初次全髋关节置换围手术期的新型营养管理模式
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摘要
[目的]以传统营养管理模式为对照,探讨快速康复流程下新型营养管理模式在全髋关节置换术(THA)中的临床疗效。[方法] 2016年12月～2017年6月在本院行初次单侧THA的患者142例纳入本前瞻性研究,采用随机软件RandA 1.0产生随机数字,将患者分为两组,每组71例。新型组即新型营养管理模式组,围手术期每日进食高蛋白食物;传统组即传统营养管理模式组,常规术前准备,术前8 h禁食,术前6 h禁水,术后6 h开始恢复进食。记录术后输蛋白率、输蛋白量,发生率和术后住院天数,检测白蛋白的变化。[结果]新型组输蛋白率(26.76%vs 45.07%,P<0.05)和输蛋白量[(9.93±18.70) g vs(13.80±18.77) g,P<0.05]均显著少于传统组。新型组的术后住院天数更短[(3.94±1.42) vs(5.06±2.12),P<0.01]。新型组伤口渗出的发生例数少于传统组(2 vs 11,P<0.01)。术后早期,血红蛋白和白蛋白水平均呈降低趋势,不同时间点差异有统计学意义(P<0.05),术后1 d和3d,新型组的Hb和血清白蛋白均高于传统组,但相应时间点两组间的差异均无统计学意义(P>0.05)。[结论]加速康复流程下新型营养管理模式能够有效降低初次单侧THA围术期输蛋白率和输蛋白量,缩短住院时间,提升术后白蛋白水平,降低伤口并发症发生率。
[Objective] To evaluate the early outcomes of a new perioperative nutritional management model combined with enhanced recovery after surgery(ERAS) for primary unilateral total hip arthroplasty(THA). [Methods] From December 2016 to June 2017, a total of 142 patients who underwent primary unilateral THA were included into this prospective study. The patients were divided into two groups by random numbers produced with RandA 1.0 software. Of them, 71 patients who ate high protein food every day perioperatively were termed as the novel group, while the remaining 71 patients who followed the traditional perioperative nutritional management protocol were named as the conventional group, including fasting at 8 hours before operation,water deprivation at 6 hours before operation and eating at 6 hours after operation. The perioperative albumin infusion, complications and hospital stay, as well as hemoglobin and albumin variation were compared between the two groups. [Results] The novel group proved significantly superior to the conventional group regarding to the rate of albumin infusion(26.76% versus45.07%, P<0.05) and the amount of albumin infusion [(9.93±18.70) g vs(13.80±18.77) g, P<0.05]. In addition, the novel group took significantly shorter hospital stay [(3.94±1.42) vs(5.06±2.12), P<0.01], and significantly less rate of incision effusion(2/71 versus 11/71, P<0.05) than the conventional group. Both hemoglobin and albumin in the two group significantly declined during the early period postoperatively compared with those before operation(P<0.05). The novel group had slight higher hemoglobin and albumin than the conventional group at 1 and 3 days postoperatively, although no statistically significant difference was proved between them at any corresponding time point postoperatively(P>0.05). [Conclusion] The new perioperative nutritional management model combined with enhanced recovery after surgery does reduce albumin infusion, shorten hospital stay and decrease incision complications during the perioperative period of unilateral total hip arthroplasty.
[Objective] To evaluate the early outcomes of a new perioperative nutritional management model combined with enhanced recovery after surgery(ERAS) for primary unilateral total hip arthroplasty(THA). [Methods] From December 2016 to June 2017, a total of 142 patients who underwent primary unilateral THA were included into this prospective study. The patients were divided into two groups by random numbers produced with RandA 1.0 software. Of them, 71 patients who ate high protein food every day perioperatively were termed as the novel group, while the remaining 71 patients who followed the traditional perioperative nutritional management protocol were named as the conventional group, including fasting at 8 hours before operation,water deprivation at 6 hours before operation and eating at 6 hours after operation. The perioperative albumin infusion, complications and hospital stay, as well as hemoglobin and albumin variation were compared between the two groups. [Results] The novel group proved significantly superior to the conventional group regarding to the rate of albumin infusion(26.76% versus45.07%, P<0.05) and the amount of albumin infusion [(9.93±18.70) g vs(13.80±18.77) g, P<0.05]. In addition, the novel group took significantly shorter hospital stay [(3.94±1.42) vs(5.06±2.12), P<0.01], and significantly less rate of incision effusion(2/71 versus 11/71, P<0.05) than the conventional group. Both hemoglobin and albumin in the two group significantly declined during the early period postoperatively compared with those before operation(P<0.05). The novel group had slight higher hemoglobin and albumin than the conventional group at 1 and 3 days postoperatively, although no statistically significant difference was proved between them at any corresponding time point postoperatively(P>0.05). [Conclusion] The new perioperative nutritional management model combined with enhanced recovery after surgery does reduce albumin infusion, shorten hospital stay and decrease incision complications during the perioperative period of unilateral total hip arthroplasty.
