目的 探讨不同浓度罗哌卡因弓状韧带腰方肌阻滞对腹腔镜全子宫切除术患者术后镇痛效果及应激反应的影响。 方法 选取2023年1月至2024年12月内江市第一人民医院行腹腔镜全子宫切除术患者285例，按随机数字表法分为A、B、C组，各95例。A组麻醉前行双侧弓状韧带腰方肌阻滞，给予0.25%罗哌卡因给予常规镇痛；B组给予0.375%罗哌卡因；C组给予0.5%罗哌卡因。比较3组手术指标、疼痛评分、应激指标、血流动力学指标、不良反应发生率。 结果 B组、C组舒芬太尼输注剂量低于A组（P < 0.05）；术后，B组、C组疼痛评分均低于A组（P < 0.05）；术后1 d，B组、C组皮质醇（Cor）、C反应蛋白（CRP）、肾上腺皮质激素（ACTH）水平均低于A组（P < 0.05）；手术30 min、术毕3组平均动脉压、心率两两比较，差异有统计学意义，B组、C组平均动脉压、心率变化小于A组（P < 0.05）；3组不良反应比较差异无统计学意义（P > 0.05）。 结论 0.375%与0.5%罗哌卡因具有同等的镇痛效果，并均优于0.25%浓度，故推荐将0.375%作为优选的临床浓度，在保证优良镇痛的同时不良反应发生率较低。

Objective Exploring the effects of different concentrations of ropivacaine on the postoperative analgesic efficacy and stress response in patients undergoing laparoscopic total hysterectomy using the arcuate ligament lumbar muscle block. Methods Between January 2023 and December 2024， a total of 285 patients undergoing elective laparoscopic total hysterectomy were selected from the hospital. These patients were randomly divided into three groups （Group A， Group B， Group C） with the application of a random number table， with 95 patients in each group. Prior to anesthesia in Group A， bilateral arcuate ligament lumbar muscle block was performed， and 0.25% ropivacaine was administered； Group B was given 0.375% ropivacaine； Group C was given 0.5% ropivacaine. Compare three sets of surgical indicators， pain scores， stress indicators， hemodynamic indicators， and incidence of adverse reactions. Results The dose of sufentanil administered via infusion to patients in Groups B and C was lower than that given to those in Group A （P < 0.05）； After surgery， the pain scores of Group B and Group C were lower than those of Group A （P < 0.05）； On postoperative day 1， the levels of cortisol （Cor）， C-reactive protein （CRP）， and adrenocortical hormone （ACTH） in groups B and C were lower than those in group A （P < 0.05）； The average arterial pressure and heart rate of the three groups were compared pairwise at 30 minutes after surgery and after surgery， and the differences were statistically significant. The changes in average arterial pressure and heart rate of groups B and C were smaller than those of group A （P < 0.05）； The differences among the three groups were not statistically significant （P > 0.05）. Conclusions 0.375% and 0.5% ropivacaine have equal analgesic effects and are both superior to 0.25% concentration. Therefore， it is recommended to use 0.375% as the preferred clinical concentration to ensure excellent analgesia while the incidence of adverse reactions is low.