右美托咪定在小儿围术期应用的研究进展
Research Progress on the Application of Dexmedetomidine in Pediatric Perioperative Period
DOI: 10.12677/acm.2025.1592568, PDF,   
作者: 康玉雯, 何 群*：吉首大学医学院附属第一医院麻醉科，湖南 吉首
关键词: 右美托咪定；小儿；围术期；抗焦虑；Dexmedetomidine； Pediatric； Perioperative Period； Anxiolytic
摘要: 右美托咪定是一种高选择性α2受体肾上腺素受体激动药，具有镇静、镇痛、催眠等效果，DEX一般应用于插管和机械通气成年患者的短期镇静(<24 h)，以及外科全身麻醉和其他手术期间非插管患者的镇静，其在小儿麻醉中也同样有较好的临床应用。小儿由于陌生环境以及疼痛刺激会出现紧张、焦虑情绪，对患儿预后造成一定影响。本文对其右美托咪定的药理学特点、在小儿围术期的应用、安全性及风险管理以及如何优化舒适化医疗进行综述，为合理用药提供参考。
Abstract: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist with sedative, analgesic, and hypnotic effects. DEX has been approved by the US Food and Drug Administration for short-term sedation (<24 hours) in adult patients undergoing initial intubation and mechanical ventilation in the intensive care unit (ICU), as well as for sedation in non-intubated patients during general anesthesia and other surgeries. It also has good clinical applications in pediatric anesthesia. Due to the unfamiliar environment and pain stimulation, children may experience tension and anxiety, which can have a certain impact on their prognosis. This article reviews the pharmacological characteristics of dexmedetomidine, its application in pediatric perioperative period, safety and risk management, and how to optimize comfortable medical care, providing a reference for rational drug use.
文章引用：康玉雯, 何群. 右美托咪定在小儿围术期应用的研究进展[J]. 临床医学进展, 2025, 15(9): 875-883. https://doi.org/10.12677/acm.2025.1592568

参考文献

[1] 彭景燕, 李玉霞, 杨运亮, 等. 不同剂量右美托咪定对扁桃体腺样体切除术患儿术后躁动的影响[J]. 中国医刊, 2021, 56(11): 1250-1253.
[2] 罗玲, 王春. 盐酸右美托咪定对小儿扁桃体、腺样体切除术中应激反应的影响[J]. 解放军医药杂志, 2018, 30(4): 100-103.
[3] 王涛, 江亚楠, 魏明, 等. 右美托咪定经鼻给药在小儿扁桃体及腺样体切除术中应用[J]. 中华实用诊断与治疗杂志, 2017, 31(4): 381-383.
[4] 卜月, 席宏杰. 右美托咪定调控ERK1/2/HO-1信号通路对肝脏缺血再灌注损伤的影响[J]. 哈尔滨医科大学学报, 2023, 57(4): 360-365.
[5] Seppänen, S., Kuuskoski, R., Mäkelä, K.T., Saari, T.I. and Uusalo, P. (2021) Intranasal Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Total Knee Arthroplasty under General Anesthesia. The Journal of Arthroplasty, 36, 978-985.e1. [Google Scholar] [CrossRef] [PubMed]
[6] Berkenbosch, J.W. (2015) Options and Considerations for Procedural Sedation in Pediatric Imaging. Pediatric Drugs, 17, 385-399. [Google Scholar] [CrossRef] [PubMed]
[7] Anttila, M., Penttilä, J., Helminen, A., Vuorilehto, L. and Scheinin, H. (2003) Bioavailability of Dexmedetomidine after Extravascular Doses in Healthy Subjects. British Journal of Clinical Pharmacology, 56, 691-693. [Google Scholar] [CrossRef] [PubMed]
[8] 闫丽娟, 王霄. 右美托咪定滴鼻改善儿童扁桃体全切后急性躁动和术后不良行为的临床效果观察[J]. 中国妇幼保健, 2025, 40(3): 448-451.
[9] Singariya, G., Malhotra, N., Kamal, M., Jaju, R., Aggarwal, S. and Bihani, P. (2022) Comparison of Nebulized Dexmedetomidine and Ketamine for Premedication in Pediatric Patients Undergoing Hernia Repair Surgery: A Randomized Comparative Trial. Anesthesia and Pain Medicine, 17, 173-181. [Google Scholar] [CrossRef] [PubMed]
[10] Sun, Y., Lu, Y., Huang, Y., et al. (2014) Is Dexmedetomidine Superior to Midazolam as a Premedication in Children? A Meta-Analysis of Randomized Controlled Trials. Pediatric Anesthesia, 24, 863-874.
