Effect Of Dexmedetomidine Combined With Ulinastatin On Postoperative Intestinal Function Recovery In Patients Undergoing Laparoscopic Radical Surgery For Colorectal Cancer

Objective To investigate the effects of dexmedetomidine combined with ulinastatin on the levels of serum diamine oxidase（DAO）,D-lactate（D-Lac）and postoperative intestinal function recovery in patients undergoing laparoscopic radical surgery for colorectal cancer through prospective clinical observation.Methods A total of 120 patients who underwent elective laparoscopic colorectal cancer radical surgery in our hospital from May 2022 to February 2023 were randomly divided into four groups:dexmedetomidine group（group D,n=30）,ulinastatin group（group U,n=30）,dexmedetomidine combined with ulinastatin group（group S,n=30）,and control group（group C,n=30）.Group D:dexmedetomidine was pumped at the loading dose of 0.5μg/kg for 10min from 10min before induction of anesthesia,and then 0.4μg/kg/h continuously until 30min before the end of surgery.Group U:ulinastatin at a dose of 10000U/kg was dissolved in 100m L of normal saline,and intravenous infusion was started 10min before anesthesia induction and completed within 2 hours.Group S:dexmedetomidine was pumped at the loading dose of0.5μg/kg for 10min form 10min before induction of anesthesia,and then 0.4μg/kg/h continuously until 30min before the end of surgery;ulinastatin at a dose of 10000U/kg was dissolved in 100m L of normal saline,and intravenous infusion was started 10min before anesthesia induction and completed within 2 hours.Group C:the same volume of normal saline was given at the same speed.All patients in the four groups were treated with general anesthesia combined with epidural anesthesia.The heart rate（HR）and mean arterial pressure（MAP）of the patients after entering the room（T₀）,immediately after intubation（T₁）and immediately after extubation（T₂）were recorded,the dosage of remifentanil and propofol during the surgery,fluid intake and output and surgery duration were recorded;five milliliters of venous blood was collected at T₀,one hour after surgery（T₃）,and the first day after surgery（T₄）,serum DAO level was detected by ELISA,and serum D-Lac level was detected by biochemical microplate method;at T₄,visual analogue scale（VAS）was used to evaluate the pain degree of patients;the first postoperative exhaust time,the first postoperative defecation time,the postoperative hospital stay and the incidence of related complications were tracked and recorded.Results 1.There were no statistical differences in sex,age,body mass index（BMI）,ASA classification,operation duration,intraoperative fluid supplement,urine volume,bleeding volume,HR,MAP,DAO level and D-Lac level at T₀ among the four groups（P>0.05）.2.There was no significant difference in the dosage of propofol and remifentanil between group S and group D（P>0.05）,but both groups were significantly less than those in group C and group U,the differences were statistically significant（P<0.05）.3.Compared with T₀,HR and MAP of the patients in group S and group D were decreased at T₁ and T₂,the differences were statistically significant（P<0.05）;compared with the group C and the group U,HR and MAP of the patients in the group S and the group D were decreased at T₁ and T₂,and the differences were statistically significant（P<0.05）.4.Compared with T₀,the levels of DAO and D-Lac in the four groups were increased at T₃,and the differences were statistically significant（P<0.05）;compared with T₀,the levels of DAO and D-Lac in the patients of group C,group U and group D were increased at T₄,and the differences were statistically significant（P<0.05）;compared with the level of T₃,the levels of DAO and D-Lac in the four groups of patients were decreased at T₄,and the differences were statistically significant（P<0.05）;compared with the group C,the levels of DAO and D-Lac in the group S were decreased at T₃ and T₄,and the differences were statistically significant（P<0.05）;compared with the group C at T₃,the DAO and D-Lac levels in the group D and the group U were decreased,while compared with the group S,the DAO and D-Lac levels in the group D and the group U were increased,and the differences were statistically significant（P<0.05）;compared with the group D,the level of D-Lac in the group S was decreased at T₄,and the difference was statistically significant（P<0.05）.5.Compared with the group C and the group U,the first exhaust time after surgery in the group D and the group S were shortened,and the differences were statistically significant（P<0.05）.6.There were no significant differences in the first defecation time,postoperative hospital stay,VAS pain score at T₄ and the incidence of related complications among the four groups（P>0.05）.Conclusion 1.The intraoperative use of ulinastatin or dexmedetomidine can help to reduce the levels of serum DAO and D-Lac after operation,have a protective effect on intestinal mucosal barrier,and the combined use of the two drugs is more effective.2.Dexmedetomidine in laparoscopic radical surgery of colorectal cancer can shorten the first exhaust time after operation and promote the recovery of intestinal function.