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术前营养障碍诊断对髋关节置换术后短期结局的影响:一项针对老年人的队列研究

Influence of Preoperative Diagnosis of Nutritional Disorders on Short-Term Outcomes After Hip Arthroplasty: A Cohort Study of Older Adults.

作者信息

Briguglio Matteo, Latella Marialetizia, Sirtori Paolo, Mangiavini Laura, De Luca Paola, Geroldi Manuela, De Vecchi Elena, Lombardi Giovanni, Petrillo Stefano, Wainwright Thomas W, Peretti Giuseppe M, Banfi Giuseppe

机构信息

IRCCS Ospedale Galeazzi-Sant'Ambrogio, Laboratory of Nutritional Sciences, 20157 Milan, Italy.

IRCCS Ospedale Galeazzi-Sant'Ambrogio, EUORR Unit, 20157 Milan, Italy.

出版信息

Nutrients. 2025 Jul 14;17(14):2319. doi: 10.3390/nu17142319.

Abstract

: Nutritional disorders may affect short-term recovery after major orthopaedic surgery, but evidence is lacking. This study assessed whether and how different nutritional disorders diagnosed at admission could influence early recovery after hip replacement. : A prospective analytical study was designed to include 60 patients scheduled for elective primary hip replacement and assess their nutritional status to diagnose 5 malnutrition phenotypes: undernutrition, sarcopenia, obesity, sarcopenic obesity, and sarcopenic undernutrition. Outcome measures were 24 h change in neutrophils, 72 h change in haemoglobin, and 10-day gait speed regain. : Haemoglobin reached the nadir at day 2-3 and partially recovered by day 10 in all patients, with sarcopenia and undernutrition being the strongest predictors of the postoperative drop (-2.37 g∙dL and -0.80 g∙dL, < 0.05). Neutrophils peaked immediately after surgery and returned to baseline levels at discharge, with sarcopenic undernutrition displaying a blunted response after surgery (-16.20%, < 0.01). Undernutrition was found to be the most influential preoperative variable on gait speed recovery, but with a marginal effect. None of the patients covered the reference energy and protein needs through diet in the 10 postoperative days. : In this cohort, nutritional disorders with reduced body function and reserves (sarcopenia and undernutrition) grounded a greater vulnerability to surgery in terms of early stress response and short-term recovery. This calls for both advanced planning of nutritional prehabilitation strategies for these conditions and adequate postoperative nutritional support.

摘要

营养失调可能会影响骨科大手术后的短期恢复,但目前缺乏相关证据。本研究评估了入院时诊断出的不同营养失调是否以及如何影响髋关节置换术后的早期恢复。

一项前瞻性分析研究纳入了60例计划进行择期初次髋关节置换的患者,评估他们的营养状况以诊断5种营养不良表型:营养不良、肌肉减少症、肥胖、肌肉减少性肥胖和肌肉减少性营养不良。观察指标包括中性粒细胞24小时变化、血红蛋白72小时变化以及术后10天步态速度恢复情况。

所有患者的血红蛋白在术后第2 - 3天降至最低点,到第10天部分恢复,肌肉减少症和营养不良是术后血红蛋白下降的最强预测因素(分别下降 - 2.37 g∙dL和 - 0.80 g∙dL,P < 0.05)。中性粒细胞在手术后立即达到峰值,并在出院时恢复到基线水平,肌肉减少性营养不良患者术后反应迟钝(下降 - 16.20%,P < 0.01)。发现营养不良是术前对步态速度恢复影响最大的变量,但影响较小。在术后10天内,没有患者通过饮食满足参考能量和蛋白质需求。

在这个队列中,身体功能和储备下降的营养失调(肌肉减少症和营养不良)在早期应激反应和短期恢复方面使患者对手术的脆弱性增加。这就需要针对这些情况提前规划营养预康复策略,并提供充足的术后营养支持。

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