目的 探讨不同剂量右美托咪定复合舒芬太尼用于口腔癌患者围手术期镇痛的疗效及对睡眠质量的影响。 方法 前瞻性选取2023年1月至2024年6月医院收治的口腔癌手术患者158例，采用随机数字表法分为A组［n = 53，0.6 μg/（kg·h）右美托咪定 + 2 μg/kg舒芬太尼］、B组［n = 53，0.4 μg/（kg·h）右美托咪定 + 2 μg/kg舒芬太尼］、C组［n = 52，0.2 μg/（kg·h）右美托咪定 + 2 μg/kg舒芬太尼］。比较3组应激反应指标［脑源性神经营养因子（BDNF）、皮质醇（Cor）、白细胞介素-6（IL-6）］、围术期镇静镇痛指标［脑电双频指数（BIS）、镇痛/伤害刺激指数（ANI）］、疼痛水平、T淋巴细胞亚群CD3⁺、CD4⁺、CD8⁺水平、理查兹-坎贝尔睡眠量表（RCSQ）评分及不良反应。 结果 与术前12 h比较，术后48 h 3组血清BDNF、Cor、IL-6水平均降低，A组低于B组、C组，B组低于C组（P < 0.05）；与麻醉前（T₀）时相比，3组插管时、插管后1、5 min（T₁ ~ T₃）时间BIS差异均有统计学意义（P < 0.05），T₁ ~ T₃时BIS均低于T₀时（P < 0.05），3组组间相同时间点BIS比较差异无统计学意义（P > 0.05），T₁ ~ T₃时ANI高于T₀时，A组ANI高于B组、C组（P < 0.05）；与术前比较，术后1、6、24、48 h 3组疼痛评分均降低，A组低于B组、C组，B组低于C组（P < 0.05）；与术前相比，术后3组CD3⁺、CD4⁺均降低，A组低于B组、C组，B组低于C组（P < 0.05），3组CD8⁺均升高，A组高于B组、C组，B组高于C组（P < 0.05）；与术前1 d相比，术后当晚、术后第2晚 3组睡眠质量评分均降低，A组低于B组、C组，B组低于C组（P < 0.05）。A组低血压、窦性心动过缓发生率高于B组、C组（P < 0.05），B组、C组低血压、窦性心动过缓发生率差异无统计学意义（P > 0.05），3组恶心呕吐、头晕发生率差异无统计学意义（P > 0.05）。 结论 0.6 μg/（kg·h）右美托咪定复合舒芬太尼用于口腔癌手术患者可减轻机体应激反应和免疫抑制，改善睡眠质量，但术中低血压和窦性心动过缓发生率较高。

Objective To investigate the effect of high， middle and low dose dexmedetomidine combined with sufentanil on perioperative analgesia and sleep quality in patients with oral cancer. Methods A total of 158 patients undergoing oral cancer surgery in the hospital from January 2023 to June 2024 were selected and divided into group A［n = 53，0.6 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］and group B［n = 53，0.4 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］ ， Group C ［n = 52， 0.2 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］by random number table method. Stress response indexes ［brain-derived neurotrophic factor （BDNF）， cortisol （Cor）， interleukin-6 （IL-6）］， bifrequency index and analgcsia nociccption index（BIS， ANI）， pain level， T lymphocyte subsets CD3⁺， CD4⁺， CD8⁺ levels， Richards Campbell Sleep Scale （RCSQ） score and adverse reactions were compared between the two groups. Results Compared with 12 h before surgery， serum levels of BDNF， Cor and IL-6 in 3 groups were decreased 48 h after surgery， group A was lower than group B， group C， group B was lower than group C（P < 0.05）. Compared with T₀， BIS at T₁ ~ T₃ were significantly different between the 3 groups （P < 0.05）， BIS at T₁ ~ T₃ were lower than those at T₀ （P < 0.05）， and there was no significant difference in BIS at the same time between the 3 groups （P>0.05）， from T₁ to T₃， ANI was higher than that at T₀， and ANI in group A was higher than that in group B and group C （P < 0.05）. Compared with the preoperative results， the pain scores of the 3 groups were decreased at 1 h， 6 h， 24 h and 48 h after operation， and the pain scores of group A were lower than those of group B and C， and the pain scores of group B were lower than those of group C （P < 0.05）. After operation， CD3⁺ and CD4⁺ were decreased in all 3 groups， group A was lower than group B and group C， group B was lower than group C （P < 0.05）， and CD8⁺ was increased in all 3 groups， group A was higher than group B and group C， group B was higher than group C （P < 0.05）. Compared with 1 day before the operation， the sleep quality scores of the three groups on the night after the operation and the second night after the operation were all decreased， group A was lower than group B and group C， and group B was lower than group C（P < 0.05）. The incidence of hypotension and sinus bradycardia in group A was higher than that in group B and group C （P < 0.05）. There was no significant difference in the incidence of hypotension and sinus bradycardia between group B and group C （P > 0.05）. There was no significant difference in the incidence of nausea， vomiting and dizziness among the three groups （P > 0.05）. Conclusion The analgesic effect of 0.6 μg/（kg·h） dose dexmedetomidine combined with sufentanil can effectively reduce the body's stress response and immune suppression， improve sleep quality， but with a greater incidence of intraoperative hypotension and bradycardia.