Article(id=1292126527727104395, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1292126460546929080, articleNumber=null, orderNo=null, doi=10.13699/j.cnki.1001-6821.2026.03.004, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765987200000, receivedDateStr=2025-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1785996570760, onlineDateStr=2026-08-06, pubDate=1771257600000, pubDateStr=2026-02-17, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1785996570760, onlineIssueDateStr=2026-08-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1785996570760, creator=13701087609, updateTime=1785996570760, updator=13701087609, issue=Issue{id=1292126460546929080, tenantId=1146029695717560320, journalId=1246415772164075586, year='2026', volume='42', issue='3', pageStart='301', pageEnd='450', issueExtLink='null', onlineDate='null', pubDate='1771257600000', pubDateStr='2026-02-17', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1785996554742, creator='13701087609', updateTime=1786014541627, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1292201903060963536, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1292126460546929080, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1292201903060963537, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1292126460546929080, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=318, endPage=325, ext={EN=ArticleExt(id=1292126527949402508, articleId=1292126527727104395, tenantId=1146029695717560320, journalId=1246415772164075586, language=EN, title=Clinical trial of dexmedetomidine in different administration methods during total hip replacement in the elderly, columnId=1246531407326105792, journalTitle=Chinese Journal of Clinical Pharmacology, columnName=Clinical and Basic Bridging Research, runingTitle=null, highlight=null, articleAbstract=
Objective To explore the efficacy and safty of different administration routes of dexmedetomidine injection in elderly patients undergoing total hip arthroplasty (THA).
Methods The elderly THA patients were randomly divided into the intravenous group (ID group, ropivacaine injection nerve block, 0.5 μg·kg-1 dexmedetomidine injection administered by intravenous pump) and the perineural group (PD group, 0.5 μg·kg-1 dexmedetomidine injection combined with ropivacaine injection nerve block). Compare the postoperative visual analog scale (VAS) scores, inflammatory factors, hemodynamic parameters, awakening time, incidence and duration of emergence agitation (EA), mini-mental state examination (MMSE) scores, riker sedation-agitation scale (RSAS), oxidative stress and immune function between the two groups and safty evaluation was conduated.
Results A total of 102 cases were included, 51 in the ID group and 51 in the PD group. At 48 hours after surgery, the resting VAS scores of ID group and PD group were (1.85±0.73) and (1.52±0.61) points, and the movement VAS scores were (3.61±0.64) and (3.27±0.42) points, respectively. The rest/movement VAS scores of PD group were significantly lower than those of ID group (all P<0.05). Immediately after surgery, C-reactive protein (CRP) in ID group and PD group were (6.80±1.03) and (6.13±0.75) mg·L-1, interleukin-1β (IL-1β) were (8.06±0.87) and (6.07±0.63) pg·mL-1, tumor necrosis factor-α (TNF-α) were (99.24±12.03) and (81.10±9.25) ng·mL-1, interleukin-8 (IL-8) were (8.03±0.73) and (6.19±0.68) pg·mL-1, interleukin-6 (IL-6) were (39.68±7.25) and (32.35±6.86) pg·mL-1; 1 day after surgery, CRP in ID group and PD group were (6.07±1.07) and (5.37±0.81) mg·L-1, IL-1β were (6.71±0.66) and (5.24±0.65) pg·mL-1, TNF-α were (98.21±11.00) and (77.48±10.78) ng·mL-1, IL-8 were (6.76±0.57) and (5.29±0.60) pg·mL-1, IL-6 were (37.93±8.65) and (30.34±7.20) pg·mL-1; 3 day after surgery, CRP in ID group and PD group were (5.53±1.04) and (5.06±0.64) mg·L-1, IL-1β were (6.11±0.73) and (4.30±0.68) pg·mL-1, TNF-α were (83.97±13.78) and (51.32±9.69) ng·mL-1, IL-8 were (6.26±0.67) and (4.33±0.52) pg·mL-1, IL-6 were (31.35±7.06) and (28.24±5.23) pg·mL-1. The levels of CRP, IL-1β, TNF-α, IL-8 and IL-6 in PD group were statistically significantly lower than those in ID group immediately after operation, 1 day and 3 days after operation (all P<0.05). The recovery time of ID group and PD group was (28.93±3.00) and (25.93±2.91) min, respectively; the incidence of EA was 23.53% and 7.84%, respectively; the duration of EA was (2.32±0.38) and (1.82±0.36) days, respectively. Immediately after surgery, superoxide dismu-tase (SOD) in ID group and PD group were (136.47±16.96) and (154.81±15.38) U·mL-1, malondialdehyde (MDA) were (8.89±1.24) and (6.54±1.13) nmol·mL -1, CD4+ were (29.28±2.94)% and (32.62±2.57)%, CD4+/CD8+ were (1.34±0.39)% and (1.55±0.37)%; 1 day after surgery, SOD in ID group and PD group were (149.82±17.54) and (157.73±16.52) U·mL-1, MDA were (6.04±1.10) and (4.37±1.02) nmol·mL -1, CD4+ were (24.75±1.71)% and (28.36±2.31)%, CD4+/CD8+ were (1.24±0.31)% and (1.37±0.33)%; 3 day after surgery, SOD in ID group and PD group were (156.44±19.73) and (164.39±19.15) U·mL-1, MDA were (5.27±0.95) and (4.05±0.68) nmol·mL -1, CD4+ were (27.35±1.78)% and (31.16±2.33)%, CD4+/CD8+ were (1.22±0.35)% and (1.43±0.40)%. SOD、CD4+、CD4+/CD8+ in PD group were statistically significantly higher than those in ID group (all P<0.05), MDA was statistically significantly lower than that in ID group (P<0.05). Among the routes of administration, ID was a risk factor for EA during general anesthesia in THA in elderly patients (P<0.05). Among the administration doses, different administration doses did not increase the risk of EA during general anesthesia in elderly patients with THA (P>0.05).
