2026 年第 10 期 第 21 卷

艾司氯胺酮联合腹横肌平面阻滞对老年腹腔镜结直肠癌手术患者应激反应和认知功能的影响

Effects of esketamine combined with transversus abdominis plane block on stress response and cognitive function in elderly patients undergoing laparoscopic colorectal cancer surgery

作者：刘晓娟白香花胡向东

英文作者：Liu Xiaojuan Bai Xianghua Hu Xiangdong

单位：内蒙古自治区人民医院手术麻醉科,呼和浩特010017

英文单位：Department of Operation and Anaesthesia Inner Mongolia People′s Hospital Hohhot 010017 China

关键词：腹腔镜结直肠癌手术；艾司氯胺酮；腹横肌平面阻滞；应激反应；认知功能

英文关键词：Laparoscopiccolorectalcancersurgery;Esketamine;Transversusabdominisplaneblock; Stressresponse;Cognitivefunction

• 摘要：

• 目的  评估艾司氯胺酮联合腹横肌平面阻滞在老年腹腔镜结直肠癌手术中的应用效果，分析其对患者应激反应及认知功能的影响。方法 选择2023年5月至2025年5月于内蒙古自治区人民医院行择期腹腔镜结直肠癌手术的128例老年患者作为研究对象。采用随机信封法将患者分为对照组（n=64）和观察组（n=64）。2组患者均于麻醉诱导前实施超声引导下腹横肌平面阻滞，观察组于麻醉诱导时静脉注射盐酸艾司氯胺酮注射液，匀速术中泵注；对照组则在相同时点给予等容量生理盐水。对比2组患者不同时点的静息和咳嗽下的疼痛视觉模拟量表（VAS）评分、平均动脉压（MAP）和心率、血清应激反应指标［去甲肾上腺素（NE）、肾上腺素和皮质醇］、术后恢复质量、认知功能和不良反应发生情况。结果 观察组患者术后1、6、12 h的VAS评分均明显低于对照组（均P＜0.05）。观察组患者诱导完成后（T1）、插管即刻（T2）、手术开始时（T3）和手术结束时（T4）的MAP和心率均明显高于对照组（均P＜0.05）。观察组患者T3和T4时血清NE、肾上腺素和皮质醇水平均明显低于对照组（均P＜0.05）。相较于对照组，观察组患者首次下床与首次排气时间均明显缩短（均P＜0.05）。观察组患者术后第1天和术后第2天的简易精神状态量表评分均明显高于对照组［（24.4±1.0）分比（23.8±1.4）分、（28.0±1.0）分比（27.4±1.0）分］（均P＜0.05）。2组患者不良反应发生率比较差异无统计学意义（P=0.169）。结论 老年腹腔镜结直肠癌手术中应用艾司氯胺酮联合腹横肌平面阻滞，能够减轻术后疼痛，维持MAP和心率稳定，提高术后恢复质量，改善应激指标水平，提高术后认知功能。

• Objective To evaluate the clinical efficacy of esketamine combined with transversus abdominis plane block in elderly patients undergoing laparoscopic colorectal cancer surgery, and analyze its impacts on stress response and cognitive function. Methods A total of 128 elderly patients scheduled for elective laparoscopic colorectal cancer surgery in Inner Mongolia People′s Hospital from May 2023 to May 2025 were enrolled and divided into control group (64 cases) and observation group (64 cases) by random envelope method. Ultrasound-guided transversus abdominis plane block was performed before anesthesia induction in both groups. The observation group received intravenous esketamine hydrochloride injection during anesthesia induction followed by continuous uniform intraoperative infusion, while the control group was administered an equal volume of normal saline at the corresponding time points. Resting and coughing visual analogue scale (VAS) pain scores, mean arterial pressure (MAP), heart rate, serum stress biomarkers ［norepinephrine (NE), epinephrine and cortisol］, postoperative recovery quality, cognitive function and incidence of adverse reactions at different time points were compared between the two groups. Results The VAS scores at 1 h, 6 h and 12 h after surgery in the observation group were significantly lower than those in the control group (all P＜0.05). MAP and heart rate at the end of induction (T1), immediate intubation (T2), surgical incision (T3) and completion of operation (T4) in the observation group were markedly more stable than those in the control group (all P＜0.05). Serum levels of NE, epinephrine and cortisol at T3 and T4 in the observation group were significantly lower compared with the control group (all P＜0.05). The time to first ambulation and first flatus were obviously shortened in the observation group versus the control group (all P＜0.05). The mini-mental state examination scores on postoperative day 1 and day 2 were significantly higher in the observation group ［(24.4±1.0) vs (23.8±1.4), (28.0±1.0) vs (27.4±1.0)］(both P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.169). Conclusion The combined application of esketamine and transversus abdominis plane block in elderly patients undergoing laparoscopic colorectal cancer surgery can relieve postoperative pain, stabilize MAP and heart rate, improve postoperative recovery quality, reduce stress biomarker levels and preserve postoperative cognitive function.