围手术期营养筛查与管理对老年退变性脊柱畸形术后感染并发症的影响  

Impacts of perioperative nutritional screening and management on postoperative infectious complications in geriatric degenerative spinal deformity surgery

作　　者：李俊[1] 韩迪[1] 鲁世保[1] Li Jun;Han Di;Lu Shibao(Department of Orthopedics&Elderly Spinal Surgery,Xuanwu Hospital of Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院骨科与老年脊柱外科,国家老年病临床研究中心,北京100053

出　　处：《中华医学杂志》2025年第9期688-693,共6页National Medical Journal of China

基　　金：首都卫生发展科研专项(2024-1-2012)。

摘　　要：目的评估围手术期营养筛查与管理模式对老年退变性脊柱畸形术后感染并发症的影响。方法本研究为回顾性队列研究,选择2018年2月至2022年10月于首都医科大学宣武医院接受开放性后入路胸腰椎融合手术的老年退变性脊柱畸形患者,通过迷你营养评估简表(MNA-SF)筛查保留139例存在营养不良或营养风险的患者。根据是否接受规范的围手术期营养管理,患者被分为干预组和对照组。对比两组患者术后不良事件、实验室检查、输血及输白蛋白等指标。结果139例患者中,男96例,女43例,年龄(70.72±8.21)岁。最终对照组70例,干预组69例,两组术前基线和术中资料差异均无统计学意义(均P>0.05),具有可比性。干预组和对照组术后感染相关并发症发生率分别为10.1%(7/69)和22.9%(16/70)(P=0.044)。术后第3天,干预组血清白蛋白水平和预后营养指数(PNI)均高于对照组[分别为(32.40±3.58)比(30.72±3.17)g/L、37.85±4.23比35.87±4.57,均P<0.05]。干预组术后输白蛋白率低于对照组[31.9%(22/69)比48.6%(34/70),P=0.045]。结论围手术期营养筛查与管理方案对接受开放性后入路胸腰椎融合术的老年退变性脊柱畸形患者安全有效,可减少存在营养不良或风险的感染相关并发症的发生。Objective To evaluate the impacts of perioperative nutritional screening and management on postoperative infectious complications in geriatric degenerative spinal deformity surgery.Methods This retrospective cohort study included elderly patients with degenerative spinal deformity who underwent open posterior thoracolumbar fusion at Xuanwu Hospital,Capital Medical University,from February 2018 to October 2022.A total of 139 patients with malnutrition or at risk of malnutrition,as identified using the Mini Nutritional Assessment-Short Form(MNA-SF),were included.The patients were divided into an intervention group and a control group based on whether they received standardized perioperative nutritional management.Postoperative adverse events,laboratory parameters,and transfusion rates of albumin and blood products were compared between the two groups.Results Among the 139 patients,96 were male,and 43 were female,with an average age of(70.72±8.21)years.The control group included 70 patients,while the intervention group included 69 patients.There were no significant differences in preoperative baseline or intraoperative data between the two groups(all P>0.05).The incidence of postoperative infection-related complications was significantly lower in the intervention group compared to the control group[10.1%(7/69)vs 22.9%(16/70),P=0.044].On postoperative day 3,the levels of serum albumin and prognostic nutritional index(PNI)in the intervention group were higher[(32.40±3.58)vs(30.72±3.17)g/L,37.85±4.23 vs 35.87±4.57,both P<0.05].The albumin transfusion rate was lower in the intervention group[31.9%(22/69)vs 48.6%(34/70),P=0.045].Conclusion Perioperative nutritional screening and management are safe and effective for elderly patients undergoing open posterior thoracolumbar fusion for degenerative spinal deformity,these measures reduce the incidence of infection-related complications in patients with malnutrition or at risk of malnutrition.

关 键 词：老年 退变性脊柱畸形 营养管理 术后并发症 危险因素 

分 类 号：R47[医药卫生—护理学]