Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China.
Department of Anesthesiology, Naval Medical Center, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200052, China.
Aging (Albany NY). 2021 Mar 10;13(6):8929-8943. doi: 10.18632/aging.202711.
Postoperative gastrointestinal function influences postoperative recovery and length of hospital stay for patients undergoing colorectal surgery. Goal-directed fluid therapy (GDFT) restricts fluid administration to an amount required to prevent dehydration. Although the fluid management of GDFT could decrease the incidence of postoperative complications in patients who undergo high-risk surgery, certain patients may not respond to GDFT. Thus, to achieve optimal treatment, identification of patients suitable for GDFT is necessary. Metabolomic profiling of 48 patients undergoing surgery for colorectal cancer was performed. Patients were divided into delayed- and enhanced-recovered groups based on gastrointestinal function within 72 hours, and the results of omics analysis showed differential serum metabolites between the two groups of patients in the post anesthesia care unit 24 hours after surgery. A support vector machine model was applied to evaluate the curative effects of GDFT in different patients. Four metabolites, oleamide, ubiquinone-1, acetylcholine, and oleic acid, were found to be highly associated with postoperative gastrointestinal function and could be used as potential biomarkers. Moreover, four pathways were found to be highly related to postoperative gastrointestinal recovery. Among them, the vitamin B6 metabolism pathway may be a common pathway for improving postoperative recovery in various diseases. Our findings proposed a novel method to predict postoperative recovery of gastrointestinal function based on metabolomic profiling and suggested the potential mechanisms contributing to gastrointestinal function after surgical resection of colorectal cancer under the fluid management of GDFT.
术后胃肠道功能影响结直肠手术患者的术后恢复和住院时间。目标导向液体治疗（GDFT）将液体管理限制在预防脱水所需的量。虽然 GDFT 的液体管理可以降低高危手术患者术后并发症的发生率，但某些患者可能对 GDFT 没有反应。因此，为了达到最佳治疗效果，有必要确定适合 GDFT 的患者。对 48 例接受结直肠癌手术的患者进行了代谢组学分析。根据术后 72 小时内胃肠道功能，将患者分为延迟恢复组和快速恢复组，术后麻醉后护理单元 24 小时的组学分析结果显示两组患者的血清代谢物存在差异。应用支持向量机模型评估不同患者 GDFT 的疗效。发现四种代谢物，油酸酰胺、泛醌-1、乙酰胆碱和油酸，与术后胃肠道功能高度相关，可作为潜在的生物标志物。此外，还发现了四个与术后胃肠道恢复高度相关的途径。其中，维生素 B6 代谢途径可能是改善各种疾病术后恢复的共同途径。我们的研究结果提出了一种基于代谢组学分析预测术后胃肠道功能恢复的新方法，并提示了在 GDFT 液体管理下结直肠手术后胃肠道功能恢复的潜在机制。
