目的 探究右美托咪啶联合瑞芬太尼用于术中唤醒期的麻醉策略。方法 选取2013年1月-2016年12月新疆自治区人民医院收治的45例行功能神经外科手术且术中需要唤醒的患者，随机分为3组：A组（n=15）使用右美托咪定联合瑞芬太尼，B组（n=15）使用丙泊酚联合瑞芬太尼，C组（n=15）使用生理盐水联合瑞芬太尼。检测各组受试者的苏醒时间、唤醒时间、自主呼吸恢复时间、不同时间点（T0-T6）的心率和平均动脉压以及术中不良反应等基本参数，对比分析右美托咪定联合瑞芬太尼用于术中唤醒期的麻醉管理策略。结果 A组患者的苏醒时间、唤醒时间以及自主呼吸恢复时间显著短于B组和C组（P<0.05）；T3时刻A组患者的平均动脉压显著高于B组和C组患者，心率显著低于B组和C组患者（P<0.05）；T5和T6时刻A组患者的收缩压低于B组和C组（P<0.05）；A组患者对指令反应的准确性以及对唤醒的满意度均显著高于其他两组（P<0.05）。A组患者术后不良反应（呛咳、躁动）例数较B组和C组患者少，术中知晓例数显著高于B组和C组（P<0.05）。结论 通过靶控输注的方式，结合Narcotrend检测仪，应用右美托咪定联合瑞芬太尼用于术中唤醒期的麻醉管理策略，临床效果最佳。

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.