组织工程与重建外科杂志 ›› 2024, Vol. 20 ›› Issue (3): 344-.

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加速康复外科理念在牙颌面畸形患者围手术期营养管理中的应用效果评价

  

  • 出版日期:2024-06-01 发布日期:2024-07-05

Evaluation of enhanced recovery after surgery concept in perioperative nutritional management of patients with dental and maxillofacial malformations·

  • Online:2024-06-01 Published:2024-07-05

摘要:

目的 评价加速康复外科(Enhanced recovery after surgery, ERAS)在牙颌面畸形患者围手术期营养管理中的效果。方法 回顾性分析2023年7—12月在我院行正颌手术患者的个人基本信息、一般临床资料、营养指标等信息,采用倾向性评分匹配(Propensity score matching,PSM)后,入组应用ERAS干预措施的患者79例(观察组),以及同数量的作为对照组的非 ERAS 患者 79 例。采用倾向评分匹配控制混杂因素,通过 t 检验、χ2 检验、多元线性回归分析等,评估ERAS措施对正颌患者术后营养相关指标的影响。结果 倾向性评分匹配后,两组一般资料差异均无统计学意义(P>0.05)。患者年龄中位数为23(21,28)岁。女性患者较多(63.3%)。就诊原因中,仅因功能原因就诊与仅因面型原因就诊的患者比例为1∶7.7。95.6%患者具有大学专科及以上学历,有基础疾病及用药史的患者均少于10%。围手术期营养风险筛查结果显示,术前存在营养风险的患者占19%,术后存在营养风险的患者达27.8%。术后患者体质量下降(1.40±2.02) kg。两组术后营养相关指标分析结果显示,术后实验室指标(血红蛋白数值)、手术当日进食量、术后第 1日进食量、术后第2日进食量及术后进食总量等的差异均具有统计学意义(P<0.05)。多元回归分析显示,性别及就诊原因是患者术后第1日血红蛋白数值的影响因素。结论 正颌患者术后营养风险增加,ERAS措施能够改善患者部分术后营养相关指标。

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Abstract:

Objective To evaluate the effectiveness of enhanced recovery after surgery (ERAS) in the perioperative
nutritional management of patients with dentofacial malformations. Methods Retrospective analysis of personal basic
information, general clinical data, and nutritional indexes of orthognathic surgery patients who underwent orthognathic
surgery from July 2023 to December 2023 was performed. A total of 79 patients who accepted ERAS interventions were
selected, and 79 non-ERAS patients were matched using propensity score matching. Propensity score matching was used to
control confounders,t-test,χ2 test and multifactorial analyses were used to assess the effects of ERAS measures on
postoperative nutritional status indicators in orthognathic patients. Results After propensity score matching, no statistical 
difference was found in general data (P>0.05).The median age of the patients was 23(21,28) years old. Female patients
accounted for a higher proportion (63.3%).Among the reasons for seeking medical treatment, the proportion of patients
seeking medical treatment only for functional reasons and only for facial reasons was 1∶7.7. And 95.6% of the patients had a
college degree or higher. Less than 10% of patients had both underlying diseases and medication history. The results of
perioperative nutritional risk screening showed that 19% of patients were at nutritional risk preoperatively and 27.8% were at
nutritional risk postoperatively. The postoperative weight loss of patients was (1.40±2.02) kg. Statistical analysis of the
postoperative nutritional status indicators in the ERAS and non-ERAS groups showed significant differences in the
postoperative laboratory indexes (hemoglobin value), food-intake on the day of surgery, food-intake on the first day after
surgery, food-intake on the second day after surgery, and the total food-intake in the postoperative period (P<0.05)
.Multiple regression analysis showed that gender and the reason for the surgery were the factors influencing the hemoglobin
value on the first postoperative day. Conclusion Postoperative nutritional risk is increased in orthognathic patients, and
ERAS can improve some postoperative nutrition-related indexes in patients.

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