目的：探讨不同剂量右美托咪定配伍罗哌卡因硬膜外麻醉在股骨干骨折患者中的临床应用效果。方法：选取东南大学附属中大医院溧水分院2015年2月至2018年2月行股骨干骨折切开复位内固定术的患者共计88例，年龄27~63岁，采用计算机随机软件，依据右美托咪定浓度不同将纳入患者随机分为4组：0.25 μg·kg^-1右美托咪定配伍0.75%罗哌卡因组（D_0.25组）、0.50 μg·kg^-1右美托咪定配伍0.75%罗哌卡因组（D_0.50组）、0.75 μg·kg^-1右美托咪定配伍0.75%罗哌卡因组（D_0.75组）、0.75%罗哌卡因组（R组），每组22例。记录4组患者感觉、运动阻滞起效时间、持续时间及术后24 h镇痛泵按压次数、术后恶心呕吐（PONV）和术后寒战发生率。分别使用Bromage分级和Ramsay镇静分级评价患者出室即刻运动阻滞情况及镇静程度。结果：在感觉阻滞方面，D_0.50组和D_0.75组患者感觉阻滞起效时间显著短于R组患者，差异具有统计学意义（P<0.05）。D_0.50组和D_0.75组患者感觉阻滞持续时间显著长于R组和D_0.25组患者，差异具有统计学意义（P<0.05）。在运动阻滞方面，4组患者运动阻滞起效时间和持续时间差异均无统计学意义（P>0.05）。D_0.50组和D_0.75组患者术后寒战发生率显著低于R组，差异具有统计学意义（P<0.05）。4组患者Bromage分级人数差异无统计学意义（P>0.05）。D_0.50组和D_0.75组患者术后镇痛泵按压次数显著少于R组和D_0.25组患者，差异有统计学意义（P<0.05）。结论：罗哌卡因配伍0.50 μg·kg^-1右美托咪定能够优化罗哌卡因在股骨干骨折切开复位内固定患者硬膜外麻醉中的镇痛效果，并且不影响患者运动功能，在提供满意镇静效果的同时还能减少术后镇痛药物使用、缓解患者术后寒战。

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