目的：探讨亚麻醉剂量艾司氯胺酮联合肋缘下腹横肌平面阻滞（STAPB）对机器人辅助根治性膀胱切除术 （RARC）患者镇痛效果、应激反应、苏醒质量及情绪的影响。方法：选取宝鸡市人民医院于 2023 年 8 月—2024 年 2 月行 RARC 的 70 例患者，按照随机数字表法分为对照组（给予常规麻醉联合 STAPB，35 例）和研究组（给予亚 麻醉剂量艾司氯胺酮联合 STAPB，35 例），比较两组临床指标。结果：两组患者术后疼痛数字分级评分法（NRS） 评分随着时间变化呈降低趋势，且研究组 NRS 评分均低于对照组（P<0.05）；在术前（T0）、手术开始后 10 min（T1）、 拔管后 5 min（T2），两组 DBP 先降低后升高，T1、T2 时研究组 DBP 高于对照组；研究组 SBP 先降低后升高，对 照组 SBP 先升高后降低，T1、T2 时研究组 SBP 低于对照组；两组 HR 先升高后降低，T1、T2 时研究组 HR 低于对 照组（P<0.05）；研究组苏醒相关时间均短于对照组，拔管后 15 min、30 min 的 Steward 苏醒评分表评分高于对照 组（P<0.05）；术后 3 d 两组患者焦虑自评量表（SAS）、抑郁自评量表（SDS）评分均降低，各项炎症因子水平均 升高，研究组低于对照组（P<0.05）；两组患者术后并发症总发生率相比，差异无统计学意义（P>0.05）。结论： RARC 患者使用亚麻醉剂量艾司氯胺酮联合 STAPB，可减轻机体应激反应和炎症反应，缓解焦虑抑郁症状，苏醒质 量较高，且有一定安全性，临床应用效果较好。

Objective: To investigate the effects of subanesthetic dose of esketamine combined with subcostal transversus abdominis plane block (STAPB) on the analgesic effect, stress response, awakening quality, and mood of patients undergoing robot-assisted radical cystectomy (RARC). Methods: 70 patients who underwent RARC in Baoji People’s Hospital from August 2023 to February 2024 were selected and divided into the control group (conventional anesthesia combined with STAPB, n=35) and the study group (subanesthetic dose of esketamine combined with STAPB, n=35) using a random number table, and the clinical indicators of the two groups were compared. Results: The postoperative pain numerical rating scale (NRS) scores showed a decreasing trend over time in both groups, and the scores of the study group were lower than those of the control group (P<0.05). At the preoperative period (T0), 10 minutes after the start of the operation (T1), and 5 minutes after extubation (T2),the diastolic blood pressure (DBP) decreased and then increased in both groups. At T1 and T2, the DBP in the study group was higher than that in the control group. Systolic blood pressure (SBP) in the study group initially decreased and then increased, whereas in the control group it initially increased and then decreased. At T1 and T2, the study group showed lower SBP than that of the control group. In both groups, the heart rate (HR) initially increased and subsequently decreased, it was lower in the study group than the the control group at T1 and T2 (P<0.05). The awakening-related time was shorter in the study group, and at 15 and 30 minutes after extubation, the study group got higher Steward’s Awakening Scale scores than the control group (P<0.05). At 3 d after surgery, both groups had lower scores on the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) and increased levels of various inflammatory factors, while it was lower in the study group than that in the control group (P<0.05). There is no statistically significant difference in the total incidence of postoperative complications between the two groups (P>0.05). Conclusion: The use of subanesthetic dose of esketamine combined with STAPB can reduce the stress response and inflammatory response, alleviate the anxiety and depression, and obtain a higher quality of awakening in RARC patients, with a certain degree of safety and an effective clinical application.

基金项目：陕西省重点研发计划项目（2021SF-265） 

Foundation Item: Key R&D Plan Project of Shaanxi Province (2021SF-265) 

通讯作者：马亚芳，Email：18191796760@163.com 

Corresponding Author: MA Yafang, Email: 18191796760@163.com 

引用格式：闫岸军，陈治富，马亚芳 . 亚麻醉剂量艾司氯胺酮联合肋缘下腹横肌平面阻滞在机器人辅助根治性膀胱切除术患者中 的应用效果 [J]. 机器人外科学杂志（中英文），2025，6（1）：53-59. 

Citation: YAN A J, CHEN Z F, MA Y F. Effect of subanesthetic dose of esketamine combined with subcostal transversus  abdominis plane block in patients undergoing robot-assisted radical cystectomy [J]. Chinese Journal of Robotic Surgery, 2025,  6(1): 53-59.

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