目的 探究右美托咪啶聯(lián)合瑞芬太尼用于術(shù)中喚醒期的麻醉策略。方法 選取2013年1月-2016年12月新疆自治區(qū)人民醫(yī)院收治的45例行功能神經(jīng)外科手術(shù)且術(shù)中需要喚醒的患者，隨機(jī)分為3組：A組（n=15）使用右美托咪定聯(lián)合瑞芬太尼，B組（n=15）使用丙泊酚聯(lián)合瑞芬太尼，C組（n=15）使用生理鹽水聯(lián)合瑞芬太尼。檢測(cè)各組受試者的蘇醒時(shí)間、喚醒時(shí)間、自主呼吸恢復(fù)時(shí)間、不同時(shí)間點(diǎn)（T0-T6）的心率和平均動(dòng)脈壓以及術(shù)中不良反應(yīng)等基本參數(shù)，對(duì)比分析右美托咪定聯(lián)合瑞芬太尼用于術(shù)中喚醒期的麻醉管理策略。結(jié)果 A組患者的蘇醒時(shí)間、喚醒時(shí)間以及自主呼吸恢復(fù)時(shí)間顯著短于B組和C組（P<0.05）；T3時(shí)刻A組患者的平均動(dòng)脈壓顯著高于B組和C組患者，心率顯著低于B組和C組患者（P<0.05）；T5和T6時(shí)刻A組患者的收縮壓低于B組和C組（P<0.05）；A組患者對(duì)指令反應(yīng)的準(zhǔn)確性以及對(duì)喚醒的滿意度均顯著高于其他兩組（P<0.05）。A組患者術(shù)后不良反應(yīng)（嗆咳、躁動(dòng)）例數(shù)較B組和C組患者少，術(shù)中知曉例數(shù)顯著高于B組和C組（P<0.05）。結(jié)論 通過靶控輸注的方式，結(jié)合Narcotrend檢測(cè)儀，應(yīng)用右美托咪定聯(lián)合瑞芬太尼用于術(shù)中喚醒期的麻醉管理策略，臨床效果最佳。

Objective To explore the anesthetic management strategy of dexmedetomidine combined with remifentanil for intraoperative wake-up period.Methods A total of 45 subjects who underwent functional neurosurgery and needed need to wake up during the operation in Xinjiang Autonomous Region People's Hospital from January 2013 to December 2016 were selected and divided into three groups. Patients of group A (n=15) were treated with dexmedetomidine combined with remifentanil; Patients of group B (n=15) were treated with propofol combined with remifentanil; patients group C (n=15) were treated with normal saline combined with remifentanil. The parameters of recovery time, wake-up time, spontaneous breathing recovery time, heart rate and mean arterial pressure at different time points (T0-T6), and adverse reactions during operation was measured. Through comparative analysis, the anesthetic management strategy of dexmedetomidine combined with remifentanil for intraoperative wake-up period was analyzed.Results The recovery time, wake-up time, spontaneous breathing recovery time in group A were significantly shorter than those of the groups B and C (P< 0.05). In addition, at T3, the level of mean arterial pressure in group A were significantly higher than that of the groups B and C, while the level of heart rate in group A was the lowest (P< 0.05). The systolic blood pressure of group A was lower at T5 and T6 than groups B and C (P< 0.05). The accuracy of the instructions and arousal satisfaction of group A were significantly higher than the other two groups (P< 0.05). The number of adverse events (cough and restlessness) in group A was lower than that in the groups B and C, while the number of intraoperative awareness in group A was the most (P< 0.05).Conclusion By the way of target controlled infusion, combined with Narcotrend detector, the application of dexmedetomidine combined with remifentanil for anesthesia management during the waking period was the best.