加速康复外科理念下的营养管理在围手术期脊柱结核患者中的价值

Value of nutrition management under the concept of enhanced recovery after surgery in perioperative patients with spinal tuberculosis

目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)理念下的营养管理在围手术期脊柱结核患者中的价值。方法:收集2021年1—12月于北京胸科医院骨科住院并接受手术治疗的脊柱结核患者79例,采用随机数字表法将患者随机分为观察组(42例)和对照组(37例),观察组2例患者中途退出试验,最终纳入40例。观察组患者采用ERAS理念下的围手术期营养管理,对照组采用常规手术管理。比较两组患者在入院时、术后第6天及第13天营养风险发生情况,两组患者在入院时、术后第1天、第6天及第13天血清学化验指标的差异,以及两组在术中出血量、术后引流量、拔管时间、术后排气时间、排便时间等临床结局间的差异。结果:术后第6天、第13天观察组营养风险发生率分别为70.0%(28/40)、57.1%(20/35),均低于对照组[94.6%(35/37)、81.8%(27/33)],差异均有统计学意义(χ^(2)值分别为7.816和4.845,P值分别为0.005和0.028)。观察组患者术后第1天白细胞计数平均值为(9.99±3.12)×10^(9)/L,低于对照组[(11.69±2.74)×10^(9)/L],差异有统计学意义(t=2.529,P=0.014)。术后第6天观察组患者白蛋白平均水平为(33.48±4.47)g/L,高于对照组[(31.35±3.51)g/L],差异有统计学意义(t=-2.310,P=0.024)。观察组术后第1天尿酸平均水平为(274.67±116.91)μmol/L,低于对照组[(339.19±115.79)μmol/L],差异有统计学意义(t=2.416,P=0.018)。观察组患者术中中位出血量为300.0(175.0,500.0)ml,少于对照组患者[400.0(250.0,600.0)ml],差异有统计学意义(Z=2.098,P=0.036);观察组术后中位排气时间为25.5(15.5,37.5)h、平均排便时间为(95.7±46.9)h,对照组术后中位排气时间为30.7(21.5,44.5)h、平均排便时间为(117.3±38.8)h,差异均有统计学意义(Z=2.050,P=0.040;t=2.140,P=0.036)。结论:ERAS理念下的营养管理可有效改善脊柱结核患者术后营养状况,促进术后胃肠道功能恢复,利于患者加速康复。

Objective:To explore the value of nutrition management under the concept of enhanced recovery after surgery(ERAS)in perioperative patients with spinal tuberculosis.Methods:A total of 79 patients with spinal tuberculosis who were hospitalized and operated in the Department of Orthopaedics in the Beijing Chest Hospital during January to December 2021 were chosen and were randomly allocated into observation group(42 cases)and control group(37 cases)using random number table.Two cases in the observation group withdrew from the experiment halfway which left the group with 40 patients finally.Patients in the observation group were given perioperative nutrition management under ERAS concept,while those in the control group were given routine operation management.The nutritional risks of these two groups were observed at the time of admission,the 6th and 13th day after operation.Differences of serological test results at admission,the 1st,6th and 13th day after operation were compared,as well as the differences of intraoperative and postoperative blood loss,drainage,extubation time,time of first gas and defecation.Results:On the 6th and 13th day after operation,among the observation group,70.0%(28/40)and 57.1%(20/35)had nutritional risk,which were lower than that in the control group(94.6%(35/37)and 81.8%(27/33),χ^(2)=7.816,P=0.005;χ^(2)=4.845,P=0.028).On the 1st day after operation,the average amount of WBC among the observation group was(9.99±3.12)×10^(9)/L,which was lower than that of the control group((11.69±2.74)×10^(9)/L,t=2.529,P=0.014).On the 6th day after operation,the average blood albumin in the observation group was(33.48±4.47)g/L,which was higher than that in the control group((31.35±3.51)g/L,t=-2.310,P=0.024).The average uric acid level of the observation group was(274.67±116.91)μmol/L,lower than that in the control group((339.19±115.79)μmol/L,t=2.416,P=0.018).The median(IQR)blood loss during operation in the observation group was 300.0(175.0,500.0)ml,which was less than that in the control group(400.0(250.0,600.0)ml,Z=2.098,P=0.036).Median(IQR)postoperative exhaust time and average defecation time in the observation group were 25.5(15.5,37.5)h and(95.7±46.9)h,both of which were shorter than that in the control group(30.7(21.5,44.5)h,(117.3±38.8)h,Z=2.050,P=0.040;t=2.140,P=0.036).Conclusion:The nutrition management under ERAS concept can effectively improve the nutritional status of patients with spinal tuberculosis and promote the recovery of gastrointestinal function thus help patients recover quickly.