Ye Caimin, Shen Jian, Zhang Chengcheng, Hu Cuiyun
Department of Anesthesiology, Shanghai Jiading District Anting Hospital, Shanghai, China.
Department of anesthesiology, Chang-Hai Hospital, The Second Military Medical University, Shanghai, China.
Medicine (Baltimore). 2024 May 3;103(18):e37931. doi: 10.1097/MD.0000000000037931.
BACKGROUND: This study evaluates the efficacy of dexmedetomidine (DEX) in reducing postoperative delirium (POD) and modulating pro-inflammatory cytokines in elderly patients undergoing thoracolumbar compression fracture surgery. METHODS: In this randomized, double-blind, placebo-controlled trial conducted from October 2022 to January 2023 at Anting Hospital in Shanghai, 218 elderly patients were randomized into DEX (n = 110) and normal saline (NS, n = 108) groups. The DEX group received 0.5 µg/kg/h DEX, and delirium incidence was assessed using the Confusion Assessment Method (CAM) on days 1 to 3 post-surgery. Levels of interleukins IL-1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured pre-operation (T0) and on postoperative days 1 (T1) and 3 (T3). Preoperative (T0) and postoperative day 1 (T1) cerebrospinal fluid (CSF) samples were treated with varying concentrations of olanzapine or DEX to observe their regulatory effects on the expression of Phospho-ERK1/2 and Phospho-JNK. RESULTS: Dexmedetomidine significantly lowered the incidence of POD to 18.2%, compared to 30.6% in the NS group (P = .033). While all patients showed an initial increase in cytokine levels after surgery, by T3, IL-6 and TNF-α levels notably decreased in the DEX group, with no significant change in IL-1β levels across groups. The adverse events rate was similar between groups, demonstrating the safety of DEX in this population. In postoperative CSF samples, treatment with 0.5 mM DEX significantly downregulated Phospho-JNK and upregulated Phospho-ERK1/2 expression, demonstrating a dose-dependent modulation of inflammatory responses. CONCLUSION: Dexmedetomidine is effective in reducing early POD in elderly patients post-thoracolumbar compression fracture surgery. It also decreases IL-6 and TNF-α levels, indicating its potential in managing postoperative inflammatory responses. Treatment with 0.5 mM DEX significantly modulated Phospho-ERK1/2 and Phospho-JNK expressions in postoperative CSF samples, indicating a dose-dependent effect on reducing inflammation. This study contributes to understanding DEX's role in improving postoperative outcomes in elderly patients.
背景：本研究评估右美托咪定（DEX）在降低胸腰椎压缩性骨折手术老年患者术后谵妄（POD）及调节促炎细胞因子方面的疗效。 方法：在2022年10月至2023年1月于上海安亭医院进行的这项随机、双盲、安慰剂对照试验中，218例老年患者被随机分为DEX组（n = 110）和生理盐水（NS，n = 108）组。DEX组接受0.5 μg/kg/h的DEX，术后第1至3天使用谵妄评估方法（CAM）评估谵妄发生率。在术前（T0）、术后第1天（T1）和第3天（T3）测量白细胞介素IL-1β、IL-6和肿瘤坏死因子-α（TNF-α）水平。术前（T0）和术后第1天（T1）的脑脊液（CSF）样本用不同浓度的奥氮平或DEX处理，以观察它们对磷酸化ERK1/2和磷酸化JNK表达的调节作用。 结果：与NS组的30.6%相比，右美托咪定显著降低POD发生率至18.2%（P = 0.033）。虽然所有患者术后细胞因子水平最初均升高，但到T3时，DEX组的IL-6和TNF-α水平显著降低，各组间IL-1β水平无显著变化。两组不良事件发生率相似，表明DEX在该人群中的安全性。在术后脑脊液样本中，0.5 mM DEX处理显著下调磷酸化JNK并上调磷酸化ERK1/2表达，表明对炎症反应具有剂量依赖性调节作用。 结论：右美托咪定在降低胸腰椎压缩性骨折手术老年患者早期POD方面有效。它还降低IL-6和TNF-α水平，表明其在控制术后炎症反应方面的潜力。0.5 mM DEX处理显著调节术后脑脊液样本中磷酸化ERK1/2和磷酸化JNK表达，表明对减轻炎症具有剂量依赖性作用。本研究有助于理解DEX在改善老年患者术后结局中的作用。
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