右美托咪定鼻喷雾剂在围术期的临床应用进展

Clinical Application Progress of Dexmedetomidine Nasal Spray in Perioperative Period

摘要: 右美托咪定鼻喷雾剂(Dexmedetomidine Nasal Spray, DNS)通过鼻–脑直达递送，为围术期无创镇静提供了新选择。DNS经鼻给药后生物利用度高(59%~89%)，镇静起效快。临床研究显示，在儿童术前镇静和抗焦虑中使用DNS疗效显著，呼吸道并发症少于苯二氮䓬类药物，适用于腺扁桃体切除等高风险气道手术。成人术前DNS可用于抗焦虑以及辅助区域麻醉镇静，有助于减少术后阿片用量。安全性上，DNS呼吸抑制较轻，但需警惕心动过缓、低血压等不良反应，尤其对心动过缓或房室传导阻滞患者需加强监测。研究局限：高质量证据主要来自儿科，成人与老年患者研究不足；给药方案和制剂标准化有待统一；特殊人群的药代动力学尚需进一步研究。未来需开展大规模多中心研究，实现DNS围术期管理的精准化与规范化。

Abstract: Dexmedetomidine Nasal Spray (DNS) offers a novel option for non-invasive sedation during the perioperative period through the “nose-to-brain” direct delivery mechanism. After nasal administration, DNS exhibits high bioavailability (59%~89%) and rapid onset of sedation. Clinical studies have demonstrated that DNS is highly effective for preoperative sedation and anxiety reduction in children, with fewer respiratory complications compared to benzodiazepines, and it is particularly suitable for high-risk airway surgeries such as tonsillectomy. In adults, DNS can be used for preoperative anxiety reduction and as an adjunct for regional anesthesia sedation, helping to reduce postoperative opioid consumption. In terms of safety, DNS has mild respiratory depression; however, caution is needed for bradycardia, hypotension, and other adverse effects, especially in patients with bradycardia or atrioventricular block, for whom monitoring should be intensified. Study Limitations: High-quality evidence primarily comes from pediatric populations, and research involving adults and elderly patients is still insufficient. Standardization of administration protocols and formulations is needed, and the pharmacokinetics in special populations require further investigation. Future studies should focus on large-scale, multicenter trials to enable the precision and standardization of DNS perioperative management.