目的 比较瑞马唑仑与右美托咪定对老年良性前列腺增生（benign prostatic hyperplasia，BPH）患者前列腺切除术后痛觉过敏及炎症-氧化应激反应的影响，为临床麻醉药物选择提供依据。 方法 选取2024年9月至2025年9月于南华大学附属第二医院就诊的210例老年BPH患者，均拟行前列腺电切术。采用随机数字表法将患者分为对照组（n = 105）与观察组（n = 105）。对照组泵注1.5 μg/（kg·h）右美托咪定，观察组静脉推注0.2 mg/kg瑞马唑仑，两组麻醉诱导后均调整为0.5 μg/（kg·h）持续泵注。评估术后24、48 h时恢复质量［15项恢复质量量表（15-item Quality of Recovery scale， QoR-15）］与术前、术后3 d时认知功能［蒙特利尔认知评估（Montreal Cognitive Assessment，MoCA）］；观察术前及术后24、48 h时机械痛觉阈值（mechanical pain threshold， MPT）与术后4、12、24、48 h时疼痛程度［疼痛数字评分（Numeric Rating Scale， NRS）］，并记录术后芬太尼总消耗量；测定麻醉之前（T₀）、手术结束的时刻（T₁）与麻醉结束的时刻（T₂）炎症指标［肿瘤坏死因子（tumor necrosis factor， TNF）-α、白细胞介素（interleukin，IL）-6、IL-17A，γ-干扰素（interferon， IFN）、IL-10、高迁移率族蛋白（high mobility group box 1， HMGB1）］、氧化应激指标［超氧化物歧化酶（superoxide dismutase， SOD）、谷胱甘肽过氧化物酶（glutathione peroxidase， GSH-Px）、过氧化氢酶（catalase，CAT）、丙二醛（malondialdehyde，MDA）］，并评价安全性。 结果 与对照组比较，观察组术后24、48 h时QoR-15评分与MPT值更高，术后3 d时MoCA评分更高；术后4、12、24、48 h时静息NRS评分更低，芬太尼消耗量更低。观察组T?、T?时血清TNF-α、IL-6、IL-17A、IFN-γ、HMGB1与MDA水平均低于对照组，IL-10与SOD、CAT、GSH-Px水平均高于对照组（P < 0.05）。安全性评价中观察组低血压与心动过缓发生率均低于对照组（P < 0.05）。 结论 在老年BPH患者行前列腺电切术时予以瑞马唑仑，相较于右美托咪定，能更有效提升其术后恢复质量，保护术后认知功能，减轻痛觉过敏及术后疼痛，减少阿片类药物消耗，并具有更优的抑制炎症反应与氧化应激的作用，同时血流动力学相关不良事件发生率更低，可作为该类手术更理想的麻醉选择。

Objective To compare the effects of remimazolam and dexmedetomidine on postoperative hyperalgesia and the inflammatory-oxidative stress response in elderly patients with benign prostatic hyperplasia （BPH） undergoing transurethral resection of the prostate， aiming to provide evidence for clinical anesthetic drug selection. Methods A total of 210 elderly patients with BPH who were scheduled for transurethral resection of the prostate at The Second Affiliated Hospital of University of South China from September 2024 to September 2025 were selected. By using a random number table， the patients were randomly divided into a control group （n = 105） and an observation group （n = 105）. The control group received an infusion of dexmedetomidine at a rate of 1.5 μg/（kg·h）， whereas the observation group was given an intravenous bolus of 0.2 mg/kg remimazolam. After anesthetic induction， both groups had their infusions adjusted to a continuous rate of 0.5 μg/（kg·h）. The quality of recovery at 24 h and 48 h post-operatively was assessed using the 15-item Quality of Recovery scale （QoR-15）， and cognitive function was evaluated preoperatively and on the third postoperative day using the Montreal Cognitive Assessment （MoCA）. The mechanical pain threshold （MPT） was measured preoperatively and at 24 h and 48 h postoperatively. Pain intensity was assessed using the Numeric Rating Scale （NRS） at 4， 12， 24， and 48 h postoperatively， and the total postoperative fentanyl consumption was recorded. Inflammatory markers including Tumor Necrosis Factor （TNF）-α， Interleukin （IL）-6， IL-17A， Interferon （IFN）-γ， IL-10， and High Mobility Group Box （HMGB） 1， as well as oxidative stress markers such as Superoxide Dismutase （SOD）， Glutathione Peroxidase （GSH-Px）， Catalase （CAT）， and Malondialdehyde （MDA） were measured before anesthesia （T?）， at the end of surgery （T?）， and at the end of anesthesia （T?）. The safety of the treatments was evaluated. Results Compared with the control group， the observation group exhibited significantly higher QoR-15 scores and MPT values at 24 h and 48 h post-operatively， as well as a higher MoCA score on the third postoperative day. Additionally， the observation group had significantly lower resting NRS scores at 4， 12， 24， and 48 h post-operatively， along with lower total fentanyl consumption. At T? and T?， the observation group showed significantly lower serum levels of TNF-α， IL-6， IL-17A， IFN-γ， HMGB1， and MDA， while the levels of IL-10， SOD， CAT， and GSH-Px were significantly higher （P < 0.05）. In terms of safety evaluation， the incidence of hypotension and bradycardia was significantly lower in the observation group （P < 0.05）. Conclusions For elderly patients with BPH who are undergoing transurethral resection of the prostate， remimazolam， when compared to dexmedetomidine， more effectively enhances the quality of postoperative recovery， safeguards postoperative cognitive function， relieves hyperalgesia and postoperative pain， decreases opioid consumption， exhibits superior suppression of the inflammatory response and oxidative stress， and is linked to a lower incidence of hemodynamic adverse events. Therefore， it can be regarded as a more ideal anesthetic option for this type of surgery.