目的 探讨腰方肌阻滞复合依托咪酯麻醉对老年结直肠癌手术患者苏醒质量和肠道屏障功能的影响。 方法 选取常州市第一人民医院2023年1月至2025年2月接诊的126例老年结直肠癌患者，随机分为对照组和观察组各63例。对照组术中实施全身静脉麻醉，观察组在全身麻醉前给予外侧弓状韧带上腰方肌阻滞。记录术前（T₀）、切皮时（T₁）、手术开始后15 min（T₂）、病灶切除时（T₃）、手术结束前5 min（T₄）时的心率、平均动脉压波动。记录术中的手术指标及术后苏醒情况。比较两组的术后疼痛、应激指标、肠道屏障指标及安全性。 结果 经重复测量的方差分析，组间比较：T₀、T₁、T₂、T₃、T₄时点，两组心率、平均动脉压比较，差异无统计学意义（P > 0.05）。组内比较：T₀、T₁、T₂、T₃、T₄时点，两组心率、平均动脉压比较，差异有统计学意义（P < 0.05）。两组不同时点的变化趋势比较，差异有统计学意义（P < 0.05）。观察组和对照组术后苏醒时间分别为（40.02 ± 16.31）、（48.61 ± 15.09）min，气管导管拔除时间分别为（8.03 ± 1.92）、（9.15 ± 1.23）min，差异有统计学意义（P < 0.05）。经重复测量的方差分析，组间比较：术后2、24、72 h和术后1周时点，观察组的疼痛程度评分低于对照组（P < 0.05）。组内比较：术后2、24、72 h和术后1周时点，两组疼痛程度评分逐渐降低（P < 0.05）。观察组术后48 h内的自控镇痛泵有效按压次数少于对照组（P < 0.05）。治疗后，两组去甲肾上腺素、肾上腺素、皮质醇、D-乳酸、二胺氧化酶水平升高，观察组低于对照组（P < 0.05）。两组未见严重并发症及不良反应。 结论 腰方肌阻滞复合依托咪酯麻醉应用于老年结直肠癌的腹腔镜根治术中，有助于缩短患者术后的苏醒时间，降低肠道屏障损伤，减轻术后疼痛应激反应，安全性良好。

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.