep duration after immunization. Methods: We conducted a prospective, randomized controlled trial to compare the sleep of 70 infants monitored by using ankle actigraphy for 24 hours before and after their first immunization series at ∼2 months of age. Mothers of infants in the control group received standard care instructions from their infants' health care provider, and mothers of infants in the intervention group were provided with predosed acetaminophen and instructed to administer a dose 30 minutes before the scheduled immunization and every 4 hours thereafter, for a total of 5 doses. Infant age and birth weight and immunization factors, such as acetaminophen use and timing of administration, were evaluated for changes in infant sleep times after immunization. Results: Sleep duration in the first 24 hours after immunization was increased, particularly for infants who received their immunizations after 1:30 pm and for those who experienced elevated temperatures in response to the vaccines. Infants who received acetaminophen at or after immunization had smaller increases in sleep duration than did infants who did not. However, acetaminophen use was not a significant predictor of sleep duration when other factors were controlled. Conclusions: If further research confirms the relationship between time of day of vaccine administration, increased sleep duration after immunization, and antibody responses, then our findings suggest that afternoon immunizations should be recommended to facilitate increased sleep in the 24 hours after immunization, regardless of acetaminophen administration.
