摘要
目的探讨基于加速康复外科(ERAS)的多模式镇痛联合目标导向液体治疗在骨科机器人辅助椎弓根内固定术患者麻醉管理中的应用效果。方法选取2024年2月至2025年2月在淮安八十二医院行机器人辅助手术的80例腰椎骨折患者为研究对象,按随机数字表法分为ERAS组和对照组,每组40例。ERAS组实施基于ERAS的多模式镇痛联合目标导向液体治疗,对照组采用传统麻醉方案。比较两组麻醉开始前(T_(0))、术前即刻(T_(1))、手术结束时(T_(2))、术后苏醒时(T_(3))血流动力学指标[心率、平均动脉压(MAP)],T_(0)、术后24 h(T_(4))、术后48 h(T_(5))、术后72 h(T_(6))IL-6水平,记录术后苏醒时间、视觉模拟量表(VAS)评分、并发症发生率及住院时间、围手术期体液管理指标[总输液量、液体正平衡量、每搏量变异度(SVV)达标率等]。结果与对照组比较,ERAS组MAP波动≤±10%的比例(87.5%vs.62.5%)、心率增幅≤20%基础值比例(95.0%vs.70.0%)更高(P<0.05)。T_(4)时两组IL-6水平最高,T_(4)~T_(6)时ERAS组IL-6水平低于对照组(P<0.05)。与对照组比较,ERAS组苏醒时间[(18.5±3.2)min vs.(25.1±4.5)min]、首次下床时间[(8.2±2.1)h vs.(20.5±4.3)h]、住院时间[(4.2±1.1)d vs.(6.5±1.3)d]更短,24 h静息VAS评分[(2.1±0.6)分vs.(3.8±0.9)分]、并发症发生率(20.0%vs.57.5%)更低,总输液量[(1850±220)mL vs.(2550±310)mL]、胶体液用量[(620±95)mL vs.(850±120)mL]、液体正平衡量[(320±90)mL vs.(1120±210)mL]更少,术中尿量[(0.55±0.08)mL·kg^(-1)·h^(-1)vs.(0.30±0.10)mL·kg^(-1)·h^(-1)]更多,差异有统计学意义(P<0.05)。ERAS组SVV达标率为95.0%(38/40)。结论基于ERAS的多模式镇痛联合目标导向液体治疗可有效稳定机器人辅助脊柱手术患者的围手术期生理状态,加速术后功能恢复并减少并发症发生。
Objective To explore the application effect of multimodal analgesia combined with goal-directed fluid therapy based on enhanced recovery after surgery(ERAS)in the anesthesia management of patients undergoing orthopedic robot-assisted pedicle internal fixation.Methods Eighty patients with lumbar fractures who underwent robot-assisted surgery in Huai’an 82 Hospital from February 2024 to February 2025 were selected as the research objects and divided into the ERAS group and the control group according to the random number table method,with 40 cases in each group.The ERAS group received multimodal analgesia combined with goal-directed fluid therapy based on ERAS,while the control group adopted the traditional anesthesia protocol.The hemodynamic indicators[heart rate,mean arterial pressure(MAP)]before the start of anesthesia(T_(0)),immediately before the operation(T_(1)),at the end of the operation(T_(2)),and at the time of postoperative recovery(T_(3)),as well as the IL-6 levels at T_(0),24 hours after the operation(T_(4)),48 hours after the operation(T_(5)),and 72 hours after the operation(T_(6))were compared between the two groups.Recorded the postoperative recovery time,visual analogue scale(VAS)score,incidence of complications and hospital stay,as well as perioperative infusion management parameters[total infusion volume,positive fluid balance volume,the compliance rate of stroke volume variation(SVV),etc.].Results Compared with the control group,the proportion of MAP fluctuations≤±10%(87.5%vs.62.5%),and the proportion of basal heart rate increase≤20%(95.0%vs.70.0%)in the ERAS group were higher than those in the control group(P<0.05).At T_(4),the IL-6 levels in both groups were the highest,while the IL-6 levels from T_(4) to T_(6) in the ERAS group were lower than those in the control group(P<0.05).Compared with control group,wake times[(18.5±3.2)min vs.(25.1±4.5)min],bed time for the first time[(8.2±2.1)h vs.(20.5±4.3)h],the length of time[(4.2±1.1)d vs.(6.5±1.3)d]in the ERAS group were shorter,24-hour resting VAS score(2.1±0.6 vs.3.8±0.9)and the incidence of complications(20.0%vs.57.5%)were lower,the total infusion volume[(1850±220)mL vs.(2550±310)mL],the amount of colloid solution[(620±95)mL vs.(850±120)mL],and the positive balance volume of liquid[(320±90)mL vs.(1120±210)mL]were less,the intraoperative urine volume[(0.55±0.08)mL·kg^(-1)·h^(-1)vs.(0.30±0.10)mL·kg^(-1)·h^(-1)]was more,the differences were statistically significant(P<0.05).The compliance rate of SVV in the ERAS group was 95.0%(38/40).Conclusion Multimodal analgesia combined with goal-directed fluid therapy based on ERAS can effectively stabilize the perioperative physiological state of patients undergoing robot-assisted spinal surgery,accelerate postoperative functional recovery and reduce complications.
作者
胡丹丹
袁光华
丁颖
陈捷
宗林
HU Dandan;YUAN Guanghua;DING Ying;CHEN Jie;ZONG Lin(Department of Anesthesiology,Huai’an 82 Hospital,Huai’an,Jiangsu 223000,China;Department of Anesthesiology,Jinling Hospital Affiliated to Medical School of Nanjing University,Nanjing,Jiangsu 210000,China)
出处
《重庆医学》
2025年第8期1924-1929,共6页
Chongqing Medical Journal
关键词
加速康复外科
目标导向液体治疗
多模式镇痛
骨科机器人
麻醉管理
enhanced recovery after surgery
goal-directed fluid therapy
multimodal analgesia
orthopedic robot
anesthetic management
