口服霄乔补充在围手术期脊柱结核患者中的疗效观察

Observation on efficacy of oral nutritional supplements among patients with spinal tuberculosis in perioperative period

目的探讨口服营养补充在围手术期脊柱结核患者中的疗效。方法搜集2015年1月至2015年6月在我院骨科新人院且有手术指征的66例脊柱结核患者，采取随机数字表法分为对照组和试验组（各33例）。试验组患者在整个住院期间给予口服安素补充营养，并采用《营养风险筛查2002》（Nutritional risk screening2002，NRS2002）对两组患者进行营养风险筛查，观察两组患者在入院时、术后第6天及术后第13天营养风险发生情况的差异，以及两组在入院时、术后第1天、术后第6天及术后第13天血清白蛋白（albumin，ALB）、C反应蛋白（Creactive protein，CRP）间的差异和引流量、住院天数等临床结果间的差异。对两组之间的各项指标，方差齐且符合正态分布者进行t检验，不符合者进行非参数检验，两组间率的比较根据理论数的多少选择7。检验、校正的x。检验或Fisher确切概率法，以P〈O．05为差异有统计学意义。结果术后第6天，两组之间营养风险发生率差异无统计学意义[试验组为80．00％（24／30），对照组为93．75％（30／32），X2=1．525，P〉0．05]，但是试验组术后NRS2002得分要低于对照组[试验组平均得分为（3．03±0．72）分，对照组平均得分为（3．47±0．67）分，X2=2．525，P〈0．05]。术后第13天，试验组营养风险发生率为16．67％（5／30），平均得分为（1．73±0．98）分；对照组营养风险发生率为43．75％（14／32），平均得分为（2．38±0．87）分，试验组营养风险发生率及NRS2002得分均低于对照组（检验值分别为X2=5．344，Z=-2．929，P值均〈O．05）。同时，术后第13天试验组患者的ALB水平要高于对照组[试验组平均值为（36．30±3．18）g／L，对照组平均值为（33．81±3．58）g／L，t=2．153，P〈0．053。患者术后的NRS2002得分与出院时的NRS2002得分、排气时间及引流量之间均存在正相关关系（r值分别为0．779、0．355、0．294，P值均〈0．05）。结论经口服营养补充后，试验组患者术后的营养风险发生情况要好于对照组患者，口服营养补充可以改善患者的营养状况。

Objective To evaluate on the efficacy of oral nutritional supplements among patients with spinal tuberculosis in perioperative period. Methods Sixty-six new spinal tuberculosis patients with surgical indications spinal tuberculosis were randomly divided into the control group and the research group （33 cases each） in our hospital from Jan 2015 to Jun 2015. In the research group, all patients took ENSURE as oral nutrition. According to NRS2002 （Nutritional risk screening 2002, NRS2002）, we observed the data including the difference between of nutritional risk occurrences on the date of admission, on postoperative day 1 and day 13, and the difference of out- come of the difference of albumin, C-reactive protein, drainage fluid volume, hospitalization days in two groups on the date of admission, on postoperative day l, day 6 and day 13. length of stay. t test was performed in the data with homogeneity of variance and normal distribution, and non-parametric test was done in another data. Chi square test, corrected Chi square test, and Fisher definite probability method were performed in comparison of rates according to theoretical number in two groups. P〈0.05 as significant difference statistically. Results On postoperative day 6, nutritional risk was no statistical difference between two groups 80.00~ （24/30） in the research group and 93. 750//00 （30/32） in the control group, Z2= 1. 525, P〉0.05）, however, the NRS2002 score in the research group was lower than that in the control group on postoperative day 6 （the average score 3.03±0.72 in the experimental group, and 3. 47±0. 67 in the control group, Z=-2. 525,P〈0. 05）. On postoperative day 13, the incidence of nutritional risk in the research group was 16.67% （5/30）, and the average score was 1.73±0. 98, the incidence of nutritional risk in the control group was 43.75% （14/32）, and the average score was 2.38±0.87. The rate of nutritional risk and its NRS2002 score in the research group were lower than those of the control group, respectively （X2=5. 344,Z=-2. 929,P〈0.05）. Meanwhile, the albumin value of the research group was higher than that of the control group on postoperative day 13 （（36.30±3.18） g/L in the research group, and （33.81±3.58） g/L in the control group, t=2. 153,P〈0.05）. The NRS2002 score of patients with postoperative compared to discharge, exhaust time and the drainage fluid volume were positive correlation （r： 0. 779, 0. 355, 0. 294, P〈0. 05）. Conclusion After oral nutritional supplements, the rate of nutritional risk after surgery in research group is better than that in the control group. Oral nutritional supplements can improve the nutritional status of patients.