目的 探讨右旋美托咪定（dexmedetomidine， Dex）对脊柱侧弯矫形术患者术中唤醒的影响。 方法 40例择期全麻下行脊柱侧弯矫形手术患者，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级。采用完全随机分组法均分为Dex组 （D组） 和对照组 （C组）（每组20例）。D组麻醉诱导前10 min给予0.8 μg/kg Dex， C组给予同等剂量的生理盐水，分别在10 min内静脉泵入，随后行常规诱导插管。术中D组使用维持剂量Dex 0.2 μg·kg-1·h-1至术毕。唤醒试验开始时两组停用麻醉维持药物（D组Dex不停用），从停用所有麻醉药物（Dex除外）到患者活动脚趾的时间定为唤醒时间，唤醒后维持药物继续使用至术毕。记录唤醒试验开始时、唤醒时患者脑电双频指数（bispectralindex， BIS）值、心率（heart rate， HR）、平均动脉压（mean arterial pressure， MAP）指标，记录唤醒时间、唤醒质量评分及唤醒期间出血量。 结果 两组唤醒时间差异无统计学意义；唤醒试验开始时两组患者的MAP、HR比较差异无统计学意义；唤醒时D组患者MAP和HR分别为（79±6） mm Hg（1 mm Hg=0.133 kPa）和（80±9） 次/min，低于对照组MAP（88±6） mm Hg和HR（98±7） 次/min（P＜0.05）； D组患者的唤醒质量要明显高于C组（P＜0.01）；D组患者在唤醒期间的出血量为（269±34） ml，小于C组同时期出血量（328±50） ml（P＜0.05）。 结论 Dex能明显提高脊柱侧弯矫形手术术中唤醒质量，不延长唤醒时间；并且能维持唤醒期间血流动力学稳定，减少唤醒期间出血量。
Objective To investigated the effect of dexmedetomidine（Dex） on wake-up tests of patients undergoing scoliosis surgery. Methods Forty patients， aged 12 y-20 y， ASA I-II， undergoing elective scoliosis surgery were randomly divided into 2 groups： Dex group （group D， n=20）and control group （group C， n=20）. Group D received loading dose of Dex 0.8 μg/kg within 10 min before induction followed by 0.2 μg·kg-1·h-1 throughout the surgery. Group C received equal volume of normal saline intravenously. The maintenance drugs were withdrawed at the beginning of wake-up tests. Wake-up time was recorded. BIS values and hemodynamic index， such as HR， MAP， were recorded at the time points of withdrawal and awakening. At the same time， the wake-up time and wake-up quality score， the amount of bleeding during the wake-up tests were also recorded. Results There was no significant difference in wake-up time between two groups. MAP， HR of patients in group D decreased significantly than that in control group（P＜0.05） during wake-up. The wake-up quality of group D was better than that in control group（P＜0.01）. Conclusions Dex can increase the wake-up quality of scoliosis surgery significantly without prolonged wake-up time， meanwhile it keeps hemodynamic stable.
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