右美托咪啶：最新情况
Dexmedetomidine: an update.
摘要(中文译文)
右美托咪定已从一种镇静辅助药物发展为多模式围手术期辅助药物，其作用已超越催眠和镇痛。越来越多的研究关注其阿片类药物节约效应、对手术应激反应的调节、血流动力学稳定、器官保护以及以患者为中心的康复结局。本综述总结了与围手术期及重症监护应用相关的近期临床和转化研究证据。当代荟萃分析证实，右美托咪定可一致性地减少围手术期阿片类药物需求量并减轻术后疼痛。右美托咪定可减弱神经内分泌和炎症应激反应，并提供可预测的 sympatholytic 血流动力学控制。新出现的高质量证据提示其具有肾脏保护作用并可减少术后急性肾损伤，而心肺保护和神经保护获益仍不够明确。已有研究描述了早期康复指标的改善，包括谵妄减少、苏醒更平稳以及ICU住院时间缩短，尤其是在高危人群中。区域麻醉和儿科应用显示其可延长镇痛时间并减少苏醒期躁动，而ICU研究提示其获益主要体现在谵妄预防和睡眠质量方面，而非死亡率。当前证据支持右美托咪定作为一种多模式辅助药物，可增强围手术期稳定性和康复质量，而非作为一种独立的麻醉药或改变结局的治疗手段。仔细的患者选择和剂量滴定至关重要。
Abstract
Dexmedetomidine has evolved from a sedative adjunct to a multimodal perioperative adjunct with effects extending beyond hypnosis and analgesia. Growing interest has focused on its opioid-sparing properties, modulation of the surgical stress response, hemodynamic stabilization, organ protection, and patient-centered recovery outcomes. This review summarizes the recent clinical and translational evidence relevant to perioperative and critical care use. Contemporary meta-analyses confirm consistent reductions in perioperative opioid requirements and postoperative pain. Dexmedetomidine attenuates neuroendocrine and inflammatory stress responses and provides predictable sympatholytic hemodynamic control. Emerging high-quality evidence suggests renoprotective effects and reduced postoperative acute kidney injury, whereas cardiopulmonary and neuroprotective benefits remain less definitive. Improvements in early recovery profile, including reduced delirium, smoother emergence, and shorter ICU stay, have been described, particularly in high-risk populations. Regional and pediatric applications demonstrate prolonged analgesia and reduced emergence agitation, while ICU studies indicate benefits primarily in delirium prevention and sleep quality rather than mortality. Current evidence supports dexmedetomidine as a multimodal adjunct that enhances perioperative stability and recovery quality rather than a standalone anesthetic or outcome-modifying therapy. Careful patient selection and dose titration are essential.
如何引用
AMA
Jelena Zivadinovic, Aleksandar Nikolic, Radmilo Jankovic. Dexmedetomidine: an update.. Current opinion in anaesthesiology. 2026; doi:10.1097/ACO.0000000000001651.
APA
Jelena Zivadinovic, Aleksandar Nikolic, Radmilo Jankovic (2026). Dexmedetomidine: an update.. Current opinion in anaesthesiology. https://doi.org/10.1097/ACO.0000000000001651
GB/T 7714
Jelena Zivadinovic, Aleksandar Nikolic, Radmilo Jankovic. Dexmedetomidine: an update.[J]. Current opinion in anaesthesiology, 2026 doi:10.1097/ACO.0000000000001651.
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