目标导向液体治疗联合竖脊肌平面阻滞对机器人辅助脊柱手术患者应激反应及术后恢复的影响

doi:10.3969/j.issn.1006-5725.2025.21.013

Abstract

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

CLC Number:

R614

Dandan HU,Ying DING,Jie CHEN,Qi. WU. Effect of goal⁃directed fluid therapy combined with erector spinae plane block on stress response and postoperative recovery after robot⁃assisted spine surgery[J]. The Journal of Practical Medicine, 2025, 41(21): 3385-3391.

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References 32

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组别	年龄（x ± s）/岁	性别		高血压	糖尿病	ASA分级
组别	年龄（x ± s）/岁	男	女	高血压	糖尿病	Ⅰ级	Ⅱ级	Ⅲ级
常规组（n = 40）	56.42 ± 8.25	19（47.5）	21（52.5）	7（17.5）	3（7.50）	12	23	5
观察组（n = 40）	55.37 ± 8.78	20（50.0）	20（50.0）	8（20.0）	4（10.0）	14	21	5
χ²/t值	0.015	0.229		0.357	0.159	0.233
P值	0.975	0.632		0.550	0.690	0.842

指标	组别	T?	T?	T?	T?
HR/ (次/min)	常规组	76.2 ± 8.1	92.5 ± 11.3^?	88.7 ± 9.6^?	82.4 ± 7.8^?
HR/ (次/min)	观察组	75.8 ± 7.9	79.3 ± 8.5^?#	78.1 ± 7.2^?#	77.5 ± 6.9^?#
MAP/mmHg	常规组	85.3 ± 6.7	101.6 ± 9.8^?	94.2 ± 8.3^?	89.1 ± 7.5^?
MAP/mmHg	观察组	84.9 ± 6.2	88.7 ± 7.1^?#	86.4 ± 6.8^?#	85.3 ± 6.0^?#

指标	组别	T?	T?	T?	T?	交互效应P值
Cor /（ng/mL）	常规组	125.6 ± 20.3	284.7 ± 35.1^?	198.5 ± 28.9^?#	168.3 ± 25.4^?#△	< 0.001
Cor /（ng/mL）	观察组	124.8 ± 19.7	189.2 ± 26.5^?▲	152.7 ± 22.1^?#▲	136.4 ± 20.8^?#△▲
NE /（pg/mL）	常规组	235.4 ± 42.1	587.6 ± 68.9^?	402.3 ± 55.7^?#	315.8 ± 47.2^?#△	< 0.001
NE /（pg/mL）	观察组	233.9 ± 40.5	352.4 ± 51.3^?▲	286.1 ± 43.6^?#▲	254.7 ± 38.4^?#△▲
GLU /（mmol/L）	常规组	5.3 ± 0.6	8.9 ± 1.1^?	7.6 ± 0.9^?#	6.8 ± 0.7^?#△	< 0.001
GLU /（mmol/L）	观察组	5.2 ± 0.5	6.2 ± 0.7^?▲	6.0 ± 0.6^?#▲	5.7 ± 0.5^?#△▲

组别	晶体输液量/mL	胶体输液量/mL	瑞芬太尼总量/mg
常规组	2 180 ± 320	980 ± 150	2.8 ± 0.5
观察组	1 650 ± 290^?	750 ± 130^?	1.9 ± 0.4^?

组别	T₀	T?	T?	T?	镇痛补救次数/次
常规组	4.1 ± 0.9	4.8 ± 0.9	3.9 ± 0.7	2.7 ± 0.6	3.2 ± 1.1
观察组	4.0 ± 0.8	2.1 ± 0.6^?	1.8 ± 0.5^?	1.3 ± 0.4^?	1.1 ± 0.6^?

Effect of goal⁃directed fluid therapy combined with erector spinae plane block on stress response and postoperative recovery after robot⁃assisted spine surgery

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组别	首次下床时间/h	术后住院时间/d	总住院费用/万元
常规组	24.5 ± 4.2	7.1 ± 1.4	5.8 ± 0.7
观察组	16.8 ± 3.5^?	5.2 ± 1.1^?	5.1 ± 0.6^?

组别	恶心呕吐	术后躁动	呼吸抑制	总并发症数
常规组（n = 40）	6（15.0）	5（12.5）	2（5.00）	13（32.5）
观察组（n = 40）	3（7.50）	1（2.50）	1（2.50）	4（10.0）
χ² 值	1.131	2.879	0.350	6.051
P值	0.042^?	0.045^?	0.151	0.012^?

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