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

doi:10.3969/j.issn.1000-6621.2021.05.011

Abstract

Abstract:

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) (χ²=46.425,P=0.000;χ²=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) (χ²=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) (χ²=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.

Key words: Tuberculosis, spinal, Perioperative, Nutrition therapy, Comparative study, Enhanced recovery after surgery

MIAO Rui-rui, XIN Shi-zhen, TANG Liang, NING Hua-ying, BAO Yu-cheng, ZHANG Wen-long. Application of perioperative nutrition therapy in the treatment of spinal tuberculosis under the guidance of enhanced recovery after surgery[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 468-474. doi: 10.3969/j.issn.1000-6621.2021.05.011

Figures/Tables 5

基本情况及营养治疗	观察组(49例)	对照组(48例)	统计检验值	P值
性别[例(构成比,%)]			χ²=2.450	0.118
男	25(51.02)	32(66.67)
女	24(48.98)	16(33.33)
年龄[岁,M(Q₁,Q₃)]	66(53,71)	63(53,65)	Z=-1.707	0.450
BMI ( $x ˉ$ ±s)	21.82±3.93	21.75±3.30	Z=-0.756	0.450
NRS 2002≥3分[例(构成比,%)]	24(48.98)	27(56.25)	χ²=20.514	0.473
中毒症状[例(构成比,%)]	9(18.37)	7(14.58)	χ²=0.252	0.616
营养治疗[例(构成比,%)]			χ²=0.267	0.606
单纯饮食	24(48.98)	21(43.75)
联合营养支持	25(51.02)	27(56.25)
整蛋白型ONS	20	25
短肽型ONS	4	2
肠外营养	1	0
药物不良反应[例(构成比,%)]	8(16.33)	7(14.58)	χ²=0.056	0.812
腰大肌脓肿穿刺[例(构成比,%)]	2(4.08)	2(4.17)	$χ 校正 2$ =0.000	1.000
白蛋白输注
输注白蛋白[例(构成比,%)]	5(10.20)	4(8.33)	$χ 校正 2$ =0.000	1.000
输注比[M(Q₁,Q₃)]^a	0.20(0.18,0.46)	0.38(0.35,0.45)	Z=-1.470	0.142

时间与分组	干预内容
术前
观察组与对照组	风险筛查:入院应用NRS 2002评分进行营养风险筛查,NRS 2002≥3分制定营养干预方案,NRS 2002评分<3分,1周后再次评估诊断评估:营养科综合BMI、膳食、感染应激状态、生化指标等诊断评估营养不良,计算目标能量、蛋白及其他营养素需求营养处方:阶梯化模式从肠内到肠外开始营养支持,首选整蛋白型ONS(如佳膳悠选),根据情况增加乳清蛋白。目标能量为35~50kcal·kg^-1· $d - 1 [14 ? 15]$ ,蛋白质1.2~1.5g·kg^-1·d^-1。初始可以略低于目标能量供给,逐步增加随访调整:根据患者饮食、胃肠道反应、耐受、吸收、排便等情况动态评估干预方案,调整方案及增减微生态制剂、膳食纤维等术前目标:Hb>100g/L,ALB>30g/L。必要时补充铁剂、叶酸和维生素B12,必要时输血和输注ALB治疗
术前12h至手术开始
观察组	术前午夜前可以进食,术前8~12h加饮800ml含糖饮品,术前2~4h再加饮400ml 含糖饮品;下午手术,每1h加饮200ml 含糖饮品至术前2h。(含糖饮品:12.5%葡萄糖液或含12.5%糖饮品)
对照组	术前禁食8h、禁水4h
手术结束至术后48h
观察组	不等排气尽早进食,清醒且没有明显恶心、呕吐即可进食清亮无渣流质饮食,如无不良反应,1~2h后可少量多次流质饮食(如,百普素50g温水冲至200ml,分4次服用),术后24h达到日需要量的1/4~1/3,术后24~48h过渡至普通饮食,可予以整蛋白型营养补充剂补足至日需要量,目标能量(35~50) kcal·kg^-1·d^-1
对照组	术后6h,清醒后进食清亮无渣流质饮食,排气后流质饮食,目标能量(35~50) kcal·kg^-1·d^-1,必要时整蛋白型ONS补充
术后
观察组与对照组	动态营养评估及随访,提供个性化营养支持

组别	患者例数	血清PAB (g/L, $x ˉ$ ±s)					F值	P值	血清ALB (g/L, $x ˉ$ ±s)			F值	P值	血清Hb (g/L, $x ˉ$ ±s)			F值	P值
组别	患者例数	入院		术前 1天		术后 2周	F值	P值	入院	术前 1天	术后 2周	F值	P值	入院	术前 1天	术后 2周	F值	P值
观察组	49	0.14± 0.04	0.17± 0.03		0.25± 0.04		139.591	0.000	33.77± 7.03	37.68± 5.93	44.33± 6.86	31.882	0.000	111.95± 18.23	116.74± 17.09	119.48± 19.72	2.107	0.125
对照组	48	0.14± 0.03	0.17± 0.03		0.23± 0.03		89.931	0.000	32.79± 7.16	38.48± 5.05	39.96± 5.47	19.326	0.000	114.05± 20.80	117.25± 18.75	113.70± 22.28	0.430	0.651
t值		-0.632	0.742		3.165				0.677	-0.720	3.468			-0.530	-0.140	1.353
P值		0.529	0.460		0.002				0.500	0.473	0.001			0.597	0.889	0.179

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组别	患者例数	外周血血糖(mmol/L)				F值	P值
组别	患者例数	入院时	术前即刻	术后即刻	术后4h	F值	P值
观察组	49	5.42±1.06	5.99±0.99	7.89±1.39	6.90±1.17	42.441	0.000
对照组	48	5.27±0.90	5.30±1.03	8.80±1.08	7.06±1.12	127.015	0.000
t值		0.710	3.398	-3.602	-0.688
P值		0.479	0.001	0.001	0.493