摘要目的:比较不同剂量右美托咪定复合舒芬太尼用于胸腰椎骨折手术的效果。方法:采用随机对照研究，选取河南省洛阳正骨医院（河南省骨科医院）2022年5月至2023年5月收治的行全身麻醉手术的胸腰椎骨折患者100例为研究对象，按照随机数字表法分为右美托咪定低剂量组（ n=50）和高剂量组（ n=50）。高剂量组输注右美托咪定注射液0.8 μg·kg -1·h -1+舒芬太尼0.02 μg·kg -1·h -1，低剂量组输注右美托咪定注射液0.5 μg·kg -1·h -1+舒芬太尼0.02 μg·kg -1·h -1。比较两组临床指标、氧化损伤、血小板活化指标、不良反应发生率。 结果:拔管时、拔管后20 min，高剂量组视觉模拟评分法评分分别为（4.12±0.05）分、（2.65±0.12）分，均低于低剂量组的（5.23±0.12）分、（4.23±0.52）分，Ramsay评分分别为（5.02±0.36）分、（5.65±0.12）分，均高于低剂量组的（4.01±0.23）分、（4.36±0.23）分（ t=-60.38、-20.94、16.72、35.16，均 P < 0.001）。术后24 h，高剂量组血清谷胱甘肽过氧化物酶、超氧化物歧化酶分别为（412.23±52.12）U/L、（98.65±10.23）U/L，均低于对照组的（452.36±50.23）U/L、（114.25±11.21）U/L（ t=-4.74、-7.27，均 P < 0.05）；高剂量组血栓素A2、血小板颗粒膜蛋白140水平分别为（362.23±20.32）ng/L、（20.12±2.56）μg/L，均低于对照组的（412.03±21.23）ng/L、（25.64±3.01）μg/L（ t=-11.98、-9.88，均 P < 0.05）。高剂量组不良反应发生率为12%（6/50），低于低剂量组的30%（15/50）（ χ2=4.88， P < 0.001）。 结论:高剂量右美托咪定麻醉可降低胸腰椎骨折手术患者的氧化损伤反应，抑制血小板活化，改善临床指标，减少不良反应的发生。

abstractsObjective:To compare the effects of different doses of dexmedetomidine combined with sufentanil on outcomes of thoracolumbar fracture surgery.Methods:A randomized controlled study was conducted involving 100 patients with thoracolumbar spine fractures who underwent general anesthesia at Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) from May 2022 to May 2023. The patients were randomly assigned to either a low-dose dexmedetomidine group ( n = 50) or a high-dose dexmedetomidine group ( n = 50) using a random number table method. The high-dose dexmedetomidine group received an infusion of dexmedetomidine at a rate of 0.8 μg·kg -1·h -1, along with sufentanil at 0.02 μg·kg -1·h -1. In contrast, the low-dose dexmedetomidine group received dexmedetomidine at a rate of 0.5 μg·kg -1·h -1, also combined with sufentanil at 0.02 μg·kg -1·h -1. Clinical indicators, oxidative damage, platelet activation markers, and the incidence of adverse reactions were compared between the two groups. Results:At extubation and 20 minutes post-extubation, the Visual Analogue Scale scores for the high-dose dexmedetomidine group were (4.12 ± 0.05) points and (2.65 ± 0.12) points, respectively, which were significantly lower than those in the low-dose dexmedetomidine group [(5.23 ± 0.12) points, (4.23 ± 0.52) points, t = -60.38, -20.94, both P < 0.001]. At extubation and 20 minutes post-extubation, the Ramsay sedation scores for the high-dose dexmedetomidine group were (5.02 ± 0.36) points and (5.65 ± 0.12) points, respectively, which were significantly higher than those in the low-dose dexmedetomidine group ( t = 16.72, 35.16, both P < 0.001). At 24 hours post-surgery, the serum levels of glutathione peroxidase and superoxide dismutase in the high-dose dexmedetomidine group were (412.23 ± 52.12) U/L and (98.65 ± 10.23) U/L, respectively, which were significantly lower than those in the control group [(452.36 ± 50.23) U/L, (114.25 ± 11.21) U/L, t = -4.74, -7.27, both P < 0.05]. The levels of thromboxane A2 and platelet alpha-granule membrane protein 140 in the high-dose dexmedetomidine group were (362.23 ± 20.32) ng/L and (20.12 ± 2.56) μg/L, respectively, both of which were significantly lower than those in the control group [(412.03 ± 21.23) ng/L, (25.64 ± 3.01) μg/L, t = -11.98, -9.88, both P < 0.05]. The incidence of adverse reactions in the high-dose dexmedetomidine group was 12% (6/50), which was significantly lower than that in the low-dose dexmedetomidine group [30% (15/50), χ2 = 4.88, P < 0.001]. Conclusions:Anesthesia with high-dose dexmedetomidine can reduce oxidative damage responses, inhibit platelet activation, improve clinical outcomes, and decrease the incidence of adverse reactions in patients undergoing surgery for thoracolumbar spine fractures.