Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
Tech Coloproctol. 2023 Mar;27(3):217-226. doi: 10.1007/s10151-022-02695-w. Epub 2022 Sep 5.
Postoperative ileus (POI) is a common complication following colorectal surgery and is mediated in part by the cholinergic anti-inflammatory pathway (CAIP). Neostigmine (acetylcholinesterase inhibitor), co-administered with glycopyrrolate, is frequently given for neuromuscular reversal before tracheal extubation and modulates the CAIP. An alternative reversal agent, sugammadex (selective rocuronium or vecuronium binder), acts independently from the CAIP. The aim of our study was to assess the impact of neuromuscular reversal agents used during anaesthesia on gastrointestinal recovery.
Three hundred thirty-five patients undergoing elective colorectal surgery at the Royal Adelaide Hospital between January 2019 and December 2021 were retrospectively included. The primary outcome was GI-2, a validated composite measure of time to diet tolerance and passage of stool. Demographics, 30-day complications and length of stay were collected. Univariate and multivariate analyses were performed.
Two hundred twenty-four (66.9%) patients (129 [57.6%] males and 95 [42.4%] females, median age 64 [19-90] years) received neostigmine/glycopyrrolate and 111 (33.1%) received sugammadex (62 [55.9%] males and 49 [44.1%] females, median age 67 [18-94] years). Sugammadex patients achieved GI-2 sooner after surgery (median 3 (0-10) vs. 3 (0-12) days, p = 0.036), and reduced time to first stool (median 2 (0-10) vs. 3 (0-12) days, p = 0.035). Rates of POI, complications and length of stay were similar. On univariate analysis, POI was associated with smoking history, previous abdominal surgery, colostomy formation, increased opioid use and postoperative hypokalaemia (p < 0.05). POI was associated with increased complications, including anastomotic leak and prolonged hospital stay (p < 0.001). On multivariate analysis, neostigmine, bowel anastomoses and increased postoperative opioid use (p < 0.05) remained predictive of time to GI-2.
Patients who received sugammadex had a reduced time to achieving first stool and GI-2. Neostigmine use, bowel anastomoses and postoperative opioid use were associated with delayed time to achieving GI-2.
术后肠梗阻（POI）是结直肠手术后的一种常见并发症，部分由胆碱能抗炎途径（CAIP）介导。新斯的明（乙酰胆碱酯酶抑制剂）与格隆溴铵联合使用，常用于气管拔管前的神经肌肉逆转，并调节 CAIP。另一种逆转剂，琥珀酸舒更葡糖钠（罗库溴铵或维库溴铵的选择性结合剂），独立于 CAIP 起作用。我们的研究旨在评估麻醉期间使用的神经肌肉逆转剂对胃肠道恢复的影响。
2019 年 1 月至 2021 年 12 月期间，在阿德莱德皇家医院接受择期结直肠手术的 335 例患者被回顾性纳入研究。主要结局是 GI-2，这是一种经过验证的衡量饮食耐受和粪便通过时间的综合指标。收集了人口统计学、30 天并发症和住院时间等数据。进行了单变量和多变量分析。
224 例（66.9%）患者（129 例男性[57.6%]，95 例女性[42.4%]，中位年龄 64[19-90]岁）接受了新斯的明/格隆溴铵，111 例（33.1%）接受了琥珀酸舒更葡糖钠（62 例男性[55.9%]，49 例女性[44.1%]，中位年龄 67[18-94]岁）。琥珀酸舒更葡糖钠组患者术后达到 GI-2 的时间更早（中位数 3（0-10）天 vs. 3（0-12）天，p=0.036），首次排便时间也更早（中位数 2（0-10）天 vs. 3（0-12）天，p=0.035）。POI、并发症和住院时间的发生率相似。单变量分析显示，POI 与吸烟史、既往腹部手术史、结肠造口术、阿片类药物使用增加和术后低钾血症有关（p<0.05）。POI 与并发症增加有关，包括吻合口漏和住院时间延长（p<0.001）。多变量分析显示，新斯的明、肠吻合术和术后阿片类药物使用增加（p<0.05）与 GI-2 时间相关。
接受琥珀酸舒更葡糖钠的患者首次排便和 GI-2 的时间更早。新斯的明的使用、肠吻合术和术后阿片类药物的使用与达到 GI-2 的时间延迟有关。
