Background

Dexmedetomidine (DEX) is a highly selective alpha2 adrenoceptor agonist with broad pharmacological effects, including sedation, analgesia, anxiolysis, and sympathetic tone inhibition. Here we report a systematic review and meta-analysis of its effects on stress, inflammation, and immunity in surgical patients during the perioperative period.

Methods

We searched MEDLINE, METSTR, Embase, and Web of Science for clinical studies or trials to analyse the effects of DEX on perioperative stress, inflammation, and immune function.

Results

Sixty-seven studies (including randomised controlled trials and eight cohort studies) with 4842 patients were assessed, of which 2454 patients were in DEX groups and 2388 patients were in control (without DEX) groups. DEX infusion during the perioperative period inhibited release of epinephrine, norepinephrine, and cortisol; decreased blood glucose, interleukin (IL)-6, tumour necrosis factor-α, and C-reactive protein; and increased interleukin-10 in surgical patients. In addition, the numbers of natural killer cells, B cells, and CD4⁺ T cells, and the ratios of CD4⁺:CD8⁺ and Th1:Th2 were significantly increased; CD8⁺ T-cells were decreased in the DEX group when compared with the control group.

Conclusions

DEX, an anaesthesia adjuvant, can attenuate perioperative stress and inflammation, and protect the immune function of surgical patients, all of which may contribute to decreased postoperative complications and improved clinical outcomes.

中文翻译：

---

右美托咪定对围手术期应激，炎症和免疫功能的影响：系统评价和荟萃分析

背景

右美托咪定（DEX）是一种高度选择性的α2肾上腺素受体激动剂，具有广泛的药理作用，包括镇静，镇痛，抗焦虑和交感神经抑制作用。在这里，我们对围手术期对手术患者的压力，炎症和免疫的影响进行了系统的综述和荟萃分析。

方法

我们搜索MEDLINE，METSTR，Embase和Web of Science进行临床研究或试验，以分析DEX对围手术期压力，炎症和免疫功能的影响。

结果

评估了487例患者的67项研究（包括随机对照试验和8项队列研究），其中DEX组为2454例，对照组（无DEX）为2388例。围手术期的DEX输注抑制了肾上腺素，去甲肾上腺素和皮质醇的释放。降低血糖，白介素（IL）-6，肿瘤坏死因子-α和C反应蛋白；并增加外科手术患者的白介素10水平。此外，自然杀伤细胞，B细胞和CD4 ⁺ T细胞的数量以及CD4 ⁺：CD8 ⁺和Th1：Th2的比例显着增加；与对照组相比，DEX组的CD8 ⁺ T细胞减少。

结论

麻醉辅助剂DEX可以减轻围手术期的压力和炎症，并保护手术患者的免疫功能，所有这些都可能有助于减少术后并发症并改善临床效果。