Yang Zhoujing, Tong Chuandi, Qian Xinye, Wang Hailian, Wang Yingwei
Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
Front Aging Neurosci. 2022 Apr 4;14:847610. doi: 10.3389/fnagi.2022.847610. eCollection 2022.
Postoperative delirium (POD) is a frequent complication in patients undergoing gastrectomy. Increasing evidence suggests that abnormal gut microbiota composition may contribute to its morbidity. However, it is unclear whether mechanical bowel preparation would cause postoperative delirium by altering the gut microbiota of patients. This study aimed to investigate the association between mechanical bowel preparation and postoperative delirium in patients undergoing gastrectomy.
A prospective randomized single-center study was performed. A total of 81 patients with gastric cancer were enrolled and randomly assigned to two groups: preparation group and non-preparation group according to whether the patient received MBP before surgery. To diagnose postoperative delirium, we used the 3-Min Diagnostic Interview for Confusion Assessment Method-defined delirium for five successive days after surgery. 16s rRNA gene sequencing was used to investigate changes in the intestinal bacteria. The linear discriminant analysis and effect size (LefSe) analysis were also used to identify the different taxa of fecal microbiota between the postoperative delirium and non-postoperative delirium groups.
We found that there was a significant difference in β-diversity of the gut microbiota between the preparation group and non-preparation group ( = 0.048). Furthermore, patients in the preparation group had a much higher rate of postoperative delirium (13/40, 32.5%) compared with that in non-preparation groups (4/41, 9.8%). Multivariate regression analysis adjusted by other risk factors indicated that mechanical bowel preparation was associated with the occurrence of delirium (odds ratio = 4.792; 95% confidence interval: 1.274-18.028; = 0.020). When comparing the gut microbiota of patients with and without POD, and (genus), which were higher in the preparation group, were also higher in delirium patients ( < 0.05). Genus was both relatively higher in the non-preparation group and non-POD group ( < 0.05).
Mechanical bowel preparation not only altered the gut microbiota composition of patients with gastric cancer but also increased the incidence of postoperative delirium. Among all the gut microbiota altered by mechanical bowel preparation, and genus might be a risk factor of POD. Genus might be a beneficial bacteria to reduce the incidence of POD.
术后谵妄（POD）是接受胃切除术患者常见的并发症。越来越多的证据表明肠道微生物群组成异常可能导致其发病。然而，尚不清楚机械性肠道准备是否会通过改变患者肠道微生物群而导致术后谵妄。本研究旨在探讨机械性肠道准备与接受胃切除术患者术后谵妄之间的关联。
进行一项前瞻性随机单中心研究。共纳入81例胃癌患者，根据患者术前是否接受机械性肠道准备（MBP）随机分为两组：准备组和非准备组。为诊断术后谵妄，我们在术后连续5天使用用于混乱评估方法定义的谵妄的3分钟诊断访谈。采用16s rRNA基因测序研究肠道细菌的变化。线性判别分析和效应大小（LefSe）分析也用于识别术后谵妄组和非术后谵妄组之间粪便微生物群的不同分类群。
我们发现准备组和非准备组肠道微生物群的β多样性存在显著差异（=0.048）。此外，准备组患者术后谵妄发生率（13/40，32.5%）远高于非准备组（4/41，9.8%）。经其他危险因素调整的多因素回归分析表明，机械性肠道准备与谵妄的发生有关（优势比=4.792；95%置信区间：1.274-18.028；=0.020）。比较有和无POD患者的肠道微生物群时，准备组中较高的和（属）在谵妄患者中也较高（<0.05）。属在非准备组和非POD组中均相对较高（<0.05）。
机械性肠道准备不仅改变了胃癌患者的肠道微生物群组成，还增加了术后谵妄的发生率。在机械性肠道准备改变的所有肠道微生物群中，和属可能是POD的危险因素。属可能是降低POD发生率的有益细菌。
