目标营养管理在老年人工髋膝关节置换围手术期中的实践  

Practice of Target Nutritional Management with Idea of Fast Track Surgery for Elderly Following Total Hip and Knee Arthroplasty

作　　者：李玉[1] 何洁[1] 杨昌凤[1] 张玉梅[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《中国食物与营养》2017年第3期71-75,共5页Food and Nutrition in China

摘　　要：目的:为髋膝关节置换患者更好地提供围手术期营养支持,以适应现代快速康复的要求。方法:组建营养支持小组团队,以快速康复外科理念为指导,对2015年6—12月在第三军医大学新桥医院骨科住院的行髋膝关节置换术的60岁以上老年患者行个体化目标营养管理,实施术前营养评估、个体营养目标方案的制定、实施及评价等措施。结果:对290例患者实施营养评估,其中151例(52.07%)病人都不同程度存在营养不良或营养风险,其中老年人比例为97.84%;对所有存在营养不良或营养风险的患者均进行不同方案的营养支持,最终完成营养支持的患者数量为142例,完成率为94.04%;并发症发生率由上半年的15.91%下降为2.82%;平均住院时间由上半年的10.86±0.67下降为6.07±0.76;患者出院满意度调查中满意度由上半年的86.36%上升为97.18%。结论:现阶段快速康复外科理念日益盛行,骨科有必要组建营养支持小组,针对比例较高的老年髋膝关节置换术的患者进行目标营养管理,即目的性较强且有效结合个体化实施的营养管理模式,这对于提升营养管理效果,手术效果以及患者满意度都具有重要作用。[Objective] To offer the better nutritional support during the perioperative period of people following total hip and knee arthroplasty to adapt to the idea of fast track surgery today. [Method] A nutritional supporting team was built with the idea of fast track sur- gery, and gave the target nutritional management to those people over 60 years old following total hip and knee arthroplasty in Department of Orthopaedics of Xinqiao Hospital of Third Military Medical University during July to December, 2015. The management included preopera- tive assessment, individual target nutritional strategy, implement and effectiveness-appraisal. [Result] Totally 290 cases were assessed, 151 （52. 07% ） patients had the malnutrition or risk of nutrition more or less, of which 97. 84% was the elderly. Totally 151 patients were given the different nutritional management according to their particular conditions, and 142 patients （94. 04% ） were in this management from the beginning to the end; The rate of complications fell from 15.91% in the first half year to 2. 82%. Average length of stay fell from 10. 86 ±0. 67d in the first half year to 6. 07±0. 76. The rate of satisfaction in survey before discharging day rose from 86. 36% in the first half year to 97. 18%. [Conclusion] With the prevailing of the fast track surgery, the department of orthopedics need to build nutritional support- ing team, aim at the high proportion of older patients following total hip and knee arthroplasty, and offer them the target nutritional manage- ment which means a management model of both has the definite purpose and the individual scheme. It＇s important to improve the effectiveness of nutritional management, operation effect and satisfaction of patients.

关 键 词：快速康复 目标营养管理 关节置换 

分 类 号：R687.4[医药卫生—骨科学] R459.3[医药卫生—外科学]