择期全髋关节置换患者的术前营养

Preoperative nutrition in selective hip replacement patient

目的：观察分析骨科全髋置换术患者对术前营养补液的反应，探讨术前营养的必要性和可行性，提出适合骨科全髋关节置换患者的营养方案。方法：将我院2013年3月到6月65～95岁因股骨颈骨折适行择期全髋置换术的患者据入院号分为两组（试验组和对照组），分别接受等体积的葡萄糖氯化钠溶液或脂肪乳、氨基酸混合营养液，观察比较各组患者手术前后的白蛋白、前白蛋白、T3、T4、TSH等指标的情况。结果：所有患者均随访至术后1个月（平均29．4d），无失访病例。两组患者术前的白蛋白、前白蛋白、T3、T4、TSH经独立样本t检验，差异无统计学意义（P〉0．05）。试验组患者术后的前白蛋白、T3、TSH优于对照组，差异有统计学意义（P〈0．05），白蛋白、T4的差异无统计学意义（P〉0．05）。试验组有3例出现创口红肿，对照组有5例患者出现创口红肿，延期使用抗生素后创口一期愈合。试验组患者术后平均下地时间（4．6±0.9）d，早于对照组患者的（5．3±1．2）d（P〈0．05）。结论：术前使用混合营养液能够有效改善髋关节置换患者术后的营养状况，是一种安全、科学、有效的营养方案。

Objective： To explore the necessity and feasibility of preoperative nutrition through the observation and analysis of the reaction of the patients, and to propose a reasonable way of nourishing fit for the patients to receive total hip replacement. Methods： A total of 46 patients in our hospital who suffered femoral neck fracture from March to June 2013 were chosen and divided into the experimental group and the control group based on the admission number. The patients in the two groups were applied with mixed nutrition or traditional liquid of glucose at the same dose. The changes of albumin, prealbumin, T3, T4, TSH were observed. Results： All patients were followed-up till a month after operation （average 29.4 days）, no one was lost to follow-up. The data was analyzed by independent-sample t test. There was no significant difference in albumin, prealbumin, T3, T4, TSH before operation （P〉0.05）. However, there existed significant differences in prealbumin, T3, TSH between the two groups after operation （P〈0.05）, but no significant difference was found in albumin and T3 （P〉0.05）. 3 patients in experimental group appeared a redness of incision, while 5 in control group, All of them healed by first intention after prolonged use of antibiotics. The patients in experimental group were able to walk on ground in （4.6 ± 0.9） days after operation, much earlier than that of control group, which need （5.3 ± 1.2） days （P〈0.05）. Conclusion： Admission of mixed nutrition preoperatively may effectively improve the nutritional status of patients to receive total hip replacement, it may be a safe, scientific, and effective program of nutrition.