[1]代茂红,刘载阳,李杰,等.围术期精细化营养支持在人工全膝关节置换手术加速康复中价值及初步机制[J].中华老年骨科与康复电子杂志,2021,(05):298-303.[doi:DOI：10.3877/cma.j.issn.2096-0263.2021.05.008]
　Dai Maohong,Liu Zaiyang,et al.The value and preliminary mechanism of perioperative nutritional support in the enhanced recovery after total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2021,(05):298-303.[doi:DOI：10.3877/cma.j.issn.2096-0263.2021.05.008]
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围术期精细化营养支持在人工全膝关节置换手术加速康复中价值及初步机制()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2021年05期
页码:
298-303
栏目:
膝关节
出版日期:
2021-11-05

文章信息/Info

Title:
The value and preliminary mechanism of perioperative nutritional support in the enhanced recovery after total knee arthroplasty
作者:
代茂红1; 2; 刘载阳1; 李杰1; 贺开麒1; 张珺1; 黄陈3; 张玉梅1; 张瑗1
400037 重庆，陆军军医大学第二附属医院骨科1；564500 仁怀市，贵州茅台医院2；400037 重庆，陆军军医大学第二附属医院营养科3
Author(s):
Dai Maohong1;  2;  Liu Zaiyang1;  Li Jie1;  He Kaiqi1;  Zhang Jun1;  Huang Chen3;  Zhang Yumei1;  Zhang Yuan1
1Department of Orthopedics, Second Affiliated Hospital, Army Medical University, Chongqing 400037, China; 2Department of Orthopedics, Kweichow Moutai Hospital, Renhuai 564500, China; 3Department of Nutrition, Second Affiliated Hospital, Army Medical University, Chongqing 400037, ChinaCorresponding author: Zhang Yuan, Email: zhangyuan@tmmu.edu.cn
关键词:
精细化支持;  营养干预;  关节成形术; 置换; 膝;  加速康复外科;  炎症反应
Keywords:
Delicacy?management;  Nutrition intervention;  Arthroplasty;  replacement;  Enhanced recovery after surgery;  Inflammation
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2021.05.008
文献标志码:
A
摘要:
目的 评价围术期精细化营养支持在行人工全膝关节置换术的患者加速康复中的价值，并初步探索其机制。方法 本研究通过回顾分析调查陆军军医大学第二附属医院2017 年1月至2018年12月之间因骨关节炎而由同一高年资主刀医生完成的单侧人工全膝关节置换术的患者资料。将2017年尚未进行围术期精细化营养干预的患者设定为常规化营养组，2018年正式进行围术期精细化营养支持的患者设定为精细化营养组。其中常规营养组120例，男性56例，女性64例；年龄47～83岁，平均（64±8）岁，精细化营养组112例，男性44例，女性68例；年龄49～82岁，平均（63±8）岁。分析比较两组患者术前卫生经济学指标、术后早期炎症和营养血液学指标、术后1年关节功能评分、并发症等随访指标。结果 232例患者均获得完整随访，随访率100%，随访时间12～18个月，平均（14.35±1.93）个月。与常规化营养组相比，精细化营养组术后住院日和总住院时间均明显降低，其降幅分别为1.16 d（20.24%，P＜0.001）和1.36 d（15.11%，P＜0.001）。住院费用也得以明显降低（0.55万元，21.83%，P＜0.001）。精细化营养组术后第3日炎症指标C反应蛋白（CRP），及白蛋白、前白蛋白等营养指标明显优于常规营养组。精细化营养组术后1年门诊随访关节功能评分有所增加，但缺乏统计学意义。术后切口并发症、浅表感染、深静脉血栓形成等总体发生率显著性降低约16.7%（P＜0.05）。结论 围术期精细化营养支持对人工膝关节置换术后加速康复具有明确的促进意义，其作用途径在于降低的手术创伤的炎症反应、减少蛋白丢失、降低并发症几率。
Abstract:
Objective To evaluate the value of perioperative nutritional support in the enhanced recovery of patients undergoing total knee replacement, and further explore its mechanism. Methods This study retrospectively analyzed the data of patients undergoing unilateral total knee arthroplasty performed by the same senior surgeon for osteoarthritis in the second affiliated hospital of the army medical university from January 2017 to December 2018. Patients who did not receive perioperative refined nutrition intervention in 2017 were set as the routine nutrition group, and patients who formally received perioperative refined nutrition intervention in 2018 were observed as the refined nutrition group. The preoperative health economics variates, postoperative early inflammation and nutritional hematology index, postoperative 1 year joint function score, complications and other follow-up variables were analyzed and compared between the two groups. Results Compared to the conventional nutrition group, the length of hospital stay and total length of stay in the refined nutrition group were significantly reduced by 1.16 days (20.24%, P<0.001) and 1.36 days (15.11%, P<0.001), respectively. Hospitalization expenses were also significantly reduced (55,00 RMB, 21.83%, P<0.001). CRP and other inflammatory indexes, as well as nutritional indexes such as albumin and prealbumin on the 3rd day after the operation, were significantly improved in the refined nutrition group, than those in the conventional nutrition group. Besides, there was an increase in the score of joint function in the refined nutrition group at clinic follow-up (1 year after surgery), but the result was not statistically significant. The overall incidence of postoperative incision complications, superficial infection, and deep vein thrombosis was significantly reduced by 16.7% (P=0.002). Conclusion The perioperative refined nutrition support has a definite significance in promoting the enhanced recovery after artificial knee arthroplasty, by mechanisms of minimizing the inflammatory response of surgical trauma, reducing protein loss, and lowering the incidence of complications.

备注/Memo

备注/Memo:
基金项目：重庆市技术创新与应用示范项目（cstc2018jscx-msybX0051）；重庆市基础与前沿研究计划项目（cstc2016jcyjA0520）
更新日期/Last Update: 2021-12-02