Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, China; Anhui Provincial Clinical Research Center for Critical Respiratory Disease, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, China.
Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, Anhui, China.
J Surg Res. 2022 Sep;277:181-188. doi: 10.1016/j.jss.2022.03.031. Epub 2022 Apr 29.
Gastrointestinal failure results in death in critically ill patients. This study aimed to explore the effect of dexmedetomidine (DEX) on intestinal barrier function and its mechanism in critically ill patients undergoing gastrointestinal surgery.
Patients undergoing gastrointestinal surgery were randomized into the DEX group (n = 21) or midazolam (MID) group (n = 21). Sufentanil was used for analgesia in both groups. In the DEX group, DEX was loaded (1 μg/kg) before sedation and infused (0.7 μg/kg/h) during sedation. In the MID group, MID was loaded (0.05 mg/kg) before sedation and infused (0.1 mg/kg/h) during sedation. The mean arterial pressure , heart rate , borborygmus resumption time , first defecation time, length of intensive care unit stay, and length of hospital stay were observed. The diamine oxidase (DAO), D-lactate , TNF-α, IL-6, and α7nAChR levels in plasma or hemocytes were detected before the start of sedation (0 h) and after sedation (24 h).
No significant differences in age, sex, body mass index, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were noted (P > 0.05). The mean arterial pressure between 0 h and 24 h showed no significant difference between the groups (P > 0.05), but the heart rate was significantly lower in the DEX group (P = 0.042). The borborygmus resumption time was significantly earlier in the DEX group (P = 0.034). The lengths of intensive care unit stay (P = 0.016) and hospital stay (P = 0.031) were significantly shorter in the DEX group. The TNF-α level in the DEX group was lower at 24 h than 0 h. The D-lactate level was significantly lower in the DEX group than the MID group at 24 h (P = 0.016). The expression of α7nAChR in the DEX group was significantly higher at 24 h than 0 h (P < 0.05).
DEX maintained intestinal barrier integrity in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.
胃肠道衰竭可导致危重症患者死亡。本研究旨在探讨右美托咪定（DEX）对接受胃肠手术的危重症患者肠屏障功能的影响及其机制。
胃肠手术患者随机分为 DEX 组（n=21）或咪达唑仑（MID）组（n=21）。两组均采用舒芬太尼镇痛。DEX 组在镇静前负荷（1μg/kg），镇静时输注（0.7μg/kg/h）；MID 组在镇静前负荷（0.05mg/kg），镇静时输注（0.1mg/kg/h）。观察平均动脉压、心率、肠鸣音恢复时间、首次排便时间、重症监护病房住院时间和住院时间。检测两组患者镇静前（0h）和镇静后（24h）血浆或血细胞中二胺氧化酶（DAO）、D-乳酸、TNF-α、IL-6 和α7nAChR 水平。
两组患者年龄、性别、体重指数、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）和序贯器官衰竭评分（SOFA）比较差异无统计学意义（P>0.05）。两组 0h 至 24h 平均动脉压比较差异无统计学意义（P>0.05），但 DEX 组心率显著降低（P=0.042）。DEX 组肠鸣音恢复时间较早（P=0.034）。DEX 组患者重症监护病房住院时间（P=0.016）和住院时间（P=0.031）明显缩短。DEX 组患者 24h TNF-α水平低于 0h。DEX 组患者 24h D-乳酸水平明显低于 MID 组（P=0.016）。DEX 组患者 24h α7nAChR 表达明显高于 0h（P<0.05）。
DEX 通过胆碱能抗炎途径维持胃肠手术患者肠屏障完整性。
