West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2022 Oct;14(10):2535-2544. doi: 10.1111/os.13424. Epub 2022 Aug 30.
Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte-carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA.
From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I-III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ test was used. The primary outcomes were the patient-reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications.
The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes.
The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.
接受全膝关节置换术（TKA）的患者主要为老年患者，术后电解质紊乱和营养不良的风险较高。关于 TKA 中口服营养补充（ONS）策略的随机对照试验很少。本研究旨在评估术前口服电解质-碳水化合物营养补充（OECNS）对 TKA 患者（年龄>65 岁）的疗效。
本前瞻性随机对照研究纳入了 2019 年 4 月至 2020 年 1 月在我院接受初次单侧 TKA 的 94 例患者。本研究纳入了年龄>65 岁、ASA I-III 级的患者，并排除了电解质紊乱、营养不良和合并症的患者。对照组（对照组）接受膳食营养补充（术前 6 小时[Pre 6h]）和水（术前 2 小时[Pre 2h]），而 OECNS 组（干预组）接受膳食营养补充（Pre 6h）和 OECNS（Pre 2）。采用 Student's t 检验和 χ 检验。主要结局是患者报告的舒适度指标（PRCIs），包括饥饿感、口渴感、恶心、呕吐、乏力、疼痛、焦虑和总体舒适度。次要结局包括电解质、营养、功能评分、临床结果和并发症的指标。
与对照组（饥饿感，1.19±0.21；疼痛，3.79±0.26；焦虑，11.21±3.02）相比，OECNS 组患者术前饥饿感（0.43±0.10）、疼痛（2.30±0.34）和焦虑（9.04±2.71）的评分明显更低（Pre 1h）（均 p<0.05），以及术后第 1 天（POD1）的乏力评分（OECNS 组 3.57±0.24；对照组 5.15±0.29；p<0.001）。OECNS 组患者术后第 1 天（POD1）的血钠水平更高（OECNS 组 140.54±3.39；对照组 138.07±5.21；p=0.008），低钠血症的发生率更低（OECNS 组 6.4%；对照组 21.3%；p=0.036）。此外，对照组患者术后第 2 小时（Post 2h）的血糖水平更高（p<0.05），术前第 2 小时（Pre 2h）和术后第 6 小时（Post 6h）的异常血糖发生率更低（均 p<0.05）。其他结果无显著差异。
在接受 TKA 的（年龄>65 岁）患者中，给予 OECNS 可显著提高患者的主观舒适度、电解质和血糖水平，而不会增加并发症的发生率。
