目的 评价右美托咪定（dexmedetomidine， Dex）对脊柱外科手术术中唤醒试验的影响。 方法 择期胸腰椎后路手术患者40例，按照随机数字表法随机分成两组：丙泊酚?蛳瑞芬太尼组（R组）和丙泊酚?蛳瑞芬太尼?蛳Dex组（D组）（每组20例）。两组患者均静脉注射咪达唑仑、芬太尼、丙泊酚、顺式阿曲库铵进行麻醉诱导，气管插管完成后，D组患者持续泵注Dex至手术结束，R组患者泵注相同剂量的生理盐水，其余麻醉方法及用药两组相同。术中分别记录从麻醉诱导至唤醒试验开始所需的时间、唤醒时间及唤醒质量，并统计唤醒试验开始前丙泊酚及瑞芬太尼用量和在麻醉后恢复室（post-anesthesia care unit， PACU）芬太尼的使用情况。术后第1天随访患者对术中事件、唤醒过程有无回忆。 结果 所有患者均成功实施唤醒试验，至唤醒试验开始时D组患者丙泊酚及瑞芬太尼用量较R组明显减少，两组患者唤醒时间差异无统计学意义（P>0.05）。D组（18例）患者唤醒质量良好，较R组（8例）唤醒质量明显提高，两组比较差异有统计学意义（P<0.05）。所有患者术后唤醒试验回忆发生率均为0，但D组患者在PACU应用芬太尼几率小于R组患者（P<0.05）。 结论 Dex作为麻醉辅助用药不影响唤醒时间，且能提高唤醒质量，可以安全用于唤醒试验。
Ｏｂｊｅｃｔｉｖｅ To evaluate the effects of dexmedetomidine（Dex） on intraoperative wake-up tests in patients undergoing spinal surgery. Methods Forty ASA Ⅰ or Ⅱ patients scheduled for spinal surgery were randomly divided into 2 groups （n=20） by random digits table， propofol-refentanyl group（group R） and Dex-propofol-refentanyl group （group D）. All patients were induced by injecting midazolam， fentanyl， propofol and cisatracurium intravenously. After intubation， Dex were pumped intravenously until the end of operation in group D. In group R， the same volume of saline was pumped instead of Dex. Anesthesia was maintained with propofol and remfentanil in the same target concentration in two groups. During the wake-up test，the patients were asked to keep moving their fingers until they could respond correctly. The following targets were recorded including the time from anesthetic induction to the beginning of the wake?蛳up test， the time of the wake?蛳up test， the quality of the wake?蛳up test， the dosage of propofol and remfentanil before the beginning of the wake?蛳up test， and the use rate of fentanyl in the post?蛳anesthesia care unit（PACU）. On the next day， patients were asked about whether they could remind the intraoperative events including pain and voice during the wake?蛳up test. Results All tests were completed successfully. In group D， the dosage of propofol and remfentanil obviously reduced before the beginning of the wake-up test（P<0.05）. There was no obvious difference in the wake-up time between two groups（P>0.05）. In group D， the cases of better wake-up quality were 18， but in group R， the number was 8. The patients in group D had a better wake-up quality than those in group R. There was an obvious difference in quality between two groups（P<0.05）. All patients couldn't remind the event happened during the operation. But in PACU， the rate of using fentanyl in group D is smaller than that in group R（P<0.05）. Conclusions As an anesthetic adjuvant， Dex can improve the quality of the wake-up test and there was no influence on the wake-up time， so it can be administered safely in those operations in which the wake-up test was made.
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