Objective To observe the effect of dexmedetomidine (DEX) on myocardial injury marker and postoperative recognition during cardiac surgery. Methods Fifty patients diagnosed with rheumatic heart disease were randomly divided into experiment group and control group. The experiment group was treated by DEX, and the control group was treated by normal saline. The removal time, intensive care unit (ICU) retention time, resuscitation after opening aortic, vital signs, changes of myocardial injury markers, and incidence of postoperative recognition were compared. Results There was no significant difference in the removal time, ICU retention time, and resuscitation after opening aortic between the two groups (P>0.05). The levels of systolic blood pressure (SBP) in the experiment group [(97.26±11.18), (106.93±11.75), and (104.35±11.09) mmHg (1 mmHg=0.133 kPa)] were higher than in the control group [(83.17±10.69), (95.16±13.33), and (97.03±7.08) mmHg] from period of cardiopulmonary bypass to the end of surgery (P<0.05); The levels of diastolic blood pressure (DBP) in the experiment group [(70.06±11.43), (60.44±9.47), (61.40±8.66), and (63.63±7.61) mmHg] after injection of loading dose, longitudinal sternotomy, the period from cardiopulmonary bypass to the end of surgery were higher than in the control group [(57.22±12.43), (56.45±9.06), (55.23±6.59), and (56.62±6.88) mmHg, P<0.05]; The levels of heart rate (HR) in the experiment group [(66.37±9.59), and (68.62±10.08)/min] after the incision, and longitudinal sternotomy were lower than in the control group [(75.52±12.08), and (81.64±8.79)/min, P<0.05]. The levels of 24-h human heart fatty acid binding protein (H-FABP) in the experiment group [(0.49±0.09), (1.74±0.13), (1.97±0.11), and (1.41±0.13) μg/ml] were lower than those in the control group [(0.58±0.14), (1.97±0.26), (2.35±0.41), and (1.57±0.21) μg/ml] after completion of cardiopulmonary bypass to the end of surgery (P<0.05); The levels of 24-h Creatine kinase isoenzyme MB(CK-MB) in the experiment group [(89.69±15.88) U/ml] were lower than in the control group [(116.85±18.27) U/ml, P<0.05]; The levels of 24-h cardiac Troponin Ⅰ (cTnⅠ) in the experiment group [(1.43±0.18), and (1.20±0.21) ng/ml] were lower than in the control group [(1.79±0.21), and (1.47±0.14) ng/ml, P<0.05]; The scores of mini-mental state examination (MMSE) and Montreal cognitive assessment scale (MoCA) in the experiment group [(28.23±1.52)/min, and (24.25±1.35)/min] were higher than those in the control group [(26.22±1.43)/min, and (22.03±1.51)/min, P<0.05]. Conclusion It can be concluded that DEX may reduce the myocardial injury and improve the condition of postoperative recognition. It could better maintain the hemodynamic stability during cardiac surgery. Key words: Cardiac surgery; Dexmedetomidine; Myocardial injury marker; Cognitive function