ERAS理念下术后早期营养管理在腰椎融合术病人中的应用

Early postoperative nutrition management under ERAS guidelines in patients undergoing lumbar fusion

目的:探讨ERAS理念下术后早期营养管理对腰椎融合术病人营养生化指标及住院时间的影响。方法:将2020年1月至2021年3月于宁夏医科大学总医院骨三科行腰椎后路内固定+椎间融合术的94例病人作为研究对象,分为干预组(n=47)和对照组(n=47)。干预组病人在确定麻醉清醒2 h后由临床营养师给予分时段营养干预,对照组病人在确定麻醉清醒6 h后进食流质饮食。观察两组病人术后蛋白质热卡摄入量、血糖值、总蛋白值、白蛋白值、血红蛋白值、术后住院时间及总住院时间的差异。结果:干预组手术当日及术后前3日蛋白质热卡摄入量高于对照组,差异有统计学意义(P <0.05);干预组术后1d血糖值低于对照组,差异有统计学意义(P <0.05);干预组术后3d总蛋白值高于对照组,差异有统计学意义(P <0.05);干预组术后1d、3d白蛋白值、血红蛋白值高于对照组,差异有统计学意义(P <0.05);干预组术后腹胀的发生率、住院时间低于对照组,差异有统计学意义(P <0.05)。结论:术后早期营养管理对腰椎融合术病人营养生化指标的改善及住院时间的缩短有一定的作用。

Objective:To investigate the effects of early postoperative nutritional management under enhanced recovery after surgery(ERAS) guidelines on nutritional biochemical indicators and length of hospital stay in patients undergoing lumbar fusion surgery.Method:Ninety-four patients who underwent lumbar posterior internal fixation +intervertebral fusion surgery in Department of Orthopedics III of Ningxia Medical University General Hospital from January 2020 to March 2021 were randomly divided into an intervention group(n = 47) and a control group(n = 47).The intervention group received nutritional intervention by a clinical nutritionist at 2 hours after anesthesia recovery,and the control group started to eat liquid diet at 6 hours after anesthesia recovery.The protein-calorie intake,blood glucose,total protein,albumin,hemoglobin,postoperative hospitalization time and total hospitalization time of the two groups were observed.Results:The protein-calorie intake of the intervention group was higher than that of the control group on the day of surgery and the first 3 days after surgery,with statistically significant differences(P < 0.05).The blood glucose level of the intervention group was lower than that of the control group on the first day after surgery,with statistically significant differences(P < 0.05).The total protein level of the intervention group was higher than that of the control group on the third day after surgery,with statistically significant differences(P < 0.05).The albumin and hemoglobin levels of the intervention group were higher than those of the control group on the first and third days after surgery,with statistically significant differences(P < 0.05).The incidence of abdominal distension and the length of hospital stay in the intervention group were lower than those in the control group,with statistically significant differences(P < 0.05).Conclusion:Early postoperative nutritional management has a certain effect on improving nutritional and biochemical indicators and shortening the length of hospital stay in patients undergoing lumbar fusion surgery.