南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (6): 1228-1234.doi: 10.12122/j.issn.1673-4254.2026.06.03

• • 上一篇    

术中应用右美托咪定对老年患者术后睡眠障碍的影响：一项前瞻性多中心队列研究

孟冰冰1,2(), 刘畅2,5(), 廖国松1,2(), 张凯1,2, 杨木泽1, 顾娟娟2, 娄景盛1,2, 刘艳红1,2, 傅强1,2, 曹江北1,2, 米卫东1,2,3,4(), 李皓1,2,3,4()   

  1. 1.解放军总医院，解放军医学院，北京 100853
    2.解放军总医院，第一医学中心麻醉科，北京 100853
    3.解放军总医院，国家老年疾病临床医学研究中心，北京 100853
    4.解放军总医院，围手术期多模态数智融合诊疗北京市重点实验室，北京 100853
    5.南开大学医学院，天津 300071
  • 收稿日期:2025-10-25 出版日期:2026-06-20 发布日期:2026-06-24
  • 通讯作者: 米卫东,李皓 E-mail:bingbing0121315@163.com;liuchang0121eason@163.com;lgs23@foxmail.com;wwdd1962@aliyun.com;lihao301@126.com
  • 作者简介:孟冰冰，在读硕士研究生，E-mail: bingbing0121315@163.com
    刘 畅，在读博士研究生，E-mail: liuchang0121eason@163.com
    廖国松，在读硕士研究生，E-mail: lgs23@foxmail.com
    第一联系人：同等贡献作者
  • 基金资助:
    国家重点研发计划(2018YFC2001900)

Effect of intraoperative dexmedetomidine on postoperative sleep disturbance in elderly surgical patients: a prospective multicenter cohort study

Bingbing MENG1,2(), Chang LIU2,5(), Guosong LIAO1,2(), Kai ZHANG1,2, Muze YANG1, Juanjuan GU2, Jingsheng LOU1,2, Yanhong LIU1,2, Qiang FU1,2, Jiangbei CAO1,2, Weidong MI1,2,3,4(), Hao LI1,2,3,4()   

  1. 1.PLA Medical School, Chinese PLA General Hospital, Beijing 100853, China
    2.Department of Anesthesiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    3.National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
    4.Beijing Key Laboratory of Perioperative Multimodal Digital Intelligence-Integrated Diagnosis and Treatment, Chinese PLA General Hospital, Beijing 100853, China
    5.School of Medicine, Nankai University, Tianjin 300071, China
  • Received:2025-10-25 Online:2026-06-20 Published:2026-06-24
  • Contact: Weidong MI, Hao LI E-mail:bingbing0121315@163.com;liuchang0121eason@163.com;lgs23@foxmail.com;wwdd1962@aliyun.com;lihao301@126.com

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摘要：

目的 探讨术中应用右美托咪定与非心脏手术后老年患者术后睡眠障碍的关系。 方法 本研究为前瞻性队列研究，纳入2020年4月~2022年4月在多个中心接受非心脏手术且年龄≥65岁的老年患者。主要结局指标为术后3 d内睡眠障碍的发生率，采用睡眠质量数字评定量表进行评估；次要结局指标包括手术当晚及随后两晚的睡眠障碍发生率，以及术后重度疼痛、术后谵妄、急性肾损伤、脑卒中与肺部感染的发生率。通过单多因素logistic回归分析探讨右美托咪定与术后睡眠障碍的关联。采用倾向评分匹配法平衡基线特征，并进行亚组分析以探讨右美托咪定与术后睡眠障碍之间的关系。 结果 共纳入5245例患者，其中1352例（25.78%）在术后3 d发生术后睡眠障碍。右美托咪定组术后睡眠障碍发生率低于非右美托咪定组（未校正：21.0% vs 27.9%，P<0.001；倾向评分匹配：20.7% vs 25.4%，P<0.001）。右美托咪定与术后睡眠障碍风险降低相关（未校正模型：OR=0.69，95% CI：0.60~0.79，P<0.001；模型Ⅰ：OR=0.76，95% CI：0.66~0.87，P<0.001；模型Ⅱ：OR=0.75，95% CI：0.65~0.87，P<0.001；倾向评分匹配：OR=0.77，95% CI：0.65~0.91，P<0.001）。在性别、美国麻醉医师协会分级、手术时长及手术类型这些亚组中，右美托咪定与术后睡眠障碍之间的关联依然存在。此外，右美托咪定组患者术后重度疼痛、术后谵妄及肺部感染的发生率更低（P<0.05）。 结论 术中使用右美托咪定与非心脏手术后老年患者术后睡眠障碍发生率降低相关，且右美托咪定组患者术后重度疼痛、术后谵妄及肺部感染的发生率均低于非右美托咪定组。

关键词: 右美托咪定, 术后睡眠障碍, 老年患者, 非心脏手术

Abstract:

Objective To investigate the association between intraoperative dexmedetomidine administration and postoperative sleep disturbance in elderly patients undergoing noncardiac surgeries. Methods This prospective observational study included patients aged ≥65 years undergoing noncardiac surgeries between April, 2020 and April, 2022 in multiple hospitals. The primary outcome was the incidence of postoperative sleep disturbance within 3 days after surgery, assessed using the Sleep Quality-Numeric Rating Scale. The secondary outcomes included the incidences of sleep disturbance on the night of surgery and two subsequent nights, postoperative severe pain, postoperative delirium, acute kidney injury, stroke and pulmonary infection. Univariate and multivariate logistic regression analyses were conducted to explore the relationship between dexmedetomidine and postoperative sleep disturbance. Propensity score matching was used to balance the baseline characteristics, and subgroup analyses were performed to explore the association between dexmedetomidine and postoperative sleep disturbance. Results Among the 5245 patients, 1352 (25.78%) developed postoperative sleep disturbance within 3 days after surgery. The incidence of postoperative sleep disturbance was significantly lower in dexmedetomidine group than in the non-dexmedetomidine group (unadjusted: 21.0% vs 27.9%, P<0.001; PSM: 20.7% vs 25.4%, P<0.001). Dexmedetomidine was significantly associated with a reduced risk of postoperative sleep disturbance (unadjusted: OR=0.69, 95% CI: 0.60-0.79, P<0.001; Model I: OR=0.76, 95% CI: 0.66-0.87, P<0.001; Model II: OR=0.75, 95% CI: 0.65-0.87, P<0.001; PSM: OR=0.77, 95% CI: 0.65-0.91, P<0.001), and the association remained significant in subgroup analyses for gender, ASA classification, surgery duration, and surgical types). The incidences of severe postoperative pain, postoperative delirium and pulmonary infection were all significantly lower in dexmedetomidine group. Conclusion Intraoperative dexmedetomidine administration is associated with reduced postoperative sleep disturbance in elderly patients undergoing noncardiac surgery and lowers the incidences of severe postoperative pain, postoperative delirium and pulmonary infections.

Key words: dexmedetomidine, postoperative sleep disturbance, elderly patients, noncardiac surgery