Anti-inflammatory and anti-nociceptive effects of individualized blood pressure strategy based on low-dose noradrenaline infusion in elderly patients following major surgery: A randomized, controlled study

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-23 DOI:10.1016/j.jclinane.2025.111978

Zheng Fang , Yu-jie Wang , Xiao-he Zhu , Jia-hui Zheng , Wei Liu , Erwei Gu , Xin-qi Cheng

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引用次数: 0

Abstract

Study objective

To determine whether an individualized blood pressure strategy based on low-dose noradrenaline infusion could reduce cytokines/stress level, thus reducing the acute kidney injury (AKI) complication.

Design

A prospective, randomized, controlled trial.

Setting

The study was performed in First Affiliated Hospital of Anhui Medical University, China, from December 2021 to July 2023.

Patients

108 patients older than 60 years with ASA class II-III and scheduled to hepatobiliary and pancreatic surgery were enrolled.

Intervention

Patients were randomly assigned in a 1:1 ratio to either a standard or individualized treatment group. Individualized management strategy aimed at achieving a mean arterial pressure (MAP) within 20 % of the reference value or standard management strategy of treating MAP less than 65 mmHg.

Measurements

The primary outcome was tumor necrosis factor-α (TNF-α) at 24 h after surgery. The secondary outcomes included other inflammatory cytokine IL-6 and IL-10 levels and the incidence of postoperative AKI within 7-day after surgery.

Main results

100 patients completed the trial and were included in the modified intention-to-treat analysis. The primary outcome TNF-α at 24 h was increased to 16.65 (7.36) pg/ml assigned to the individualized treatment strategy vs 21.23 (7.70) pg/ml in standard treatment group (difference −4.58, 95 %CI −7.56 to −1.58, P = 0.003). A relatively mild increase from baseline were found after surgery in IL-6 and cortisol level except for IL-10. 3 patients (6 %) in the individualized treatment group and 10 (20 %) in the standard treatment group had AKI (Relative Risk 3.33; 95 % CI, 0.95 to 11.39; P = 0.037).

Conclusion

Among elderly patients undergoing major surgery, an individualized mean arterial pressure strategy management based on low-dose norepinephrine reduced surgical stress responses and attenuated the release of proinflammatory cytokines TNF-α and IL-6. It was also associated with a lower risk of AKI.

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基于低剂量去甲肾上腺素输注的个体化血压策略在老年患者大手术后的抗炎和抗伤害作用：一项随机对照研究

研究目的探讨以低剂量去甲肾上腺素输注为基础的个体化降压策略是否能降低细胞因子/应激水平，从而减少急性肾损伤（AKI）并发症。设计一项前瞻性、随机对照试验。本研究于2021年12月至2023年7月在中国安徽医科大学第一附属医院进行。纳入108例年龄大于60岁的ASA II-III级患者，计划行肝胆胰手术。干预患者按1:1的比例随机分配到标准治疗组或个体化治疗组。个体化管理策略旨在实现平均动脉压（MAP）在参考值的20%以内，或治疗MAP低于65 mmHg的标准管理策略。主要观察指标为术后24小时肿瘤坏死因子-α (TNF-α)。次要结局包括其他炎症细胞因子IL-6和IL-10水平以及术后7天内AKI的发生率。主要结果100例患者完成了试验，并被纳入改良意向治疗分析。24小时的主要结局TNF-α增加到16.65 (7.36)pg/ml，分配给个性化治疗策略，而标准治疗组为21.23 (7.70)pg/ml（差异为- 4.58,95% CI为- 7.56至- 1.58,P = 0.003）。术后除IL-10外，IL-6和皮质醇水平较基线有相对轻微的升高。个体化治疗组3例（6%），标准治疗组10例（20%）发生AKI（相对危险度3.33;95% CI, 0.95 ~ 11.39; P = 0.037）。结论在接受大手术的老年患者中，基于低剂量去甲肾上腺素的个体化平均动脉压策略管理可降低手术应激反应，并降低促炎细胞因子TNF-α和IL-6的释放。它还与AKI的风险较低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.