Olofsson Birgitta, Stenvall Michael, Lundström Maria, Svensson Olle, Gustafson Yngve
Department of Surgical and Perioperative Science (Orthopaedics) and Community Medicine and Rehabilitation (Geriatric Medicine), Umeå University, Umeå, Sweden.
J Clin Nurs. 2007 Nov;16(11):2027-38. doi: 10.1111/j.1365-2702.2006.01864.x. Epub 2007 Apr 5.
To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up.
The design was a randomized controlled trial. The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture. The nutritional intervention included, among other things, a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively. Further, at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient's nutrition were also considered and dealt with. Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment (MNA) scale, including body mass index (BMI), on admission and at a four-month follow-up.
Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers. There were significantly fewer days of delirium in the intervention group, seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter. There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI, body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups.
Malnutrition was common among older people with hip fractures admitted to hospital. The nutritional intervention might have contributed to the patients suffering fewer days with delirium, fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status, at least not in women.
This nutritional intervention, which was included in a multifactorial multidisciplinary intervention, is inexpensive and relatively easy to implement. It has significant effects on complications but no long-term effect on nutritional parameters, at least not in women.
研究对老年股骨颈骨折男女患者进行营养干预是否会对住院期间的术后并发症以及四个月随访时的营养状况产生影响。
采用随机对照试验设计。本研究样本包括157例70岁及以上的股骨颈骨折患者。营养干预措施包括，除其他事项外，使用营养日志来检测营养缺乏情况，并在术后至少四天提供富含蛋白质的膳食。此外，在整个住院期间每天至少提供两种营养和蛋白质饮料，同时还考虑并处理了其他会影响患者营养的因素。记录术后并发症情况，并在入院时和四个月随访时使用微型营养评定（MNA）量表对患者进行评估，包括体重指数（BMI）。
营养不良情况常见，MNA评分低与术后并发症如谵妄和压疮相关。干预组谵妄天数明显较少，干预组有7例患者发生压疮，而对照组有14例患者发生压疮，且住院总时长较短。在四个月随访时，干预组和对照组之间的营养参数没有明显的显著改善，但干预组和对照组中的男性平均BMI、体重和MNA评分均有所提高，而两组中的女性均出现恶化。
在住院的老年髋部骨折患者中营养不良情况常见。营养干预可能有助于患者减少谵妄天数、减少压疮并缩短住院时间，但并未改善长期营养状况，至少对女性没有改善。
这种营养干预包含在多因素多学科干预中，成本低廉且相对易于实施。它对并发症有显著影响，但对营养参数没有长期影响，至少对女性没有影响。
