目的:探讨右美托咪定联合咪达唑仑对中重度烧伤老年患者切痂植皮术麻醉效果的影响。方法:选择2017年6月至2019年5月太钢总医院烧伤中心救治的行切痂植皮术的中重度烧伤老年患者200例为研究对象。采用随机数字表法将其分为研究组（右美托咪定联合咪达唑仑维持麻醉）和对照组（丙泊酚维持麻醉），每组100例。记录入室（Tn 0）、诱导后（Tn 1）、气管插管即刻（Tn 2）、切痂（Tn 3）、术毕（Tn 4）、术后30 min（Tn 5）时间点的心率（HR）、平均动脉压（MAP）、脉氧饱和度（SpOn 2）、脑电双频指数（BIS），记录苏醒时间、不良反应发生率，在Tn 0、Tn 3、Tn 5采集外周静脉血，检测肾上腺素、去甲肾上腺素、皮质醇水平。n 结果:研究组患者的HR在Tn 1［（90.95±8.55）次/min］，Tn 5［（92.55±8.75）次/min］较Tn 0［（105.23±9.60）次/min］降低且低于对照组Tn 1［（97.65±10.25）次/min］、Tn 5［（95.05±9.25）次/min］；研究组患者的MAP在Tn 1［（110.65±7.55）mmHg］、Tn 5［（99.05±7.78）mmHg］均高于对照组Tn 1［（98.56±8.55）mmHg］、Tn 5［（92.78±8.17）mmHg］，差异均有统计学意义（n t=10.600、5.560，均n P<0.05），研究组和对照组术后躁动率分别为0（0/100），8%（8/100），差异有统计学意义（χn 2=6.380，n P<0.05），苏醒时间分别为：研究组［（2.52±1.53）分］，对照组［（9.52±1.05）分］，差异有统计学意义（n t=-37.78，n P<0.05），但研究组患者有术后嗜睡情况出现，尚不造成致命性缺氧等风险。Tn 5时间点研究组患者肾上腺素［（94.62±2.17）ng/L］、去甲肾上腺素［（188.75±39.74）mmol/L］、皮质醇［（541.87±73.96）ng/L］的水平均明显低于对照组患者肾上腺素［（113.73±7.96）ng/L］、去甲肾上腺素［（294.25±42.26）mmol/L］、皮质醇［（668.43±95.61）ng/L］，差异均有统计学意义（n t=-23.164、-18.185、-10.471，均n P<0.05）。n 结论:右美托咪定联合咪达唑仑维持麻醉可以显著提高中重度烧伤老年患者切痂植皮术的麻醉效果，减轻应激反应，减少术后不良反应，缩短苏醒时间，具有较好的安全性和有效性。“,”Objective:To investigate the anesthetic effect of dexmedetomidine combined with midazolam for escharectomy and skin grafting in older adult patients with moderate and severe burns.Methods:A total of 200 older adult patients with moderate to severe burns who underwent escharectomy and skin grafting from June 2017 to May 2019 were included in this study. They were randomly assigned to undergo anesthesia with either dexmedetomidine combined with midazolam (study group, n n = 100) or propofol (control group, n n = 100). The heart rate, mean arterial pressure, pulse oxygen saturation (SpOn 2) and bispectral index were recorded at different time points of anesthesia: immediately after entry into the operating room (Tn 0), immediately after tracheal induction (Tn 1), immediately after intubation (Tn 2), at the time of escharectomy (Tn 3), at the end of surgery (Tn 4), and 30 minutes after surgery (Tn 5). The recovery time and the incidence of adverse reactions were recorded. At Tn 0, Tn 3 and Tn 5, peripheral blood was collected to determine the levels of epinephrine, norepinephrine and cortisol.n Results:Heart rate at Tn 1 and Tn 5 in the study group was lower than that in the control group [Tn 1: (90.95 ± 8.55) times/min n vs. (97.65 ± 10.25) times/min; Tn 5: (92.55 ± 8.75) times/min n vs. (95.05 ± 9.25) times/min], respectively]. Mean arterial pressure at Tn 1 and Tn 5 was significantly higher than that in the control group [Tn 1: (110.65 ± 7.55) mmHg n vs. (98.56 ± 8.55) mmHg; Tn 5: (99.05 ± 7.78) mmHg n vs. (92.78 ± 8.17) mmHg, n t = 10.600, 5.560, both n P < 0.05]. The postoperative agitation rate in the study and control groups was 0 (0/100), 8% (8/100), respectively, and the difference between the two groups was statistically significant (χ n 2 = 6.380, n P < 0.05). The recovery time in the study and control groups was (2.52 ± 1.53) min and (9.52 ± 1.05) min, respectively, and the difference between the two groups was statistically significant ( n t = 37.78, n P < 0.05). The patients in the study group had postoperative drowsiness, which did not cause the risk of fatal hypoxia. At T n 5, epinephrine, norepinephrine and cortisol levels in the study group were significantly lower than those in the control group [epinephrine: (94.62 ± 2.17) ng/L n vs. (113.73 ± 7.96) ng/L; norepinephrine: (188.75 ± 39.74) mmol/L n vs. (294.25 ± 42.26) mmol/L; cortisol: (541.87 ± 73.96) ng/L n vs. (668.43 ± 95.61) ng/L, n t = - 23.164, -18.185, -10.471, all n P < 0.05].n Conclusion:Dexmedetomidine combined with midazolam exhibits great anesthetic effect for escharectomy and skin grafting in older adult patients with moderate and severe burns. It alleviates stress reaction, reduces postoperative adverse reactions, shortens the recovery time, and has good safety and effectiveness..