Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People's Republic of China.
Perioperative and Systems Medicine Laboratory, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, People's Republic of China.
Clin Interv Aging. 2024 May 29;19:981-991. doi: 10.2147/CIA.S455987. eCollection 2024.
Dexmedetomidine (Dex) may have anti-inflammatory properties and potentially reduce the incidence of postoperative organ injury.
To investigate whether Dex protects pulmonary and renal function via its anti-inflammatory effects in elderly patients undergoing prolonged major hepatobiliary and pancreatic surgery.
Between October 2019 and December 2020, this randomized controlled trial was carried out at a tertiary hospital in Chongqing, China.
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.
Patients were given either Dex or an equivalent volume of 0.9% saline (Placebo) with a loading dose of 1 μg kg for 10 min, followed by 0.5 μg kg hr for maintenance until the end of surgery.
The changes in serum concentrations of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were primary outcomes.
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.
Dex administration in elderly patients undergoing major hepatobiliary and pancreatic surgery reduces inflammation and potentially protects kidneys and lungs.
Chinese Clinical Trials Registry, identifier: ChiCTR1900024162, on 28 June 2019.
右美托咪定（Dex）具有抗炎作用，可能降低术后器官损伤的发生率。
探讨右美托咪定通过其抗炎作用是否对行长时间（>4 小时）肝胆胰手术的老年患者的肺和肾功能起保护作用。
本随机对照试验于 2019 年 10 月至 2020 年 12 月在中国重庆的一家三级医院进行。
纳入 86 名年龄在 60-75 岁、无明显合并症、行长时间（>4 小时）肝胆胰手术的患者，按 1:1 比例随机分为两组。
两组患者均给予负荷剂量 1μg/kg 持续 10 分钟，然后给予右美托咪定 0.5μg/kg·h 维持至手术结束，或给予等容量的 0.9%生理盐水（安慰剂）。
血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）浓度的变化为主要观察指标。
术后 1 小时，安慰剂组血清 IL-6 增加 9 倍（P<0.05）。与安慰剂组相比，给予右美托咪定后，IL-6 降低至 278.09±45.43pg/ml（95%CI：187.75 至 368.43）（P=0.019；432.16±45.43pg/ml，95%CI：341.82 至 522.50）。但两组 TNF-α 无显著差异。安慰剂组术后急性肾损伤发生率（9.30%）是右美托咪定组（4.65%）的两倍，且右美托咪定组术后急性肺损伤发生率（23.26%）低于安慰剂组（30.23%），但两组间无统计学意义。
在老年肝胆胰手术患者中，右美托咪定的应用可减轻炎症反应，可能对肾脏和肺部起保护作用。
中国临床试验注册中心，标识符：ChiCTR1900024162，于 2019 年 6 月 28 日注册。
