加速康复外科理念指导下的围手术期营养治疗在脊柱结核诊疗中的应用  

Application of perioperative nutrition therapy in the treatment of spinal tuberculosis under the guidance of enhanced recovery after surgery

作　　者：苗瑞瑞[1] 辛士珍[1] 唐亮[1] 宁华英[1] 鲍玉成[1] 张文龙[1] MIAO Rui-rui;XIN Shi-zhen;TANG Liang;NING Hua-ying;BAO Yu-cheng;ZHANG Wen-long(Department of Orthopedics,Tianjin Haihe Hospital,TCM Key Research Laboratory for Infections Disease Prevention for State Administration Traditional Chinese Medicine,Tianjin 300350,China)

机构地区：[1]天津市海河医院骨科国家中医药管理局中医药防治传染病重点研究室,300350

出　　处：《中国防痨杂志》2021年第5期468-474,共7页Chinese Journal of Antituberculosis

基　　金：天津市海河医院科技基金项目(HHYY-201801);天津市津南区科技计划项目(20190102)。

摘　　要：目的探索加速康复外科(enhanced recovery after surgery,ERAS)理念指导下围手术期营养治疗在脊柱结核治疗中的应用。方法选取2017年1月至2019年12月于天津市海河医院手术治疗的初治活动性脊柱结核患者97例,采取随机数字表法分为观察组(49例)与对照组(48例)。两组患者规范抗结核药物治疗并开展个体化、阶梯化营养治疗,观察组应用ERAS理念指导术前、术后进食水和术前糖负荷,对照组应用传统方案指导术前、术后进食水。观察围手术期阶梯化营养治疗情况,术前即刻口渴、饥饿和术后第2日早餐前腹胀发生情况,术后首次排气时间、围手术期血糖情况。结果观察组术前即刻口渴和饥饿的发生率分别为12.24%(6/49)和8.16%(4/49),低于对照组的81.25%(39/48)和54.17%(26/48),差异均有统计学意义(χ^(2)值分别为46.425和24.021,P值均为0.000)。术后第2日早餐前腹胀发生率为4.08%(2/49),低于对照组的18.75%(9/48),差异有统计学意义(χ^(2)=5.189,P=0.023)。术后首次排气时间≤12h的患者观察组发生率为69.39%(34/49),高于对照组的39.58%(19/48),差异有统计学意义(χ^(2)=8.690,P=0.003)。两组围手术期血糖均升高,但观察组术后即刻血糖[(7.89±1.39)mmol/L]与对照组[(8.80±1.08)mmol/L]比较差异有统计学意义(t=-3.602,P=0.001)。结论ERAS理念指导下的围手术期营养治疗在脊柱结核治疗中的应用可行、安全、有效。Objective To explore the application of perioperative nutrition therapy in the treatment of spinal tuberculosis under the guidance of enhanced recovery after surgery(ERAS).Methods A total of 97 newly treated patients with active spinal tuberculosis who underwent surgical treatment in Haihe Hospital of Tianjing Municipality from January 2017 to December 2019 were chosen and randomly allocated into the observation group(49 cases)and control group(48 cases)by using random number table.Both groups were given standardized anti-tuberculosis drug therapy plus individualized and stepwise nutritional therapy.ERAS was applied on the observation group to guide preoperative and postoperative food and water intake and preoperative glucose load control.The control group took traditional plans to guide their preoperative and postoperative oral diet.The perioperative stepwise nutrition therapy,the immediate preoperative thirst and hunger,postoperative abdominal distension before breakfast of the second day after surgery,time of first gas,perioperative blood glucose were observed.Results Among the observation group,12.24%(6/49)had preoperative thirst and 8.16%(4/49)experienced hunger,which were both lower than those of the control group(81.25%,39/48 and 54.17%,26/48)(χ^(2)=46.425,P=0.000;χ^(2)=24.021,P=0.000);4.08%(2/49)of the observation group had postoperative abdominal distension,which was lower than that of the control group(18.75%,9/48)(χ^(2)=5.189,P=0.023);69.39%(34/49)of patients within the observation group had postoperative time to first gas≤12 hours,higher than that of the control group(39.58%,19/48)(χ^(2)=8.690,P=0.003);the perioperative blood glucose of both groups increased,but the postoperative blood glucose of the observational group was lower than that in the control group(7.89±1.39 mmol/L vs.8.80±1.08 mmol/L)(t=-3.602,P=0.001).Conclusion Perioperative nutrition therapy under the guidance of ERAS is feasible,safe and effective in the treatment of spinal tuberculosis.

关 键 词：结核 脊柱 围手术期 营养治疗 对比研究 加速康复外科 

分 类 号：R473.6[医药卫生—护理学]