实用老年医学

实用老年医学 ›› 2026, Vol. 40 ›› Issue (4): 367-371.doi: 10.3969/j.issn.1003-9198.2026.04.008

• 临床研究 • 上一篇    下一篇

基于多模态麻醉深度监测的右美托咪定个体化给药方案对老年非心脏手术患者术后认知功能障碍的预防效果

杨丽梅, 李顺莲, 高巍   

  1. 710061 陕西省西安市,西安交通大学第一附属医院麻醉手术部(杨丽梅,高巍);
    712046 陕西省咸阳市,陕西中医药大学临床医学院麻醉科(李顺莲)
  • 收稿日期:2025-08-21 出版日期:2026-04-23 发布日期:2026-04-23
  • 通讯作者: 高巍,Email:gaowei2906@xjtufh.edu.cn
  • 基金资助:
    山西省高层次人才特殊支持计划青年拔尖人才项目(SJRC202003)

Preventive effect of individualized dosing regimen of dexmedetomidine based on multimodal anesthetic depth monitoring on postoperative cognitive dysfunction in elderly patients undergoing non-cardiac surgery

YANG Limei, LI Shunlian, GAO Wei   

  1. Department of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China (YANG Limei , GAO Wei);
    Department of Anesthesiology, Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang 712046, China (LI Shunlian)
  • Received:2025-08-21 Online:2026-04-23 Published:2026-04-23
  • Contact: GAO Wei, Email:gaowei2906@xjtufh.edu.cn

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摘要： 目的 探讨基于多模态麻醉深度监测的右美托咪定个体化给药方案预防老年非心脏手术患者术后认知功能障碍(POCD)的效果。 方法 本研究为前瞻性随机对照研究,收集240例老年非心脏手术患者,随机分为A组(多模态监测指导的右美托咪定个体化给药组)、B组(多模态监测指导的常规麻醉组)和C组(常规监测常规麻醉组),每组80例。所有患者在术前和术后1、3、7 d进行MMSE评估,并检测血清S100β、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、超氧化物歧化酶(SOD)、丙二醛(MDA)和谷胱甘肽过氧化物酶(GSH-Px)等神经损伤和氧化应激标志物的水平。同时,记录各组不良反应发生情况。 结果 与B组和C组相比,A组术后3、7 d的POCD发生率显著降低(P<0.05),MMSE评分较C组恢复更快。术后各时间点,A组血清S100β、NSE、GFAP、MDA和GSH-Px水平明显低于B组和C组,SOD水平则明显高于B组和C组(均P<0.01)。与C组相比,A组术后过度镇静/嗜睡、低血压和心动过缓的发生率均明显降低(P<0.05)。 结论 基于多模态麻醉深度监测的右美托咪定个体化给药方案在预防老年非心脏手术患者术后认知功能障碍方面具有显著优势。   

关键词: 右美托咪定, 术后认知功能障碍, 多模态麻醉深度监测, 个体化给药, 神经保护

Abstract: Objective To investigate the effect of individualized dosing regimen of dexmedetomidine based on multimodal anesthetic depth monitoring in preventing postoperative cognitive dysfunction (POCD) in the elderly patients undergoing non-cardiac surgery. Methods This prospective randomized controlled study enrolled 240 elderly patients undergoing non-cardiac surgery. All the patients were randomly assigned to group A (individualized dexmedetomidine administration guided by multimodal monitoring), group B (conventional anesthesia guided by multimodal monitoring), and group C (conventional anesthesia with routine monitoring), with 80 cases in each group. Mini-Mental State Examination (MMSE) was assessed and serum levels of S100β, neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) were measured to evaluate neuronal injury and oxidative stress before and 1, 3, 7 d after the operation. Meanwhile, adverse events in the three groups were also recorded. Results Compared with group B and group C, group A showed a significantly lower incidence of POCD 3 d and 7 d after operation (P<0.05), with a faster recovery of MMSE scores. At all postoperative time points, the serum levels of S100β, NSE, GFAP, MDA and GSH-Px were significantly lower while the level of SOD was higher in group A than those in group B and group C (P<0.01). The incidence rates of excessive sedation/somnolence, hypotension, and bradycardia were significantly lower in group A than those in group C(P<0.05). Conclusions The individualized dosing regimen of dexmedetomidine based on multimodal anesthetic depth monitoring has significant advantages in preventing POCD in the elderly patients undergoing non-cardiac surgery.    

Key words: dexmedetomidine, postoperative cognitive dysfunction, multimodal anesthetic depth monitoring, individualized dosing, neuroprotection

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