He Guo-Zun, Bu Ning, Li Ya-Juan, Gao Yuan, Wang Ge, Kong Zhi-Dong, Zhao Min, Zhang Shan-Shan, Gao Wei
Center for Brain Science, Center for Translational Medicine, Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China.
Front Pharmacol. 2022 Apr 25;13:806950. doi: 10.3389/fphar.2022.806950. eCollection 2022.
Postoperative gastrointestinal dysfunction (POGD) may be caused by postoperative vagus nerve tension inhibition and systemic inflammation. Dexmedetomidine (Dex) increases vagus nerve tone and affords an anti-inflammatory property, which may play a role in pathogenesis. To investigate whether a higher dose of Dex enhances gastrointestinal function recovery. In this retrospective study, patients receiving colorectal surgery at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2019 were included. We evaluated the postoperative flatus time between recipients who received loading plus maintenance dose of DEX (LMD group, 237 recipients) and those who recieved maintenance dose of DEX (MD group, 302 recipients). Data were analyzed by logical regression and stratified and interaction analyses. The simulated pharmacokinetics of two DEX regimens was compared using the Tivatrainer software. Thirty paired blood samples from patients whose propensity scores matched with POGD-related factors at 24 h postoperatively were randomly selected, and their tumor necrosis factor- (TNF-α), cyclooxygenase-2 (COX-2), d-lactate (DLA), acetylcholine (Ach), interleukin (IL)-10, lipopolysaccharide (LPS), IL-6, and inducible nitric oxide synthase (iNOS) levels were measured. Operating rooms and general surgery wards. Among the 644 patients undergoing colorectal surgery, 12 who had a colostomy, 26 without Dex infusion, 20 whose Dex administration mode cannot be classified, and 47 with a history of intestinal surgery were excluded. A total of 539 patients were included. Compared with the MD group, the LMD group had a shorter recovery time to flatus; lower incidences of nausea, vomiting, abdominal distension, and abdominal pain ( < 0.05); and a slightly decreased heart rate. The LMD group was the independent factor of POGD (OR = 0.59, 95% CI = 0.41-0.87, = 0.007) without being reversed in stratified and interaction analyses and had higher Dex plasma concentration from skin incision to 8 h postoperatively. The LMD group had a 39% and 43% increase in Ach and IL-10 levels, respectively, and a 33%-77% decrease in TNF-α, IL-6, COX-2, iNOS, LPS, and DLA levels ( < 0.05). Adding an extra loading dose of Dex can increase parasympathetic tone and decrease inflammation; hence, it can enhance postoperative gastrointestinal function recovery following colorectal surgery.
术后胃肠功能障碍（POGD）可能由术后迷走神经张力抑制和全身炎症引起。右美托咪定（Dex）可提高迷走神经张力并具有抗炎特性，这可能在其发病机制中起作用。为了研究更高剂量的Dex是否能促进胃肠功能恢复。在这项回顾性研究中，纳入了2017年至2019年在西安交通大学第一附属医院接受结直肠手术的患者。我们评估了接受负荷加维持剂量Dex的患者（LMD组，237例）和接受维持剂量Dex的患者（MD组，302例）术后的排气时间。数据通过逻辑回归以及分层和交互分析进行分析。使用Tivatrainer软件比较了两种Dex方案的模拟药代动力学。从术后24小时倾向评分与POGD相关因素匹配的患者中随机抽取30对血样，检测其肿瘤坏死因子-（TNF-α）、环氧化酶-2（COX-2）、d-乳酸（DLA）、乙酰胆碱（Ach）、白细胞介素（IL）-10、脂多糖（LPS）、IL-6和诱导型一氧化氮合酶（iNOS）水平。手术室和普通外科病房。在644例行结直肠手术的患者中，排除12例行结肠造口术的患者、26例未输注Dex的患者、20例Dex给药方式无法分类的患者以及47例有肠道手术史的患者。共纳入539例患者。与MD组相比，LMD组排气恢复时间更短；恶心、呕吐、腹胀和腹痛的发生率更低（<0.05）；心率略有下降。LMD组是POGD的独立因素（OR = 0.59，95%CI = 0.41-0.87，= 0.007），在分层和交互分析中未被逆转，且术后从皮肤切开至8小时血浆Dex浓度更高。LMD组Ach和IL-10水平分别升高39%和43%，TNF-α、IL-6、COX-2、iNOS、LPS和DLA水平降低33%-77%（<0.05）。额外增加负荷剂量的Dex可增加副交感神经张力并减轻炎症；因此，它可促进结直肠手术后胃肠功能的恢复。
