目的:探讨右美托咪定不同给药方式对老年腹股沟疝无张力修补术患者神经阻滞麻醉效果和安全性的影响。方法:将2017年6月至2019年6月在沈阳市第四人民医院行腹股沟疝无张力修补术且符合纳入标准的老年患者采用随机数字表法分为罗哌卡因+右美托咪定局部神经阻滞组（局麻组）和罗哌卡因局部神经阻滞+右美托咪定静脉泵入组（局麻+静脉泵入组）。局麻组：按照1 μg/kg的剂量将右美托咪定入0.9%氯化钠注射液至15 ml+0.375%罗哌卡因15 ml局部注射，同时静脉泵入0.9%氯化钠注射液至手术结束；局麻+静脉泵入组：按照1 μg/kg的剂量静脉泵入右美托咪定，10 min后将0.375%罗哌卡因30 ml局部注射，同时持续静脉泵入右美托咪定至手术结束。记录患者的一般情况（性别、年龄、体重、身高、美国麻醉医师协会手术危险性分级、手术时间），比较2组患者麻醉前（Tn 0）、麻醉完成时（Tn 1）、手术开始时（Tn 2）、麻醉后15 min（Tn 3）、麻醉后30 min（Tn 4）心率和平均动脉压（MAP）的变化，感觉神经阻滞起效和持续时间，术中镇痛效果及术后24 h患者镇痛满意度评分，术后0、3、6、9、12 h静息状态下疼痛视觉模拟量表（VAS）评分以及术后不良反应发生情况。n 结果:2组患者一般情况的差异均无统计学意义（均n P>0.05）。局麻+静脉泵入组患者Tn 2、Tn 3心率低于局麻组，差异均有统计学意义[（62.55±5.66）次/min比（76.70±6.47）次/min，（53.83±5.07）次/min比（74.98±5.40）次/min，均n P<0.001]；组内比较结果显示，局麻+静脉泵入组Tn 2、Tn 3心率低于Tn 0，差异均有统计学意义[（62.55±5.66）次/min比（72.50±7.14）min/次，（53.83±5.07）min次/比（72.50±7.14）次/min，均n P0.05）；局麻组神经阻滞起效时间短于局麻+静脉泵入组[（5.2±1.1）min比（12.5±0.7）min，n P=0.010]，麻醉维持时间长于局麻+静脉泵入组[（742.5±3.5）min比（631.0±1.4）min，n P=0.010]；局麻组术中镇痛效果为优、良、差者分别为38（95%）、2（5%）和0例（0）；局麻+静脉泵入组分别为30（75%）、8（20%）和2例（5%），2组镇痛效果的差异有统计学意义（n χ2＝6.541，n P=0.038）；局麻组患者术后24 h镇痛效果满意度评分高于局麻+静脉泵入组[（9.5±0.7）分比（7.0±1.4）分，n P=0.030]；局麻+静脉泵入组术后0、3、6、9、12 h VAS评分均高于局麻组，差异均有统计学意义（均n P0.05）；局麻+静脉泵入组术后9、12 h的VAS评分高于术后3 h，差异均有统计学意义（均n P0.05 for all). The heart rate of patients at Tn 2 and Tn 3 in the local anesthesia+intravenous pumping group were lower than those in the local anesthesia group [(62.55±5.66) beats/min n vs. (76.70±6.47) beats/min, (53.83±5.07) beats/min n vs. (74.98±5.40) beats/min, n P<0.001 for both]. Intra-group comparison showed that the heart rate of patients at Tn 2 and Tn 3 were lower than that at Tn 0 in the local anesthesia+intravenous pumping group [(62.55±5.66) beats/min n vs. (72.50±7.14) beats/min, (53.83±5.07) beats/min n vs. (72.50±7.14) beats/min, n P0.05 for all). The onset time of anesthesia in the local anesthesia group was shorter than that in the local anesthesia+ intravenous pumping group [(5.2±1.1) min n vs. (12.5±0.7) min, n P=0.010], while the maintenance time of anesthesia was longer [(742.5±3.5) min n vs. (631.0±1.4) min, n P=0.010]. There were 38(95%), 2(5%), and 0(0) patients having good, fine, and bad analgesic effect in the local anesthesia group, and 30(75%), 8(20%), and 2(5%) in the local anesthesia+intravenous pumping group, respectively. The difference of analgesic effect between the 2 groups was statistically significant (n χn 2=6.541, n P=0.038). The patients′ anesthesia satisfaction score at the 24th hour after operation in the local anesthesia group was higher than that in the local anesthesia+intravenous pumping group [(9.5±0.7) n vs. (7.0±1.4), n P=0.030]. The VAS scores at 0, 3rd, 6th, 9th, and 12th hour after operation in resting state in the local anesthesia+intravenous pumping group were higher than those in the local anesthesia group (n P0.05 for all), the VAS scores at 9th and 12th hour after operation in the local anesthesia+intravenous pumping group were higher than that at 3rd hour, the differences were statistically significant (n P<0.05 for both). The dif- ference of the incidence of adverse reactions after operation between the 2 groups was not statistically significant (n χ2=0.697, n P=0.410).n Conclusions:The analgesic effect of local injection of ropivacaine+dexmedetomidine is better than that of local nerve block of ropivacaine+intravenous pumping of dexmedetomidine. Thus the anesthesia program of local nerve block with ropivacaine+dexmedetomidine is recommended in the elderly patients undergoing untensioned repair of inguinal hernia.