[11] Yao, J., Gong, H., Zhao, X., Peng, Q., Zhao, H. and Yu, S. (2022) Parental Presence and Intranasal Dexmedetomidine for the Prevention of Anxiety during Anesthesia Induction in Children Undergoing Tonsillectomy and/or Adenoidectomy Surgery: A Randomized Controlled Trial. Frontiers in Pharmacology, 13, Article ID: 1015357. [Google Scholar] [CrossRef] [PubMed]
[12] Yao, Y., Qian, B., Chen, Y., et al. (2014) Intranasal Dexmedetomidine Premedication Reduces the Minimum Alveolar Concentration of Sevoflurane for Tracheal Intubation in Children: A Randomized Trial. Journal of Clinical Anesthesia, 26, 309-314. [Google Scholar] [CrossRef] [PubMed]
[13] 支连军, 蔡慧茹. 右美托咪定对小儿扁桃体和腺样体切除术后镇静镇痛的影响[J]. 中国现代药物应用, 2022, 16(22): 48-51.
[14] Cai, Y., Wang, C., Li, Y., Chen, J., Li, J., Wu, J., et al. (2021) Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries. Frontiers in Pharmacology, 12, Article ID: 648699. [Google Scholar] [CrossRef] [PubMed]
[15] Nagoshi, M., Reddy, S., Bell, M., Cresencia, A., Margolis, R., Wetzel, R., et al. (2018) Low‐Dose Dexmedetomidine as an Adjuvant to Propofol Infusion for Children in MRI: A Double‐Cohort Study. Pediatric Anesthesia, 28, 639-646. [Google Scholar] [CrossRef] [PubMed]
[16] 徐磊, 王媛, 齐金莲, 等. 不同剂量右美托咪定口腔黏膜喷雾或滴鼻用于小儿脑电图检查的镇静效果[J]. 河南外科学杂志, 2024, 30(3): 7-11.
[17] 张文礼, 林金兵, 吴亚彬, 等. 右美托咪定滴鼻复合七氟醚面罩吸入全麻在小儿眼科短小手术中的应用[J]. 国际医药卫生导报, 2019, 25(15): 2510-2512.
[18] Lalwani, Y., Dave, B. and Shah, L. (2025) Comparative Evaluation of the Effectiveness and Acceptance of Intranasal Dexmedetomidine and Intranasal Midazolam for Sedation in Children Aged 5-8 Years Using a Mucosal Atomizer Device: A Randomized Controlled Clinical Study. Journal of Dental Anesthesia and Pain Medicine, 25, 109-122. [Google Scholar] [CrossRef] [PubMed]
[19] Kumar, M., Mishra, P., Singh, A.K. and Gupta, R. (2024) A Randomized Study to Compare the Efficacy between Intranasal and Intravenous Dexmedetomidine for the Removal of Foreign Bodies in the Esophagus at the Cricopharynx Level in Pediatric Patients. Cureus, 16, e73909. [Google Scholar] [CrossRef] [PubMed]
[20] 张爽, 孟凡涛. 右美托咪定辅助静吸麻醉在小儿上消化道特殊异物取出术中的应用及对苏醒期躁动的影响[J]. 药物生物技术, 2023, 30(6): 618-622.
[21] 庞小翼, 张培根, 周阳, 等. 右美托咪定滴鼻给药在两种类型先天性心脏病患儿术前镇静方面的临床应用研究[J]. 中国医院用药评价与分析, 2020, 20(3): 290-292+296.
[22] Piastra, M., Pizza, A., Gaddi, S., Luca, E., Genovese, O., Picconi, E., et al. (2018) Dexmedetomidine Is Effective and Safe during NIV in Infants and Young Children with Acute Respiratory Failure. BMC Pediatrics, 18, Article No. 282. [Google Scholar] [CrossRef] [PubMed]
[23] 戴庭辉, 陈艳平, 阳星星, 等. 右美托咪定滴鼻给药用于听力障碍儿童术前镇静的效果[J]. 中国新药与临床杂志, 2021, 40(3): 214-218.
[24] 李鑫, 李伟民, 吴桐, 等. 右美托咪定滴鼻联合超声引导下腹横肌平面阻滞在小儿日间腹腔镜疝修补术中的临床观察[J]. 中国医刊, 2025, 60(6): 671-674.
