麻醉与临床研究
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Dexmedetomidine's Role in Modulating Postoperative Delirium Incidence and Pro-Inflammatory Cytokine Levels Interleukin-1 Beta (IL-1β), Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) in Geriatric Thoracolumbar Compression Fracture Surgery Patients

Caimin Ye, Jian Shen, Chengcheng Zhang, Zhibin Xu, Cuiyun Hu

Objective: Evaluating dexmedetomidine's effectiveness in mitigating Postoperative Delirium (POD) and modulating pro-inflammatory markers in elderly patients following thoracolumbar compression fracture surgery.

Methods: This randomized, double-blind, placebo-controlled study was conducted from October 2022 to January 2023 at the Anting hospital in Jiading district, Shanghai. It involved patients aged 65 and above undergoing thoracolumbar compression fracture surgery. Participants were randomized into two groups; the Dexmedetomidine (DEX) group, receiving 0.5 μg/kg/hour of diazepam and the Normal Saline (NS) group. Delirium incidence was assessed on the 1^st, 2^nd and 3^rd days post-surgery using the Confusion Assessment Method (CAM). Levels of Interleukin-1 Beta (IL-1β), Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) were measured pre-operation (T0) and on postoperative day 1 (T1) and day 3 (T3).

Results: In this randomized study of 240 patients, evenly distributed into treatment arms, the administration of dexmedetomidine was significantly associated with a reduced incidence of postoperative delirium. Specifically, 18.2% of patients in the dexmedetomidine group experienced POD, compared to 30.6% in the placebo group (P=0.033). Analysis of cytokine profiles demonstrated a postoperative increase in IL-1β, IL-6 and TNF-α levels followed by a reduction by the third postoperative day (P<0.001 for time-related changes). Notably, IL-6 levels significantly decreased in the dexmedetomidine group during the first postoperative assessment (P<0.001) and TNF-α levels were consistently lower on the first and third postoperative days (P=0.003). No significant difference in IL-1β levels was observed between groups. The occurrence of adverse events was comparable in both cohorts.

Conclusion: Dexmedetomidine significantly reduces postoperative delirium in elderly patients after thoracolumbar compression fracture surgery, primarily on the first day. Additionally, it notably decreases IL-6 and TNF-α levels within the first three days’ post-surgery, highlighting its potential in managing postoperative inflammatory responses in this demographic.