不同营养治疗途径对腓骨肌皮瓣重建下颌骨缺损术后病人营养状态的影响

目的:通过NRS 2002营养风险评估和PG-SGA量表评估腓骨肌皮瓣重建下颌骨缺损术后病人不同营养治疗途径的效果,为该类病人合适的营养支持时机和方式。方法:采用营养筛查NRS2002评估表对50例腓骨肌皮瓣重建下颌骨缺损术前病人进行营养风险评价,根据营养小组的意见,将病人分为两组:混合营养支持治疗组(SPN+EN)和常规营养支持治疗组(TEN)。分别检测两组病人术前、术后1 d、7 d、13 d的淋巴细胞计数(LYM)、血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(HB)、钾离子(K)、钠离子(NA)、氯离子(CL)及营养风险筛查得分(NRS)等指标,以观察两组营养治疗效果。结果:两组病人各项指标在手术前差异无统计学意义;术后各时间段SPN+EN组的钾离子(K)、钠离子(Na)水平均显著高于TEN组;血红蛋白(HB)和NRS得分在术后13 d差异均具有统计学意义(P0.05);淋巴细胞计数(LYM)和氯离子(CL)分别在术后1 d和术后7d差异均具有统计学意义(P0.05),SPN+EN组检测指标水平均高于TEN组。结论:通过NRS 2002对病人进行术前营养风险评估,术后采用PG-SGA量表评估观测治疗效果,实施营养治疗的调整和干预,及时有效地提供足量的能量和蛋白质,纠正病人电解质、酸碱失衡,改善术后病人应激状态。并证实了营养支持治疗模式从单一的TEN趋向EN联合SPN的方式。

The Influence of different nutrition treatment approaches in the fibula muscle flap reconstruction of the mandibular defect postoperative patients

Objective:NRS 2002 nutritoanl risk assessment and PG-SGA scale were used to evaluate the effect of different nutritional treatments on fibula myocutaneous flap reconstruction of mandibular defect postoperative patients,and to find the appropriate timing and method of nutritional support for this kind of patients.Methods:50 cases of fibula myocutaneous flap reconstruction of mandibular defect postoperative patients were divided into two groups according to the nutritional risk assessment and the opinions of the research team including the mixed nutrition support treatment group (SPNS + EN) and the conventional nutrition support treatment group (TEN).The indexes of the patients on the day before surgery and 1,7,13 postoperative days were monitored,including lymphocyte count (LYM),serum albumin (ALB),hemoglobin (HB),potassium (K),sodium (NA),chloride (CL) and nutritional risk screening score (NRS) and other indicators to evaluate therapeutic effect of two groups.Results:The indicators showed no significant differences in the two groups before operation.For K and Na,the levels of the SPN + EN group was higher than that of the TEN group.Hemoglobin (HB) and NRS score on the 13rd day after surgery were statistically different between the two groups (P ＜ 0.05).Besides,Lymphocyte count (LYM) and chloride (CL) on the 1st and 7th after operation showed significant different,too(P ＜ 0.05).Conclusion:By nutritional risk assessment in patients with NRS 2002 before operation,PG-SGA after operation,we corrected the electrolyte and acid-base imbalance,improved stress state of postoperative patients with adjustment of nutritional therapy and intervention to timely and effectively provide plenty of energy and protein.