加速康复外科理念在老年髋膝关节置换术围手术期饮食方案中的应用

Perioperative Diet Plan under the Concept of Fast Track Surgery for the Elderly of Hip and Knee Arthroplasty

中文关键词: 加速康复外科  围手术期  老年人  禁食  髋膝关节置换

英文关键词: fast track surgery  preoperative  the elderly  fasting  hip and knee arthroplasty

中文摘要:

      目的 探讨在加速康复外科理念下,缩短术前禁食禁饮时间及术后早期进食在老年髋膝关节置换术中的应用效果.方法 将84例髋膝关节置换术患者随机分为试验组(42例)和对照组(42例).试验组根据不同手术台次给予个体化的饮食方案,于术前2h口服纯碳水化合物营养液200mL,术前6h口服无渣预消化营养液250 mL,术后1h口服开胃流质200mL及高蛋白全营养液250mL.对照组术前24:00后禁食禁饮,术后2～3h进食自备流质食物.比较2组患者术后误吸、胃肠道症状的发生率、肛门排气时间及住院时间.结果 2组患者术后口渴的发生率均较高,但口渴、恶心及呕吐的发生率差异无统计学意义.与对照组比,试验组饥饿(16.7％ vs 52.4％,P＜0.01)和腹胀(2.4％ vs19.1％,P＜0.05)的发生率均较低,术后肛门排气较早[(5.79±2.30) hvs (7.32±3.21)h,P＜0.05].2组患者住院天数差异无统计学意义.结论 择期髋膝关节置换的老年患者,缩短术前禁食禁饮时间及术后早期进食,能缓解胃肠道不适,缩短肛门排气时间,且无误吸的发生,具有一定的安全性和可行性.

英文摘要:

      Objective To investigate the application effect of shortening preoperative fast time and postoperative food intaking time in the elderly patients of hip and knee arthroplasty under the concept of fast track surgery.Methods 84 elderly patients of hip and knee arthroplasty were randomly divided into 2 groups:experiment group and control group,42 in each;individual diet plan was made for patients in experiment group according to the operation time:oral administration of 200 mL of nutrient solution with pure carbohydrate 2 hours before operation or 250 mL of predigested nutrient solution with no dreg 6 hours before operation was applied,and 200 mL of orexigenic fluid food and 250 mL of high protein nutrient solution were provided to patients in experiment group 1 hour after operation;fasting started in patients in control group 24 hours before operation and the patients started to intake self-prepared fluid food 2 to 3 hours after operation;a comparative study was made to the occurrence of postoperative aspiration,gastrointestinal symptoms after operation,anal exhaust time and hospitalization duration between the patients in the 2 groups.Results The occurrence of thirst in patients in both groups was high while the occurrence of thirst,nausea and vomiting between the patients in the 2 groups was of no statistical difference;the occurrence of hunger (16.7％ vs 52.4％,P＜0.01) and abdominal distension (2.4％ vs 19.1％,P＜0.05) in patients in experiment group was lower than those in control group and postoperative anal exhaust time in experiment group was earlier than that in control group (5.79±2.30) h vs (7.32±3.21) h;no statistical difference was found in hospitalization duration between the patients in the 2 group (P＜0.05).Conclusions Shortening preoperative fast time and earlier post operative food intaking time for the elderly of selective arthroplasty in the elderly of hip and knee arthroplasty can relieve the gastrointestinal discomfort and shorten the anal exhaust time and lead to no occurrence of accidental aspiration,it is of certain safety and feasibility.