营养指导对全髋关节置换术老年病人预后的影响

摘要

目的 探讨营养指导对全髋关节置换术(total hip arthroplasty,THA)老年病人预后的影响.方法 选择2016年1月至2017年1月我院骨关节外科收治的因股骨颈骨折行择期THA的194例老年病人纳入观察组,2015年1月至2016年1月因股骨颈骨折行择期THA的152例老年病人纳入对照组,对照组给予常规饮食指导,观察组在营养科会诊后给予个性化饮食指导.比较两组病人入院第1天及术后第10天的血清前白蛋白(PA)、白蛋白(ALB)、血红蛋白(Hb)、血电解质水平、感染率及住院时间.结果 观察组168例(男96例、女72例)完成试验,对照组118例(男67例、女51例)完成试验.术后第10天,观察组的PA、ALB和Hb分别为(0.352±0.074)g/L、(34.077±1.291)g/L、(117.846±7.208)g/L,显著高于对照组的(0.262±0.049)g/L、(32.750±1.067)g/L、(106.932±1.723)g/L,差异均有统计学意义(P均<0.05);除了Ca2+外,观察组病人Na+、K+和Mg2+的水平均显著高于对照组,差异均有统计学意义(P均<0.05).观察组的住院时间为(11.84±3.26)d,期间发生感染5例(5/168,3.05%);对照组的住院时间为(13.32±4.54)d,发生感染12例(12/118,10.17%),差异有统计学意义(t=-2.960,P=0.003;χ2=5.142,P=0.013).结论 术后营养指导可以改善THA老年病人的术后营养状况及预后,降低并发症发生率,有利于病人术后快速康复.%Objective To explore the effect of nutrition instruction on the prognosis of elderly patients undergoing total hip arthroplasty (THA). Methods 194 elderly patients with femoral neck fractures treated with THA in our department from January 2016 to January 2017 were enrolled in the observation group, and 152 elderly patients from January 2015 to January 2016 served as the control group. The control group was given conventional diet instruction, and the observation group was given personalized dietary guidance after consultation of nutrition specialist. The serum prealbumin (PA), albumin (ALB), hemoglobin (Hb), blood electrolyte level,infection rate and hospital stay were compared between the two groups at 1st day and 10th day after operation.Results A total of 168 cases in the observation group(96 males and 72 females)and 118 cases in the control group(67 men and 51 women)completed our test.At the 10th day after operation,the PA,ALB and Hb in the observation group were (0.352 ± 0.074) g/L, (34.077 ± 1.291) g/L and (117.846 ± 7.208) g/L respectively,significantly higher than those in the control group[(0.262±0.049)g/L,(32.750±1.067)g/L and (106.932±1.723)g/L respectively].Except Ca2+,the levels of Na+,K+and Mg2+in the observation group were significantly higher than those in the control group(P<0.05 for all).The hospitalization time was(11.84±3.26) days in the observation group and(13.32±4.54)days in the control group.There were 5 cases of infection(5/168,3.05%)in the observation group and 12 cases(12/118,10.17%)in the control group with the difference being statistically significant (t=-2.960, P=0.003; χ2=5.142, P=0.013). Conclusion Nutrition instruction for elderly patients with THA might improve the nutritional status and prognosis of elderly patients, reduce the incidence of complications,and help patients recover rapidly after operation.