MDT免疫营养支持治疗在老年颅脑手术病人中的应用效果  

Effect of MDT immunonutritional support therapy in elderly patients undergoing craniocerebral surgery

作　　者：陈璐 姚俊英[2] 俞永贇 范旻[2] CHEN Lu;YAO Junying;YU Yongyun;FAN Min(Department of Nutrition and Food Hygiene,School of Public Health,Xinjiang Medical University,Urumqi 830000,China;Institute of Clinical Nutrition,Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi 830000,China)

机构地区：[1]新疆医科大学公共卫生学院营养与食品卫生学教研室,新疆维吾尔自治区乌鲁木齐市830000 [2]新疆维吾尔自治区人民医院临床营养研究所,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《实用老年医学》2024年第3期278-282,共5页Practical Geriatrics

基　　金：国家重点研发计划项目(2018YFC2001804)。

摘　　要：目的研究多学科协作诊疗团队(multidisciplinary team,MDT)模式下免疫营养支持在老年颅脑手术病人中的治疗效果。方法选取2021—2022年就诊于新疆维吾尔自治区人民医院神经外科≥65岁的372例行颅脑手术的病人,根据是否采用MDT免疫营养支持治疗分为试验组(73例)与对照组(299例),采用1∶1倾向性评分匹配(PSM),2组分别纳入48例病人,比较2组病人治疗后7 d营养、炎症指标,术后并发症及预后情况。结果治疗后试验组血清前白蛋白(PA)、白蛋白(Alb)水平均高于对照组,降钙素原(PCT)、CRP与IL-6水平均低于对照组,差异均具有统计学意义(P<0.01);试验组老年营养风险指数(GNRI)正常比例为33.3%,明显高于对照组(4.2%),差异具有统计学意义(P<0.05);试验组术后切口愈合不良发生率(4.2%)低于对照组(16.7%),术后感染发生率(12.5%)低于对照组(31.1%),差异均具有统计学意义(P<0.05)。治疗后试验组格拉斯哥昏迷评分量表(GCS)评分高于对照组,且试验组病人的预后良好率(79.2%)高于对照组(54.2%),差异均具有统计学意义(P<0.05)。结论MDT免疫营养支持治疗能够促进老年颅脑手术病人术后康复及预后,提高生存质量。Objective To study the therapeutic effect of immunonutritional support under the multidisciplinary team(MDT)model in the elderly patients undergoing craniocerebral surgery.Methods A total of 372 patients aged≥65 years old who underwent craniocerebral surgery from January 2021 to December 2022 were enrolled and divided into experimental group(73 cases)and control group(299 cases)according to whether MDT immunonutritional support was adopted.And 48 cases were enrolled in experimental group and control group respectively by 1∶1 propensity score matching(PSM).The levels of immunonutritional indexes and inflammational indexes,postoperative complications and prognosis of the two groups were recorded and compared 7 days after treatment.Results After treatment,the levels of prealbumin(PA)and albumin(Alb)were significantly higher,and the levels of procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6)in experimental group were significantly lower than those in control group,with statistical significance(P<0.01).The normal rate of Geriatric Nutritional Risk in experimental group was significantly higher than that in control group(P<0.05).The incidence rates of poor wound healing and postoperative infection in experimental group were lower than those in control group(P<0.05).After treatment,the Glasgow Coma Scale score and the good prognosis rate in experimental group were significantly higher than those in control group(P<0.05).Conclusions MDT immunonutritional support therapy can promote postoperative rehabilitation and prognosis and improve quality of life in the elderly patients undergoing craniocerebral surgery.

关 键 词：多学科协作诊疗团队 免疫营养 老年人 颅脑手术 营养状况 预后 

分 类 号：R651.11[医药卫生—外科学]