术前营养状态对腹腔镜手术老年患者术后早期恢复质量的影响

Effect of preoperative nutritional status on the quality of early postoperative recovery in elderly patients undergoing laparo⁃scopic surgery

目的探讨术前营养状态对腹腔镜手术老年患者术后早期恢复质量的影响。方法选取100例行腹腔镜手术的老年患者作为研究对象,术前使用微型营养评估量表(Mini‑Nutritional Assessment,MNA)评分对所有患者进行营养状态评估,根据MNA评分是否≥24分将患者分为营养良好组(N组,50例)和营养欠佳组(M组,50例)。记录患者术前一般资料(年龄、性别比、身高、体重、BMI、上臂围、小腿围、MAP、吸烟史、饮酒史、MNA评分、查尔森合并症指数、白蛋白、Hb、淋巴细胞计数、尿素、手术类型)和围手术期相关指标(舒芬太尼、瑞芬太尼及丙泊酚用量,术中液体净出入量,术中出血量,术中低血压发生率,血管活性药物使用率,围手术期输血发生率以及手术时长)。在术前1 d以及术后第1、3、7天记录患者的术后早期恢复质量评分[40项恢复质量问卷(Quality of Recovery‑40 Questionnaire,QoR‑40)评分,包括身体舒适度、情绪状态、心理支持、自理能力及疼痛5个方面],并应用多元线性回归分析判断腹腔镜手术老年患者的术前营养状态与术后早期恢复质量是否存在线性关系。结果两组患者年龄、性别比、身高、MAP、吸烟史、饮酒史、查尔森合并症指数、淋巴细胞计数、尿素水平、手术类型等术前一般资料差异无统计学意义(P>0.05),M组患者的体重、BMI、上臂围、小腿围、白蛋白、Hb及MNA评分均低于N组(P<0.05)。两组患者舒芬太尼、瑞芬太尼及丙泊酚用量,术中液体净出入量,术中出血量,术中低血压发生率,血管活性药物使用率,围手术期输血发生率以及手术时长等术中资料差异均无统计学意义(P>0.05)。组间比较,两组患者术前1 d QoR‑40各项评分以及总评分差异无统计学意义(P>0.05),M组患者术后第1、3、7天QoR‑40各项评分以及总评分均低于N组(P<0.05)。组内比较,与术前1 d比较:两组患者术后第1天身体舒适度及情绪状态评分均下降(P<0.05),术后第3天身体舒适度及情绪状态评分差异无统计学意义(P>0.05),术后第7天身体舒适度及情绪状态评分均提高(P<0.05);术后第1、3天心理支持评分差异无统计学意义(P>0.05),术后第7天心理支持评分提高(P<0.05);术后第1、3、7天自理能力评分均下降(P<0.05);术后第1天疼痛评分下降(P<0.05),术后第3、7天疼痛评分差异无统计学意义(P>0.05);术后第1、3天总评分均下降(P<0.05),术后第7天总评分差异无统计学意义(P>0.05)。与术后第1天比较,两组患者术后第3、7天QoR‑40各项评分及总评分均提高(P<0.05);与术后第3天比较,两组患者术后第7天的QoR‑40各项评分及总评分均提高(P<0.05)。时间与组之间不存在交互效应(P>0.05)。多元线性回归分析表明,MNA评分分别与术后第1、3、7天QoR‑40评分存在线性正相关。结论术前营养状态欠佳不利于老年腹腔镜手术患者的术后早期恢复。

Objective To explore the effect of preoperative nutritional status on the quality of early postoperative recovery in elderly patients undergoing laparoscopic surgery.Methods A total of 100 elderly patients who underwent laparoscopic surgery were selected as subjects.Before surgery,all the patients were evaluated for their nutritional status using the Mini-Nutrition Assessment(MNA)score.According to their MNA score(≥24 points or not),the patients were divided into two groups(n=50):a good nutrition group(group N)and a poor nutrition group(group M).Then,their general information[age,gender ratio,height,weight,body mass in‑dex(BMI),upper arm circumference,lower leg circumference,mean arterial pressure(MAP),smoking history,drinking history,MNA score,Charlson comorbidity index,albumin,hemoglobin(Hb),lymphocyte count,urea level,and surgical type]and perioperative relat‑ed indicators(the consumption of sufentanil,remifentanil and propofol,the net intraoperative fluid intake and outflow,intraoperative blood loss,the incidence of intraoperative hypotension,the use of vasoactive agents,the incidence of perioperative blood transfusion and the duration of surgery)were recorded.Then,their scores of the quality of early postoperative recovery,namely the Quality of Re‑covery‑40 Questionnaire(QoR‑40)scores,including physical comfort,emotional state,psychological support,self‑care ability,and pain,were recorded 1 day before surgery and on postoperative days 1,3 and 7.Meanwhile,the multiple linear regression analysis was conducted to determine the linear relationship between the preoperative nutritional status and the quality of early recovery in elderly pa‑tients undergoing laparoscopic surgery.Results There was no statistical difference in preoperative general information between the two groups,including age,gender ratio,height,MAP,smoking history,drinking history,Charlson comorbidity index,lymphocyte count,urea level,and surgical type(P>0.05).Patients in group M showed decreases in weight,BMI,upper arm circumference,lower leg circum‑ference,albumin,Hb,and MNA score,compared with those in group N(P<0.05).There was no statistical difference between the two groups in intraoperative data,including the consumption of sufentanil,remifentanil and propofol,the net amount of intraoperative fluid input and output,intraoperative blood loss,the incidence of intraoperative hypotension,the use of vasoactive agents,the incidence of perioperative blood transfusion,and the duration of surgery(P>0.05).Furthermore,there was no statistical difference in the QoR‑40 total and subscales scores between the two groups 1 day before surgery(P>0.05),while the QoR‑40 total and subscales scores in group M were lower than those in group N on postoperative days 1,3 and 7(P<0.05).Compared with those 1 day before surgery,both groups showed reduced physical comfort and emotional state scores on postoperative day 1(P<0.05),and there was no statistical difference in physical comfort and emotional state scores on postoperative day 3(P>0.05).On postoperative day 7,the physical comfort and emotion‑al state scores increased(P<0.05).There was no statistical difference in psychological support scores on postoperative days 1 and 3(P>0.05),while the psychological support scores was elevated on postoperative day 7(P<0.05).The self‑care ability scores decreased on postoperative days 1,3 and 7(P<0.05).The pain scores decreased on postoperative day 1(P<0.05),and there was no statistical differ‑ence in pain scores on postoperative days 3 and 7(P>0.05).The total score decreased on postoperative days 1 and 3(P<0.05),and there was no statistical difference in total score on postoperative day 7(P>0.05).Compared with those on postoperative day 1,both groups presented increases in the QoR‑40 total and subscales scores on postoperative days 3 and 7(P<0.05).Compared with those on postoperative day 3,both groups presented increases in the QoR‑40 total and subscales scores on postoperative day 7(P<0.05).There is no interaction effect between time and group(P>0.05).According to multiple linear regression analysis,the MNA score was positive‑ly correlated with the QoR‑40 scores on postoperative days 1,3 and 7.Conclusion Poor preoperative nutritional status is not condu‑cive to early postoperative recovery in elderly patients undergoing laparoscopic surgery.