目的 探讨腰方肌阻滞联合羟考酮对腹腔镜经腹直肠癌根治术患者围术期应激反应及血清P物质（SP）、前列腺素E2（PGE2）的影响。 方法 采取前瞻性、非随机对照设计，选取2023年1月至2025年6月医院行经腹入路腹腔镜直肠癌根治术治疗直肠癌患者150例，根据麻醉医生选择以及患者意愿进行分组，其中77例患者气管插管完成后实施腰方肌阻滞（0.375%罗哌卡因20 mL）+围术期采用芬太尼镇痛（对照组），73例患者采取腰方肌阻滞联合羟考酮麻醉（麻醉诱导时静注羟考酮0.1 mg/kg，术毕前30 min追加羟考酮0.05 mg/kg）（研究组），比较两组患者为手术不同时间点［术前（T0）、插管前（T1）、气腹（T2）、肠道吻合（T3）、术毕（T4）］时的平均动脉压（MAP）、心率（HR）变化情况，记录围术期相关指标［手术时间、手术中出血量、术后首次下床活动时间和排气时间、术后48 h镇痛泵按压次数］，比较患者术前、术后1 d时应激指标［皮质醇（Cor）、去甲肾上腺素（NE）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）］和血清SP、PGE2水平，记录不良反应。 结果 与T0时相比，两组患者T1、T2时的MAP、HR均升高，但研究组升高趋势低于对照组（P < 0.05）；研究组T3时的HR低于对照组（P < 0.05）。两组手术时间、手术中出血量比较差异无统计学意义（P > 0.05），研究组术后首次下场活动时间和排气时间、术后48 h镇痛泵按压次数均短/低于对照组（P < 0.05）。术后1 d时，相比与术前，两组患者的Cor、NE、CRP、TNF-α、SP和PGE2水平升高，但研究组Cor、NE、CRP、TNF-α、SP和PGE2水平低于对照组（P < 0.05）。两组患者术后不良发生率比较差异均无统计学意义（P > 0.05）。 结论 腰方肌阻滞联合羟考酮运用经腹入路腹腔镜直肠癌根治术可以稳定直肠癌患者围术期手术应激反应，削弱血清SP和PGE2水平升高趋势，有助于直肠癌患者术后早期恢复。

Objective To explore the effects of quadratus lumborum block combined with oxycodone on the perioperative stress response， serum substance P （SP）， and prostaglandin E2 （PGE2） in patients undergoing laparoscopic transabdominal radical resection of rectal cancer. Methods A prospective， non-randomized controlled design was employed. From January 2023 to June 2025， a total of 150 patients who underwent laparoscopic transabdominal radical resection of rectal cancer in the hospital were recruited. Group allocation was determined based on the anesthesiologist's decision and the patient's preference. There were 77 cases in the control group ［quadratus lumborum block （20 mL of 0.375% ropivacaine） after tracheal intubation + fentanyl analgesia during the perioperative period］ and 73 cases in the study group ［quadratus lumborum block combined with oxycodone anesthesia （intravenous injection of 0.1 mg/kg oxycodone during anesthesia induction and 0.05 mg/kg oxycodone 30 min before the end of surgery）］. The changes in mean arterial pressure （MAP） and heart rate （HR） at different time points ［before surgery （T0）， before intubation （T1）， immediately after pneumoperitoneum （T2）， immediately after intestinal anastomosis （T3）， at the end of surgery （T4）］ were compared between the two groups. The perioperative indexes （operation time， intraoperative blood loss， first time out of bed， exhaust time， frequency of analgesic pump presses within 48 h after surgery） were recorded. The levels of stress indexes ［cortisol （Cor）， norepinephrine （NE）， C-reactive protein （CRP）， tumor necrosis factor-α （TNF-α）］， serum SP and PGE2 were compared before surgery and 1 day after surgery， and adverse reactions were recorded. Results Compared with T0， both mean arterial pressure （MAP） and heart rate （HR） increased at T1 and T2 in both groups. The increasing trend of MAP and HR in the study group was lower than that in the control group （P < 0.05）. At T3， the HR in the study group was lower than that in the control group （P < 0.05）. There was no significant difference in the operation time or intraoperative blood loss between the two groups （P > 0.05）. However， the postoperative first leaving-bed time， exhaust time， and the frequency of analgesic pump presses within 48 hours after surgery in the study group were shorter or lower than those in the control group （P < 0.05）. One day after surgery， the levels of cortisol （Cor）， norepinephrine （NE）， C-reactive protein （CRP）， tumor necrosis factor-α （TNF-α）， substance P （SP）， and prostaglandin E2 （PGE2） increased in both groups， but these levels were lower in the study group than in the control group （P < 0.05）. There was no significant difference in the incidence of postoperative adverse reactions between the two groups （P > 0.05）. Conclusion Quadratus lumbarum block combined with oxycodone can stabilize the peri-operative stress response， mitigate the increasing trend of serum SP and PGE2 levels in patients undergoing laparoscopic transabdominal radical resection of rectal cancer， which is beneficial for the early postoperative recovery of patients with rectal cancer.