右美托咪定通过影响神经免疫减少肝脏手术后谵妄的机制与临床应用

doi:10.3969/j.issn.1006-5725.2026.08.024

摘要/Abstract

摘要：

术后谵妄（postoperative delirium， POD）在肝脏手术患者中发生率较高，尤其在肝移植术后。术前肝功能不全、术中肝缺血再灌注损伤和术后睡眠剥夺等危险因素通过影响神经免疫促进肝脏手术POD的发生。右美托咪定可通过抗炎、抗氧化和抗凋亡作用直接阻断神经免疫环路，并通过加强大脑淋巴循环、改善睡眠、促进神经元增殖等途径改善神经系统免疫微环境，最终减少POD的发生。本文旨在系统综述右美托咪定通过减轻炎症反应、强化神经保护作用以调控神经免疫，进而降低肝脏手术POD发生率的机制及其临床应用。

关键词: 术后谵妄, 右美托咪定, 神经免疫, 肝脏手术, 缺血再灌注损伤

Abstract:

Postoperative delirium （POD） exhibits a relatively high incidence among patients undergoing liver surgery， especially after liver transplantation. Risk factors， including preoperative hepatic insufficiency， intraoperative hepatic ischemia-reperfusion injury， and postoperative sleep deprivation， contribute to the occurrence of POD in liver surgery by influencing neuroimmunity. Dexmedetomidine （DEX） can directly disrupt neuroimmune circuits via its anti-inflammatory， anti-oxidant， and anti-apoptotic effects. Moreover， it can also optimize the neuroimmune microenvironment by enhancing the glymphatic system， enhancing sleep quality， and facilitating neuronal proliferation， ultimately decreasing the incidence of POD. This article intends to systematically review the mechanisms and clinical application of DEX in reducing the incidence of POD after liver surgery by modulating neuroimmunity through mitigating inflammatory responses and reinforcing neuroprotection.

Key words: postoperative delirium, dexmedetomidine, neuroimmunity, hepatic surgery, ischemia-reperfusion

中图分类号:

R614

江逸豪,孙合亮,蔡永亮,杨建军,王忠云. 右美托咪定通过影响神经免疫减少肝脏手术后谵妄的机制与临床应用[J]. 实用医学杂志, 2026, 42(8): 1479-1484.

Yihao JIANG,Heliang SUN,Yongliang CAI,Jianjun YANG,Zhongyun WANG. Mechanisms and clinical application of dexmedetomidine in reducing postoperative delirium after liver surgery via neuroimmune modulation[J]. The Journal of Practical Medicine, 2026, 42(8): 1479-1484.

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