目的 探究艾司氯胺酮联合髋关节囊周神经阻滞对老年全髋关节置换术患者围术期应激反应、免疫功能、认知功能及术后镇痛效果的影响。 方法 选取2022年2月至2025年2月在医院进行全髋关节置换手术的110例老年患者为研究对象，采用随机数字表法分为对照组与观察组，每组55例。患者均接受全髋关节置管术治疗。对照组患者接受罗哌卡因20 mL联合髋关节囊周神经阻滞麻醉，观察组患者接受艾司氯胺酮联合髋关节囊周神经阻滞麻醉。比较两组患者入室时（T1）、麻醉后即刻（T2）、切皮时（T3）、手术30 min（T4）、切入口缝合时（T5）、手术结束即刻（T6）血压、心率、血氧饱和度、呼吸频率。对两组患者术前、术后3 d免疫功能指标、血清应激指标水平、认知功能评分进行检测、评估与比较，对两组患者术后3、6、9 h VAS疼痛评分进行比较，统计两组患者不良反应发生情况。 结果 两组患者T1 ~ T6的HR、MAP、SpO₂、RR、BIS比较， 结果 （1）不同时间点HR、MAP、SpO₂、BIS比较，差异有统计学意义（F = 118.378、70.002、44.910、242.439，均P < 0.001）；（2）观察组与对照组HR、MAP、SpO₂、BIS比较，差异有统计学意义（F = 206.643、195.586、93.077、3.953，P < 0.001、P < 0.001、P < 0.001、P = 0.049）；（3）两组HR、MAP、SpO₂、RR、BIS变化趋势比较，差异有统计学意义（F = 18.583、14.158、23.350、4.883、6.698，均P < 0.001）。术后3 d观察组CD4⁺、CD4⁺/CD8⁺低于对照组（P < 0.05）。观察组患者术中和术毕的MDA、SOD和皮质醇水平均低于对照组（P < 0.05）。两组患者术后3 d MoCA评分、MMSE评分降低，且观察组高于对照组（P < 0.05）。与对照组相比，观察组患者在术后3、6、9及12 h的VAS疼痛评分均处于更低水平。同时，观察组的不良反应出现概率为12.73%，显著低于对照组的29.09%，且该差异有统计学意义（P < 0.05）。 结论 将艾司氯胺酮与髋关节囊周神经阻滞联合应用，能有效减轻老年全髋关节置换术患者在围手术期的应激反应，不仅可增强术后镇痛效果，还能降低不良反应的出现几率。

Objective This study aims to explore the impact of esketamine combined with hip pericapsular nerve block on perioperative stress reactions， immune function， cognitive function， and postoperative analgesic efficacy in elderly patients undergoing total hip replacement. Methods From February 2022 to February 2025， 110 elderly patients who received total hip arthroplasty in the hospital were enrolled as the research participants. They were allocated into a control group and an observation group by means of a random number table， with 55 cases in each group.? All patients received total hip arthroplasty. Patients in the control group were given 20 mL of ropivacaine combined with pericapsular nerve block anesthesia of the hip joint， while those in the observation group were given esketamine combined with pericapsular nerve block anesthesia of the hip joint. The blood pressure， heart rate （HR）， oxygen saturation （SpO?）， and respiratory rate （RR） of the two groups were compared at admission （T₁）， immediately after anesthesia （T₂）， skin incision （T₃）， 30 minutes after surgery initiation （T₄）， incision suture （T₅）， and immediately after surgery completion （T₆）. Both groups underwent detection， assessment， and comparison of immune function indices， serum stress markers， and cognitive function scores before the operation and 3 days post-surgery. The Visual Analogue Scale （VAS） pain scores at 3， 6， and 9 hours after surgery were contrasted between the two groups. Additionally， statistical analysis was performed on the incidence of adverse reactions in both groups. Results The HR， mean arterial pressure （MAP）， SpO?， RR， and bispectral index （BIS） of the two groups from T1 to T6 were compared using repeated measures analysis of variance. The results showed that： （1）There were statistically significant differences in HR， MAP， SpO?， and BIS at different time points （F = 118.378， 70.002， 44.910， 242.439， all P < 0.001）. （2）There were statistically significant differences in HR， MAP， SpO?， and BIS between the observation group and the control group （F = 206.643， 195.586， 93.077， 3.953， P < 0.001， P < 0.001， P < 0.001， P = 0.049）. （3）There were statistically significant differences in the changing trends of HR， MAP， SpO?， RR， and BIS between the two groups （F = 18.583， 14.158， 23.350， 4.883， 6.698， all P < 0.001）. At 3 days after surgery， the levels of CD4? and CD4?/CD8? in the observation group were lower than those in the control group （P < 0.05）. The levels of malondialdehyde （MDA）， superoxide dismutase （SOD）， and cortisol in the observation group were lower than those in the control group during surgery and immediately after surgery （P < 0.05）. The Montreal Cognitive Assessment （MoCA） scores and Mini-Mental State Examination （MMSE） scores of both groups decreased 3 days after surgery， and those in the observation group were higher than those in the control group （P < 0.05）. The VAS pain scores of the observation group at 3， 6， 9 and 12 hours after surgery were lower than those of the control group. The incidence of adverse reactions in the observation group was lower than that in the control group （12.73% vs. 29.09%， P < 0.05）. Conclusion Esketamine combined with pericapsular nerve block of the hip joint can significantly inhibit the perioperative stress response in elderly patients undergoing total hip arthroplasty， optimize the postoperative analgesic effect， and reduce the incidence of adverse reactions.