RESUMEN
Objective To explore the clinical effect of different doses of dexmedetomidine combined with remifentanil anesthesia in oral and maxillofacial surgery.Methods 135 patients with oral and maxillofacial surgery were randomly divided into three groups according to the random number table method,45 cases in each group.All patients received dexmedetomidine and remifentanil anesthesia,the dexmedetomidine doses of A,B and C group were 0.4,0.6,0.8μg· kg-1 · h-1.MAP,HR,SpO2 and Rasmay score in the three groups were observed before administration(T0),after administration of 5min (T1),10min (T2),20min (T3),30min (T4),and the analgesic effects of patients were observed.Results Comparison within the group,the MAP,HR at T0-T4 showed a significant downward trend in all groups,the differences were statistically significant (F =3.651,3.985,4.212,all P ＜ 0.05).The Ramsay score significantly increased at T0-T4,the differences were statistically significant (F =3.156,3.827,4.546,all P ＜ 0.05).The SpO2 in each group showed a downward trend,but there were statistically significant differences in C group(F =3.737,P ＜ 0.05).Comparison among groups,at T2-T4,the MAP[(66.3 ± 6.1) mmHg,(64.6 ± 6.5) mmHg,(63.8 ± 7.5) mmHg],HR [(61.9 ± 6.8) times/min,(59.1 ± 5.9) times/min,(57.6 ±5.6) times/min] and SpO2 [(96.6 ± 0.2) ％,(94.7 ± 0.4) ％,(96.8 ± 0.4) ％] were significantly lower in C group than in A group,B group(t =3.245,2.986,3.875,4.103,all P ＜ 0.05),the Ramsay scores [(3.1 ± 0.5) points,(4.2 ± 0.8) points,(4.6 ± 0.7) points] were significantly higher than those in A group,B group (t =1.465,2.011,1.664,1.034,all P ＞ 0.05).The analgesic effect of C group was significantly better than B group and A group (93.3 ％,82.3 ％) (x2 =3.998,4.234,all P ＜ 0.05).In C group,the incidence rates of hypoxemia,bradycardia (less than 55 times/min) were significantly higher than those of A group and B group (x2 =3.365,3.112,3.365,3.365,all P ＜ 0.05).Conclusion In oral and maxillofacial surgery anesthesia,dexmedetomidine combined with remifentanil has good anesthetic effect,with the increase of dexmedetomidine dose,sedative effect is better,but the incidence rate of adverse reaction is increased.