Conclusion Compared with intravenous administration, peripheral dexmedetomidine injection can effectively reduce the incidence of EA, reduce inflammation and oxidative stress, improve analgesia and immune function in elderly patients with THA, and the effect can be achieved at a lower dose, which is recommended as the preferred anesthesia auxiliary scheme.
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目的 观察右美托咪定注射液不同给药途径对老年全髋关节置换术（THA）患者的临床疗效和安全性。
方法 将老年THA患者随机分为静脉组（ID组，罗哌卡因注射液神经阻滞，0.5 μg·kg-1右美托咪定注射液静脉泵注）和神经周围组（PD组，0.5 μg·kg-1右美托咪定注射液联合罗哌卡因注射液神经阻滞）。比较2组术后视觉模拟评分（VAS）、炎性因子、血流动力学、苏醒时间、苏醒期谵妄（EA）发生率及持续时间、简易精神状态检查量表（MMSE）评分、Riker镇静-躁动评分（RSAS）、氧化应激及免疫功能，并进行安全性评价。
结果 共纳入102例，ID组与PD组各51例，术后48 h，ID组和PD组静息VAS评分分别为（1.85±0.73）和（1.52±0.61）分，运动VAS评分分别为（3.61±0.64）和（3.27±0.42）分，PD组静息/运动VAS评分均显著低于ID组（均P<0.05）。术毕即刻ID组和PD组C反应蛋白（CRP）分别为（6.80±1.03）和（6.13±0.75）mg·L-1；白细胞介素-1β（IL-1β）分别为（8.06±0.87）和（6.07±0.63）pg·mL-1；肿瘤坏死因子-α（TNF-α）分别为（99.24±12.03）和（81.10±9.25）ng·mL-1；白细胞介素-8（IL-8）分别为（8.03±0.73）和（6.19±0.68）pg·mL-1；白细胞介素-6（IL-6）分别为（39.68±7.25）和（32.35±6.86）pg·mL-1；术后1 d，ID组和PD组CRP分别为（6.07±1.07）和（5.37±0.81）mg·L-1；IL-1β分别为（6.71±0.66）和（5.24±0.65）pg·mL-1；TNF-α分别为（98.21±11.00）和（77.48±10.78）ng·mL-1；IL-8分别为（6.76±0.57）和（5.29±0.60）pg·mL-1；IL-6分别为（37.93±8.65）和（30.34±7.20）pg·mL-1；术后3 d，ID组和PD组CRP分别为（5.53±1.04）和（5.06±0.64）mg·L-1；IL-1β分别为（6.11±0.73）和（4.30±0.68）pg·mL-1；TNF-α分别为（83.97±13.78）和（51.32±9.69）ng·mL-1；IL-8分别为（6.26±0.67）和（4.33±0.52）pg·mL-1；IL-6分别为（31.35±7.06）和（28.24±5.23）pg·mL-1，PD组术毕即刻、术后1 d、术后3 d的CRP、IL-1β、TNF-α、IL-8、IL-6均显著低于ID组（均P<0.05）。ID组和PD组苏醒时间分别为（28.93±3.00）和（25.93±2.91）min；EA发生率分别为23.53%和7.84%；EA持续时间分别为（2.32±0.38）和（1.82±0.36）d。术毕即刻，ID组和PD组超氧化物歧化酶（SOD）分别为（136.47±16.96）和（154.81±15.38）U·mL-1；丙二醛（MDA）分别为（8.89±1.24）和（6.54±1.13）nmol·mL-1；CD4+分别为（29.28±2.94）%和（32.62±2.57）%；CD4+/CD8+分别为（1.34±0.39）%和（1.55±0.37）%；术后1 d，ID组和PD组SOD分别为（149.82±17.54）和（157.73±16.52）U·mL-1；MDA分别为（6.04±1.10）和（4.37±1.02）nmol·mL -1；CD4+分别为（24.75±1.71）%和（28.36±2.31）%；CD4+/CD8+分别为（1.24±0.31）%和（1.37±0.33）%。术后3 d，ID组和PD组SOD分别为（156.44±19.73）和（164.39±19.15）U·mL-1；MDA分别为（5.27±0.95）和（4.05±0.68）nmol·mL -1；CD4+分别为（27.35±1.78）%和（31.16±2.33）%；CD4+/CD8+分别为（1.22±0.35）%和（1.43±0.40）%，PD组术毕即刻、术后1 d、术后3 d的SOD、CD4+、CD4+/CD8+均显著高于ID组（均P<0.05），MDA显著低于ID组（P<0.05）。给药途径中，与PD相比，ID是老年患者THA全麻EA的危险因素（P<0.05）；给药剂量中，不同给药剂量不会增加老年患者THA全麻EA的风险（P>0.05）。
结论 右美托咪定注射液神经周围给药较静脉给药能更有效降低老年THA患者术后EA发生率，减轻炎症和氧化应激，改善镇痛与免疫功能，且更低剂量即可达到效果，推荐作为优选麻醉辅助方案。
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魏林志（1983-），男，副主任医师，主要从事麻醉学方面的临床工作和研究
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