摘要
Abstract
Objective To investigate the effects of goal-directed fluid therapy(GDFT)combined with ultrasound-guided erector spinae plane block(ESPB)on perioperative stress response and postoperative recovery in patients undergoing robot-assisted pedicle screw fixation surgery.Methods Eighty patients scheduled for elec-tive surgery were randomly divided into two groups:control(general anesthesia+conventional fluid management,n=40)and intervention(general anesthesia+GDFT+ESPB,n=40).Heart rate(HR),mean arterial pressure(MAP),serum cortisol(Cor),norepinephrine(NE),blood glucose(GLU)levels,and resting VAS scores were measured and compared between the two groups preoperatively(T₀),at screw placement(T₁),at end of surgery(T₂),30 minutes after extubation(T₃),at 24 hours(T₄),and 48 hours(T₅)postoperatively.Intraoperative fluid volume,remifentanil consumption,postoperative rescue analgesia frequency,time to first ambulation,length of stay,and complications(agitation,nausea and vomiting,respiratory depression)were recorded.Results There were no differences in baseline(T₀)indicators between the two groups(P>0.05).The intervention group exhibited significantly lower levels of HR,MAP,Cor,NE,and GLU at T₁,T₂,and T₄ compared with the control group(P<0.05),with Cor,NE,and GLU reduced by>30%at T₁(P<0.05).Intraoperative fluid volume and remi-fentanil dosage were significantly reduced(both P<0.05).VAS scores and the number of rescue analgesia requests were lower at T₃,T₄,and T₅(P<0.01).Time to first ambulation time and postoperative hospital stay were shortened(both P<0.01).The incidence of agitation,nausea/vomiting and overall complications was lower in the interven-tion group(P<0.05),whereas respiratory depression rates did not differ(P>0.05).Conclusion GDFT plus ESPB can effectively suppress perioperative stress response in robot-assisted spinal surgery,significantly reduce intraoperative opioid dosage and fluid volume,optimize postoperative analgesia,enhance recovery,and lower complication risk.This combination provides an effective ERAS strategy for improving surgical safety and recovery quality.关键词
骨科机器人/目标导向液体治疗/竖脊肌平面阻滞/应激反应/加速康复外科Key words
orthopedic robot/goal-directed fluid therapy/erector spinae plane block/stress response/enhanced recovery after surgery分类
临床医学
