Effect Of Dexmedetomidine On Postoperative Recurrence Of Uremic Patients With Secondary Hyperparathyroidism Based On Propensity Score Matching Method

Objective To investigate the effect of perioperative dexmedetomidine(DEX)on postoperative recurrence in uremic patients with secondary hyperparathyroidism(SHPT).Methods Medical records of uremic patients with SHPT who received TPTX + AT in our hospital from January 2017 to August 2018 were retrospectively analyzed.Patients were followed up for recurrence of SHPT within 1 year after surgery and their quality of life score one year after surgery.Propensity score matching(PSM)was used to conduct 1:2 adjacent matching for the general data of the two groups of patients,and Logistic regression was used to analyze the related factors of postoperative recurrence in uremic patients with SHPT.The patients were divided into the DEX group and the control group according to the intraoperative infusion of DEX,and the differences of general data,perioperative data and one year postoperative quality of life in the two groups before and after PSM were compared.Results A total of 354 patients with nephrogenic SHPT were included in the study,and 36 patients(10.2%)had recurrence within one year after surgery.After PSM,the recurrence rate in the DEX group was significantly lower than that in the CON group(4.5% vs 12.1%,P = 0.032).There was no statistical difference in general data between the two groups before and after PSM(P>0.05).Logistic regression analysis after PSM showed that advanced age,using of DEX,preoperative high serum phosphorus level,and diabetes mellitus were the influencing factors for postoperative recurrence of uremic patients with SHPT.Patients who received dexmedetomidine had a 3.80-fold decreased risk of SHPT recurrence [odds ratio(OR)= 0.263,95% confidence interval(CI)0.081-0.854,P=0.026] and exhibited a better quality of life compared with those who did not receive dexmedetomidine.Results showed that compared with the CON group,uremic patients with SHPT in the DEX group had lower intraoperative need for sufentanil and lower incidence of remedial analgesia with Visual Analogue Scale(VAS)score≥4 during postanesthesia care unit(PACU)(P<0.05).Conclusion In uremic patients who received PTX-AT,there was an association between dexmedetomidine using and decreased risk of SHPT recurrence,and using DEX can improve the quality of life of uremic patients with SHPT after surgery,it can also reduce the amount of opioids required during the operation and provide better postoperative analgesia.However,further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.