引文
[1]Ibrahim MS,Khan MA,Nizam I,et al.Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty:an evidence-based review[J].BMC Med,2013,11(1):37.
[2]Ethgen O,Bruyere O,Richy F,et al.Health-related quality of life in total hip and total knee arthroplasty.A qualitative and systematic review of the literature[J].J Bone Joint Surg Am,2004,86-A:963-974.
[3]Puskarich CL,Nelson CL,Nusbickel FR,et al.The use of two nutritionalindicators in identifying long bone fracture patients who do and do not develop infections[J].J Orthop Res,1990,8:799-803.
[4]Greene KA,Wilde AH,Stulberg BN.Preoperative nutritional status of total joint patients.Relationship to postoperative wound complications[J].J Arthroplasty,1991,6:321-325.
[5]Inacio MC,Kritz-Silverstein D,Raman R,et al.The impact of preoperative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty[J].J Arthroplasty,2014,29(3):458-464.
[6]Berend KR,Lombardi AV Jr,Mallory TH.Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients[J].Surg Technol Int,2004,13:239-247.
[7]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复--围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[8]岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识[J].中华骨与关节外科杂志,2015,8(4):281-285.
[9]Per M.Hellstr?m.Normal gastric emptying time of acarbohydraterich drink inelderly patientswith acute hip fracture:a pilot study[J].BMC Anesthesiology,2017,17(1):23.
[10]邱维吉,李士通,花天放,等.不同营养液对麻醉诱导前禁食时间的影响[J].中华临床营养杂志.2015,(2):73-76.
[11]Nygren J.The metabolic effects of fasting and surgery[J].Best Pract Res Clin Anaesthesiol,2006,20:429-438.
[12]Lauwick SM,Kaba A,Maweja S,et al.Effects of oralpreoperative carbohydrate on early postoperative outcome after thyroidectomy[J].Acta Anaesthesiol Belg,2009,60(1):67-73.
[13]Alito MA,de Aguilar-Nascimento JE.Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty:a ran-domized pilot study[J].Nutr J,2016,15(1):34.2018-07-11
[2]Ethgen O,Bruyere O,Richy F,et al.Health-related quality of life in total hip and total knee arthroplasty.A qualitative and systematic review of the literature[J].J Bone Joint Surg Am,2004,86-A:963-974.
[3]Puskarich CL,Nelson CL,Nusbickel FR,et al.The use of two nutritionalindicators in identifying long bone fracture patients who do and do not develop infections[J].J Orthop Res,1990,8:799-803.
[4]Greene KA,Wilde AH,Stulberg BN.Preoperative nutritional status of total joint patients.Relationship to postoperative wound complications[J].J Arthroplasty,1991,6:321-325.
[5]Inacio MC,Kritz-Silverstein D,Raman R,et al.The impact of preoperative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty[J].J Arthroplasty,2014,29(3):458-464.
[6]Berend KR,Lombardi AV Jr,Mallory TH.Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients[J].Surg Technol Int,2004,13:239-247.
[7]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复--围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[8]岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识[J].中华骨与关节外科杂志,2015,8(4):281-285.
[9]Per M.Hellstr?m.Normal gastric emptying time of acarbohydraterich drink inelderly patientswith acute hip fracture:a pilot study[J].BMC Anesthesiology,2017,17(1):23.
[10]邱维吉,李士通,花天放,等.不同营养液对麻醉诱导前禁食时间的影响[J].中华临床营养杂志.2015,(2):73-76.
[11]Nygren J.The metabolic effects of fasting and surgery[J].Best Pract Res Clin Anaesthesiol,2006,20:429-438.
[12]Lauwick SM,Kaba A,Maweja S,et al.Effects of oralpreoperative carbohydrate on early postoperative outcome after thyroidectomy[J].Acta Anaesthesiol Belg,2009,60(1):67-73.
[13]Alito MA,de Aguilar-Nascimento JE.Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty:a ran-domized pilot study[J].Nutr J,2016,15(1):34.2018-07-11