[25] She, Y., Xie, G., Tan, Y., Kuang, X., Yu, G., Lian, G., et al. (2015) A Prospective Study Comparing the Onset and Analgesic Efficacy of Different Concentrations of Levobupivacaine with/without Dexmedetomidine in Young Children Undergoing Caudal Blockade. Journal of Clinical Anesthesia, 27, 17-22. [Google Scholar] [CrossRef] [PubMed]
[26] Trifa, M., Tumin, D. and Tobias, J.D. (2018) Dexmedetomidine as an Adjunct for Caudal Anesthesia and Analgesia in Children. Minerva Anestesiologica, 84, 836-847. [Google Scholar] [CrossRef] [PubMed]
[27] Chen, J.B., Su, L.M., Zhang, X.Q., Liu, Y., Li, X. and Chen, Z. (2024) Ropivacaine Combined with Dexmedetomidine in Ultrasound-Guided Axillary Brachial Plexus Block in Children, a Randomized Controlled Trial. European Journal of Medical Research, 29, Article No. 416. [Google Scholar] [CrossRef] [PubMed]
[28] El Baz, M. and Farid, A. (2020) Is Spinal Dexmedetomidine Aggravating Hypotension after Tourniquet Deflation? Anesthesia: Essays and Researches, 14, 521-524. [Google Scholar] [CrossRef] [PubMed]
[29] Li, H., Liu, J. and Shi, H. (2021) Effect of Dexmedetomidine on Perioperative Hemodynamics and Myocardial Protection in Thoracoscopic-Assisted Thoracic Surgery. Medical Science Monitor, 27, e929949. [Google Scholar] [CrossRef] [PubMed]
[30] Wujtewicz, M., Twardowski, P., Jasiński, T., Michalska-Małecka, K. and Owczuk, R. (2023) Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine. Pharmaceuticals, 16, Article No. 354. [Google Scholar] [CrossRef] [PubMed]
[31] Ni, C., Xu, W., Mu, B., Li, H., Geng, J., Qu, Y., et al. (2024) The Feasibility of Dexmedetomidine-Led Anesthesia Maintenance Strategy during Major Abdominal Surgery. Heliyon, 10, e26983. [Google Scholar] [CrossRef] [PubMed]
[32] Kim, D., Lee, C., Bae, H., Kim, J., Oh, E.J. and Jeong, J.S. (2023) Comparison of the Perfusion Index as an Index of Noxious Stimulation in Monitored Anesthesia Care of Propofol/Remifentanil and Propofol/Dexmedetomidine: A Prospective, Randomized, Case-Control, Observational Study. BMC Anesthesiology, 23, Article No. 183. [Google Scholar] [CrossRef] [PubMed]
[33] Shuai, Y., Liu, Y., Yang, X., Wan, Q., Zhao, J. and Wang, X. (2025) Delirium Risk Associated with Esketamine, Sevoflurane, Propofol, and Dexmedetomidine: A Real-World Study Based on the FDA Adverse Event Reporting System. European Journal of Pharmacology, 1000, Article ID: 177723. [Google Scholar] [CrossRef] [PubMed]
[34] Bell, C.M., Procter, L.D. and Parli, S.E. (2021) Asystole Following Concomitant Intravenous Administration of Neostigmine and Dexmedetomidine in a Patient with Acute Colonic Pseudo-Obstruction. Journal of Pharmacy Practice, 35, 650-653. [Google Scholar] [CrossRef] [PubMed]
[35] 姚依婷, 刘寒玉, 吴仔峰, 等. 麻醉药对发育期神经系统的毒性作用及机制研究进展[J]. 中国临床药理学与治疗学, 2022, 27(12): 1354-1364.
[36] 曹雅, 王东旭, 张宇轩, 等. 右美托咪定在神经外科手术围术期应用的研究进展[J]. 徐州医科大学学报, 2025, 45(7): 541-546.
[37] 黄松, 毕明壮, 黄振华, 等. 右美托咪定通过HIPK2/AKT/mTOR信号通路改善七氟醚麻醉诱导的发育海马神经毒性[J]. 中国优生与遗传杂志, 2024, 32(7): 1364-1370.
[38] 王宇恒, 吴秀, 李明选, 等. 右美托咪定对妊娠期七氟烷吸入麻醉诱发仔鼠海马神经元发育损伤的影响[J]. 海南医学院学报, 2019, 25(18): 1371-1375.
[39] 姚远, 胡学远, 王文静, 等. 右美托咪定神经保护机制的研究进展[J]. 中国兽医杂志, 2023, 59(7): 91-95.
[40] 苏志源. 右美托咪定对未成熟大鼠异氟醚暴露致大脑神经损伤的保护作用[D]: [博士学位论文]. 广州: 南方医科大学, 2015.
[41] 刘煜鑫, 闫东. 右美托咪定对大鼠海马神经元生长发育的影响及其机制[J]. 中国应用生理学杂志, 2019, 35(1): 69-73.

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