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

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 elective 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 （T?）， at screw placement （T?）， at end of surgery （T?）， 30 minutes after extubation （T?）， at 24 hours （T?）， and 48 hours （T?） 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 （T?） indicators between the two groups （P > 0.05）. The intervention group exhibited significantly lower levels of HR， MAP， Cor， NE， and GLU at T?， T?， and T? compared with the control group （P < 0.05）， with Cor， NE， and GLU reduced by > 30% at T? （P < 0.05）. Intraoperative fluid volume and remifentanil dosage were significantly reduced （both P < 0.05）. VAS scores and the number of rescue analgesia requests were lower at T?， T?， and T? （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 intervention 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.

Key words: orthopedic robot, goal-directed fluid therapy, erector spinae plane block, stress response, enhanced recovery after surgery