不同消化道管理策略在胸腰椎骨折围手术期的应用比较

Comparison of different digestive system management strategies in perioperative of thoracolumbar fractures

目的探讨胸腰椎骨折围手术期不同消化道管理策略的应用。方法回顾性分析西南医科大学附属医院2016年1月—2018年1月诊断为胸腰椎骨折并行椎弓根螺钉固定治疗患者的临床资料。根据围手术期所用的不同消化道管理策略分为2组,采用细化的消化道管理策略的患者归入观察组,采用常规消化道管理策略的患者归入对照组。比较两组患者的基线基本情况、入院时及手术前后消化道功能异常情况、术后开始进食时间、术后排气时间、术后排便时间、术后除消化道并发症以外其他并发症发生率、住院时长、满意度。并于术后6个月时比较两组患者骨折愈合、内植物松动或断裂情况。结果研究共纳入121例患者,其中观察组67例,对照组54例。两组患者的基线情况差异无统计学意义(P>0.05)。入院时两组患者消化道功能异常发生率差异无统计学意义(P>0.05),手术前后观察组消化道功能异常发生率均低于对照组(29.9%vs.53.7%,P<0.05;35.8%vs.61.1%,P<0.05)。观察组术后开始进食时间[(3.7±1.1)vs.(6.7±2.6)h]、排气时间[(7.8±2.3)vs.(13.6±4.2)h]、排便时间[(26.7±8.1)vs.(40.9±11.2)h]及住院时长[(6.5±2.4)vs.(9.0±2.7)d]均短于对照组(P<0.005),观察组患者满意度优于对照组[(8.3±1.1)vs.(7.6±1.3)分;t=−3.208,P=0.002]。两组患者术后除消化道并发症以外其他并发症发生率及术后6个月时骨折愈合率、钉棒断裂发生率差异无统计学意义(P>0.05),两组患者术后6个月时均未发现内植物松动。结论细化消化道管理策略有利于降低胸腰椎骨折患者围手术期消化道功能异常发生率,可促进围手术期消化道功能恢复,缩短住院时间,提高满意度。

Objective To explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.Methods The clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed.According to different perioperative management strategies of the digestive system,they were divided into two groups.Patients with careful management strategy were included in the observation group,and patients with routine management were included in the control group.The baseline conditions,the abnormalities of digestive tract function at admission and before and after surgery,the postoperative first feeding time,exhaust time,defecation time,the incidence of other postoperative complications except digestive tract complication,length of stay and patient satisfaction were compared between the two groups.At 6 months after surgery,the fracture healing,loosening or fracture of internal plants were compared between the two groups.Result A total of 121 patients were included in the study,including 67 cases in the observation group and 54 cases in the control group.There was no significant differences in the baseline conditions between the two groups(P>0.05).There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission(P>0.05).The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group(29.9%vs.53.7%,P<0.05;35.8%vs.61.1%,P<0.05).The first eating time[(3.7±1.1)vs.(6.7±2.6)h],exhaust time[(7.8±2.3)vs.(13.6±4.2)h],defecation time[(26.7±8.1)vs.(40.9±11.2)h]and length of stay[(6.5±2.4)vs.(9.0±2.7)d]in the observation group were shorter than those in the control group(P<0.005),and the patients’satisfaction was better than that of the control group(8.3±1.1 vs.7.6±1.3;t=−3.208,P=0.002).There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication,and the fracture healing rate,the incidence of nail-rod breakage at 6 months after surgery between the two groups(P>0.05).No internal plant loosening was found in the two groups of patients within 6 months after surgery.Conclusion The application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction,promote the recovery of perioperative gastrointestinal function,shorten the length of hospital stay,and improve patient satisfaction.