Huang He, Zhou Ling, Yu Yingying, Liu Shijiang, Xu Hao, Xu Zekuan, Yang Chun, Liu Cunming
Department of Anaesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Front Med (Lausanne). 2022 Feb 2;8:789597. doi: 10.3389/fmed.2021.789597. eCollection 2021.
Deep neuromuscular blockade (NMB) improves the surgical conditions and is benefit for the postoperative recovery after laparoscopic surgery. However, the mechanisms of deep NMB in promoting the recovery of intestinal function have not been completely investigated. The objective of our study was to determine the impact of the deep NMB and moderate NMB strategy on the intestinal barrier function after laparoscopic gastrectomy. We collected patients undergoing elective laparoscopic gastrectomy. Patients were randomized to deep NMB (post-tetanic count 1-2) vs. moderate NMB (train-of-four count 1-2) during the surgery. Primary outcomes were time to flatus, serum diamine oxidase (DAO) and D-lactate, and gut microbiota. Other outcomes were surgical condition scores, postoperative visual analog pain scores, and length of hospital stay. Ninety patients in deep NMB group and sixty patients in moderate NMB group completed the study. Main results showed that the time to flatus was decreased in deep NMB group (74 ± 32 h) than that in moderate NMB group (93 ± 52 h, = 0.006). The level of serum D-lactate was statistically increased in the moderate NMB group than that in the deep NMB group (1,209 ± 224 vs. 1,164 ± 185 ng/ml, < 0.001). But no significant differences could be detected in the level of DAO between the groups. Additionally, the 16s rRNA analysis indicated that gut microbiota were similar in Alpha diversity but distinct in Beta diversity. Furthermore, the beneficial bacteria, such as genus and , were more abundant in the deep NMB group, while the potentially harmful bacteria were more abundant in the moderate NMB group. Our findings suggested that the intestinal mucosal barrier and gut microbiota were better preserved in deep NMB, which greatly improved the postoperative recovery of intestinal function after laparoscopic gastrectomy.
深度神经肌肉阻滞（NMB）可改善手术条件，并有利于腹腔镜手术后的术后恢复。然而，深度NMB促进肠功能恢复的机制尚未完全阐明。我们研究的目的是确定深度NMB和中度NMB策略对腹腔镜胃切除术后肠屏障功能的影响。我们收集了接受择期腹腔镜胃切除术的患者。手术期间，患者被随机分为深度NMB组（强直后计数1 - 2）和中度NMB组（四个成串刺激计数1 - 2）。主要观察指标为排气时间、血清二胺氧化酶（DAO）、D - 乳酸和肠道微生物群。其他观察指标为手术条件评分、术后视觉模拟疼痛评分和住院时间。深度NMB组90例患者和中度NMB组60例患者完成了研究。主要结果显示，深度NMB组的排气时间（74±32小时）比中度NMB组（93±52小时，P = 0.006）缩短。中度NMB组血清D - 乳酸水平在统计学上高于深度NMB组（1209±224 vs. 1164±185 ng/ml，P < 0.001）。但两组间DAO水平未检测到显著差异。此外，16s rRNA分析表明，肠道微生物群在α多样性方面相似，但在β多样性方面不同。此外，深度NMB组中有益菌如属和属更为丰富，而中度NMB组中潜在有害菌更为丰富。我们的研究结果表明，深度NMB能更好地保护肠黏膜屏障和肠道微生物群，极大地改善了腹腔镜胃切除术后肠功能的术后恢复。
