关键词: 结直肠癌, 腰方肌阻滞, 依托咪酯, 疼痛, 肠道屏障

Abstract:

Objective To evaluate the effect of quadratus lumborum block combined with etomidate anesthesia on recovery quality and intestinal barrier function in elderly patients undergoing colorectal cancer surgery. Methods One hundred and twenty-six consecutive elderly patients with colorectal cancer who were admitted to The First People's Hospital of Changzhou from January 2023 to February 2025 were randomly divided into a control group and an observation group using an odd-even numbering method， with 63 cases in each group. The control group received general intravenous anesthesia during surgery， while the observation group received quadratus lumborum block on lateral arcuate ligament before general anesthesia. Heart rate and mean arterial pressure fluctuations were recorded pre-operatively （T₀）， at skin incision （T₁）， 15 minutes after the start of operation （T₂）， at lesion resection （T₃）， 5 minutes before the end of operation （T₄）. Intraoperative surgical indicators and postoperative recovery profile were documented as well. The two groups were compared in terms of postoperative pain， stress indicators， intestinal barrier indicators， and safety. Results Repeated-measures analysis of variance showed no statistically significant difference in heart rate and mean arterial pressure between the two groups at T₀， T₁， T₂， T₃， and T₄ （all P > 0.05）， but statistically significant differences in the two indicators within respective group at all the same time points （all P < 0.05）. Both groups showed statistically significant differences in variances at all the time points （P < 0.05）. The two groups had statistically significant differences in postoperative recovery time （40.02 ± 16.31 min vs. 48.61 ± 15.09 min； P < 0.05） and tracheal tube removal time （8.03 ± 1.92 min vs. 9.15 ± 1.23 min； P < 0.05）. Pain scores at 2 hours， 24 hours， 72 hours， and 1 week postoperatively were shorter in the observation group （P < 0.05）， with a parallel decrease over time in both groups （all P < 0.05）. Effective presses of the self-controlled analgesia pump within 48 hours postoperatively was significantly fewer in the observation group （P < 0.05）. Although the postoperative levels of norepinephrine， adrenaline， cortisol， D-lactate， and diamine oxidase increased in both groups， he observation group had significantly lower levels compared with the control group （P < 0.05）. No serious complications or adverse reactions were observed in either group. Conclusion The regimen of quadratus lumborum block combined with etomidate anesthesia in laparoscopic radical surgery for elderly colorectal cancer patients shortens the patient's postoperative recovery time， reduces intestinal barrier damage， alleviates postoperative pain and stress response， promising a favorable safety profile.

Key words: colorectal cancer, quadratus lumborum block, etomidate, pain, intestinal barrier