目的 比较瑞马唑仑和右美托咪定辅助镇静用于超声引导臂丛神经阻滞下行断指再植手术的麻醉效果。 方法 选择手外科行断指再植手术的60例患者，随机分为瑞马唑仑组（R组）和右美托咪定组（D组），每组30例。两组均在超声引导下经肌间沟入路行单次臂丛神经阻滞，R组静脉注射瑞马唑仑0.1 mg/kg，继以1 mg/（kg·h）泵注维持至手术结束前10 min；D组静脉注射0.5 μg/kg右美托咪定，然后以0.5 μg/（kg·h）的速度持续输注至手术结束前10 min。比较两组患者入室时（T₀）、创面清洗消毒时（T₁）、上止血带时（T₂）、手术开始时（T₃）、松止血带时（T₄）、手术结束时（T₅）的MAP、HR、SpO₂值；比较不同时刻两组患者改良警觉镇静/评分（MOAA/S评分）和脑电双频指数值（BIS）；比较两组患者用药开始至意识消失时间（LOC）和停药后的意识恢复时间（ROC）；比较两组患者第一次上止血带前和最后一次松止血带后15 min血乳酸值（Lac）；记录两组患者术中不良反应的发生情况。 结果 R组患者术中各时刻MAP波动较小，D组患者MAP在T₁、T₂、T₃时刻与T₀时刻和与R组同时刻比较明显升高（P < 0.05）；R组患者术中各时刻HR平稳，D组患者HR在T₁、T₂时刻与T₀时刻和与R组同时刻比较明显减慢（P < 0.05）。两组患者在术中均能达到理想镇静状态（MOAA/S评分 ≤ 3分），R组患者在停药后10 min的T₅时刻MOAA/S评分高于同组其他时刻和D组（P < 0.05）；R组患者术中各时刻BIS值均高于同时刻D组患者（P < 0.05）。R组患者LOC时间和ROC时间均短于D组患者（P < 0.05）。D组患者术中发生高血压、心动过缓的发生率明显高于R组患者，R组呼吸抑制的发生率高于D组（P < 0.05）。两组患者Lac比较无明显变化（P > 0.05）。 结论 瑞马唑仑与右美托咪定两种药物均能满足超声引导下臂丛神经阻滞断指再植手术的镇静需求，与右美托咪定比较，瑞马唑仑镇静可控性更好，血流动力学稳定，循环系统不良事件发生率低。

Objective To compare the anesthetic effects of remazolam and dexmedetomidine assisted sedation in the operation of finger replantation under ultrasound guided brachial plexus block. Methods 60 patients undergoing severed finger replantation were randomly divided into remazolam group （group R） and a dexmedetomidine group （group D） by random number table method， with 30 cases in each group. Both groups received a single brachial plexus block under ultrasound guidance. Group R was injected with remazolam 0.1 mg/kg， followed by 1 mg/（kg·h） pump until 10 min before the end of the operation. In group D， a load dose of 0.5 μg/kg of dexmedetomidine was injected， followed by continuous infusion at a rate of 0.5 μg/（kg·h） until 10 min before the end of surgery. The MAP， HR and SpO₂ values of the two groups were compared when the patients entered the room （T₀）， the wound was cleaned and disinfected （T₁）； the tourniquet was upper （T₂）； the operation began （T₃）； the tourniquet was relaxed （T₄）； and the operation ended （T₅）. MOAA/S scores and BIS values were compared between the two groups at different time. The time from the beginning of medication to the absence of consciousness and the time of consciousness recovery after drug withdrawal were compared between the two groups. Blood lactic acid （Lac） before applying tourniquet and 15 min after relaxing tourniquet were compared between the two groups. The occurrence of intraoperative adverse reactions was recorded in the two groups. Results The MAP of patients in group R had little fluctuation at each time during the operation， and the MAP of patients in group D was significantly increased at T₁， T₂， T₃ and T₀ moments and at the same time as that in group R （P < 0.05）； HR in group R was stable at all times， and HR in group D significantly slowed down at T₁， T₂ and at the same time with group R （P < 0.05）. Patients in both groups achieved ideal sedation during the operation （MOAA/S score ≤ 3 points）， and the MOAA/S score of patients in group R at T₅ minutes after drug withdrawal was higher than that at other moments of the same group and group D （P < 0.05）； the BIS value of group R was higher than that of group D （P < 0.05）. The loss time and recovery time of consciousness in group R were shorter than those in group D （P < 0.05）. The incidence of intraoperative hypertension and bradycardia in group D was significantly higher than that in group R， and the incidence of respiratory depression in group R was higher than that in group D （P < 0.05）. There was no significant change in lactate value between the two groups （P > 0.05）. Conclusion Remazolam and dexmedetomidine can satisfy sedation in brachial plexus nerve block for replantation of severed finger under ultrasound guidanc. Compared with dexmedetomidine， remazolam has better sedation control， stable hemodynamics， low incidence of circulatory adverse events.