Dexmedetomidine Attenuates Inflammation in Elderly Patients Following Major Hepatobiliary and Pancreatic Surgery: A Randomized Clinical Trial

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-05-29 DOI:10.2147/cia.s455987

Xingtong Chen, Qian Chen, Zhigang Qin, Azeem Alam, Hailin Zhao, Raha West, Xianzhe Liu, Jieyu Li, Xin Li, Bin Yi, Daqing Ma, Jianteng Gu

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引用次数: 0

Abstract

Background: Dexmedetomidine (Dex) may have anti-inflammatory properties and potentially reduce the incidence of postoperative organ injury.
Objective: To investigate whether Dex protects pulmonary and renal function via its anti-inflammatory effects in elderly patients undergoing prolonged major hepatobiliary and pancreatic surgery.
Design and Setting: Between October 2019 and December 2020, this randomized controlled trial was carried out at a tertiary hospital in Chongqing, China.
Patients: 86 patients aged 60– 75 who underwent long-duration (> 4 hrs) hepatobiliary and pancreatic surgery without significant comorbidities were enrolled and randomly assigned into two groups at a 1:1 ratio.
Interventions: Patients were given either Dex or an equivalent volume of 0.9% saline (Placebo) with a loading dose of 1 μg kg^{− 1} for 10 min, followed by 0.5 μg kg^{− 1} hr^{− 1} for maintenance until the end of surgery.
Main Outcome Measures: The changes in serum concentrations of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were primary outcomes.
Results: At one hour postoperatively, serum IL-6 displayed a nine-fold increase (P< 0.05) in the Placebo group. Administration of Dex decreased IL-6 to 278.09 ± 45.43 pg/mL (95% CI: 187.75 to 368.43) compared to the Placebo group (P=0.019; 432.16 ± 45.43 pg/mL, 95% CI: 341.82 to 522.50). However, no significant differences in TNF-α were observed between the two groups. The incidence of postoperative acute kidney injury was twice as high in the Placebo group (9.30%) compared to the Dex group (4.65%), and the incidence of postoperative acute lung injury was 23.26% in the Dex group, lower than that in the Placebo group (30.23%), although there was no statistical significance between the two groups.
Conclusion: Dex administration in elderly patients undergoing major hepatobiliary and pancreatic surgery reduces inflammation and potentially protects kidneys and lungs.
Registration: Chinese Clinical Trials Registry, identifier: ChiCTR1900024162, on 28 June 2019.

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右美托咪定可减轻肝胆胰大手术后老年患者的炎症反应：随机临床试验

背景：右美托咪定（Dex右美托咪定（Dex）可能具有抗炎作用，并可能降低术后器官损伤的发生率：探讨右美托咪定是否能通过其抗炎作用保护长期接受肝胆胰大手术的老年患者的肺功能和肾功能：本随机对照试验于2019年10月至2020年12月在重庆一家三级甲等医院进行：86名年龄在60-75岁之间、接受长时间（> 4小时）肝胆胰手术且无明显合并症的患者入组，并按1:1的比例随机分配到两组：干预措施：给予患者Dex或等量的0.9%生理盐水（安慰剂），负荷剂量为1 μg kg- 1，持续10分钟，然后0.5 μg kg- 1 hr- 1维持至手术结束：主要结果：白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）血清浓度的变化是主要结果：术后一小时，安慰剂组的血清 IL-6 增加了九倍（P< 0.05）。与安慰剂组相比（P=0.019；432.16 ± 45.43 pg/mL，95% CI：341.82 至 522.50），服用 Dex 可将 IL-6 降至 278.09 ± 45.43 pg/mL（95% CI：187.75 至 368.43）。不过，两组之间的 TNF-α 并无明显差异。安慰剂组术后急性肾损伤的发生率（9.30%）是地塞米松组（4.65%）的两倍，地塞米松组术后急性肺损伤的发生率为23.26%，低于安慰剂组（30.23%），但两组间无统计学意义：结论：给接受肝胆胰大手术的老年患者服用地塞米松可减轻炎症反应，并有可能保护肾脏和肺脏：注册：中国临床试验注册中心，标识符：ChiCTR19000241622：注册时间：2019年6月28日，ChiCTR1900024162。

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.