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术后低饮食摄入量与老年髋部骨折患者术后6个月内更差的功能进程相关。

Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture.

作者信息

Goisser Sabine, Schrader Eva, Singler Katrin, Bertsch Thomas, Gefeller Olaf, Biber Roland, Bail Hermann-Josef, Sieber Cornel C, Volkert Dorothee

机构信息

Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg,Kobergerstraße 60,D-90408Nuremberg,Germany.

Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Central Laboratory, Klinikum Nürnberg, Paracelsus Medical University,Professor-Ernst-Nathan-Straße 1,D-90418Nuremberg,Germany.

出版信息

Br J Nutr. 2015 Jun 28;113(12):1940-50. doi: 10.1017/S0007114515001282. Epub 2015 May 20.

Abstract

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients ≥ 75 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as >50, >25-50, ≤ 25 % of meals served. Functional status according to Barthel index (activities of daily living) and patients' mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using χ2 and Kruskal-Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28 % of participants ate >50 %, 43 % ate >25-50 % and 28 % ≤ 25 % of meals served. Irrespective of pre-fracture functional status, patients with DI ≤ 25 % had significantly lower Barthel index scores at all times after surgery (all P50 % more often had regained their pre-fracture mobility level than those with DI ≤ 25 % at discharge (>50 %: 36 %; >25-50 %: 10 %; ≤ 25 %: 0 %; P= 0·001) and 6 months after discharge (88; 87; 68 %; P= 0·087) and had significantly less complications (median 2 (25th-75th percentile 1-3); 3 (25th-75th percentile 2-4); 3 (25th-75th percentile 3-4); P= 0·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.

摘要

我们研究了老年髋部骨折(HF)患者术后饮食摄入量(DI)与其出院后6个月内功能及临床病程之间的关系。在88例年龄≥75岁的髋部骨折患者中,术后4天通过主餐餐盘图评估术后饮食摄入量。饮食摄入量分为超过所提供餐量的50%、超过25%-50%、≤25%。根据Barthel指数(日常生活活动能力)评估功能状态,并评估患者骨折前、术后、出院时及6个月后的活动水平,并将其与饮食摄入量水平相关联。根据临床诊断记录住院期间的并发症。使用χ2检验、Kruskal-Wallis检验、重复测量方差分析和协方差分析评估相关性。术后,28%的参与者进食量超过所提供餐量的50%,43%进食量超过25%-50%,28%进食量≤25%。无论骨折前的功能状态如何,饮食摄入量≤25%的患者在术后所有时间点的Barthel指数得分均显著较低(所有P值均<0.05)。与饮食摄入量≤25%的患者相比,饮食摄入量超过50%的患者在出院时(超过50%:36%;超过25%-50%:10%;≤25%:0%;P=0.001)和出院后6个月(88%;87%;68%;P=0.087)恢复到骨折前活动水平的情况更为常见,且并发症显著更少(中位数分别为2(第25-75百分位数为1-3);3(第25-75百分位数为2-4);3(第25-75百分位数为3-4);P=0.012)。总之,老年髋部骨折患者术后自主饮食摄入量非常低,因此需要特定的营养干预以实现充足的饮食摄入,从而支持功能和临床恢复。

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