Perioperative nutritional management of patients with spinal cord injury under enhanced recovery after surgery theory_West China Medical Journal

Authors：

WEI Xiaomei ¹ , QIAN Huijuan ² , SUN Lingxue ² , WANG Liang ² ,  HU Sanlian ²

1. Department of Emergency, Shanghai Sixth People’s Hospital, Shanghai 200233, P. R. China;
2. Department of Nursing, Shanghai Sixth People’s Hospital, Shanghai 200233, P. R. China;

Corresponding?author：

HU Sanlian, Email: liuliu9027@163.com

Keywords：

Enhanced recovery after surgery; Spinal cord injury; Perioperative period; Nutritional management

DOI：

10.7507/1002-0179.202007277

Video：

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Objective To explore the effect of perioperative nutritional management on patients with spinal cord injury under the enhanced recovery after surgery (ERAS) theory.Methods A total of 82 patients with spinal cord injury admitted to a tertiay hospital in Shanghai between August 2018 and May 2020 were selected by convenience sampling method. They were randomly divided into intervention group and control group, with 41 cases in each group. The patients in the control group received conventional orthopaedics elective surgery nutritional management, while the patients in the intervention group adopted perioperative nutritional management based on ERAS concept, including establishing a multidisciplinary nutritional management team, conducting admission and regular nutritional screenings, and then developing targeted nutritional interventions based on the screening results. Biochemical indexes of nutritional assessment, electrolyte indexes, nutrition-related complications and general inpatient indexes were observed and compared between the two groups.Results There were statistically significant differences in albumin, prealbumin, total protein, hemoglobin, potassium, sodium, and chlorine between the two groups on the first day after surgery and one day before discharge (P<0.05). The incidences of hypoglycemia (2.4% vs. 19.5%) and total complications (19.5% vs. 61.0%) in the intervention group were lower than those in the control group, and the differences were statistically significant (P<0.05). The total hospital stay [(10.48±2.61) vs. (12.09±2.74) d], postoperative hospital stay [(5.57±2.35) vs. (7.55±3.01) d], and hospital expenses [(11.21±4.42)×10⁴ vs. (14.73±5.51)×10⁴ yuan] in the intervention group were less than those in the control group (P<0.01).Conclusion Perioperative nutritional management under the ERAS theory can effectively improve the nutritional status of patients with spinal cord injury, maintain electrolyte balance, reduce the incidence of complications, shorten the length of hospitalization, reduce the cost of hospitalization, and promote postoperative rehabilitation of patients.

Citation： WEI Xiaomei, QIAN Huijuan, SUN Lingxue, WANG Liang, HU Sanlian. Perioperative nutritional management of patients with spinal cord injury under enhanced recovery after surgery theory. West China Medical Journal, 2020, 35(10): 1175-1180. doi: 10.7507/1002-0179.202007277 Copy

1.	Jazayeri SB, Beygi S, Shokraneh F, et al. Incidence of traumatic spinal cord injury worldwide: a systematic review. Eur Spine J, 2015, 24(5): 905-918.
2.	Wong S, Derry F, Jamous A, et al. The prevalence of malnutrition in spinal cord injuries patients: a UK multicentre study. Br J Nutr, 2012, 108(5): 918-923.
3.	Wong S, Derry F, Jamous A, et al. Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre?. Eur J Clin Nutr, 2014, 68(1): 125-130.
4.	Gorgey AS, Dolbow DR, Dolbow JD, et al. Effects of spinal cord injury on body composition and metabolic profile - part I. J Spinal Cord Med, 2014, 37(6): 693-702.
5.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
6.	孫天勝, 沈建雄, 劉忠軍, 等. 中國脊柱手術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2017, 10(4): 271-279.
7.	Bordes J, Cardinal M, Kaiser E. Prehabilitation versus rehabilitation. Anesthesiology, 2015, 122(6): 1438.
8.	陳強譜, 冀海斌, 魏強. 加速康復外科理念下圍手術期營養管理. 中華普通外科學文獻(電子版), 2018, 12(5): 289-291.
9.	Wong S, Derry F, Jamous A, et al. Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study. Eur J Clin Nutr, 2012, 66(3): 382-387.
10.	周靜, 陳偉, 胡汝均, 等. 脊髓損傷營養篩查量表和營養不良通用篩查量表在脊髓損傷患者早期康復中的應用比較. 中國脊柱脊髓雜志, 2017, 27(9): 829-831.
11.	中華醫學會腸外腸內營養學分會, 中國醫藥教育協會加速康復外科專業委員會. 加速康復外科圍手術期營養支持中國專家共識(2019版). 中華消化外科雜志, 2019, 18(10): 897-902.
12.	中華醫學會糖尿病學分會, 國家基層糖尿病防治管理辦公室. 國家基層糖尿病防治管理指南(2018). 中華內科雜志, 2018, 57(12): 885-893.
13.	Oh CH, Ji GY, Yoon SH, et al. Paralytic ileus and prophylactic gastrointestinal motility medication after spinal operation. Yonsei Med J, 2015, 56(6): 1627-1631.
14.	李幼生. 加速康復外科: 現狀及今后需要關注的問題. 中華醫學雜志, 2017, 97(4): 244-247.
15.	Mariette C. Role of the nutritional support in the ERAS programme. J Visc Surg, 2015, 152(Suppl 1(1)): S18-S20.
16.	黎介壽. 營養支持治療與加速康復外科. 腸外與腸內營養, 2015, 22(2): 65-67.
17.	邱遠, 楊樺. 淺析加速康復外科時代的術前營養支持與預康復. 外科理論與實踐, 2020, 25(2): 102-105.
18.	Dhall SS, Hadley MN, Aarabi B, et al. Nutritional support after spinal cord injury. Neurosurgery, 2013, 72(Suppl 2(2)): 255-259.
19.	Wong S, Derry F, Grimble G, et al. How do spinal cord injury centres manage malnutrition? A cross-sectional survey of 12 regional centres in the United Kingdom and Ireland. Spinal Cord, 2012, 50(2): 132-135.
20.	張麗河, 洪毅, 王方永. 脊髓損傷后營養代謝狀況及干預的研究進展. 中國康復理論與實踐, 2018, 24(9): 1039-1042.
21.	張頤, 蔣朱明. 營養篩查、評定與干預是成人營養診療的關鍵步驟: 美國腸外腸內營養學會(ASPEN)2011年臨床指南. 中華臨床營養雜志, 2012, 20(5): 261-268.
22.	董芳芳, 趙書敏, 魯華鵬, 等. 基于加速康復外科的全程營養管理模式在胰十二指腸切除術患者中的應用. 西部醫學, 2019, 31(12): 1952-1956.
23.	中華醫學會腸外腸內營養學分會. 成人圍手術期營養支持指南. 中華外科雜志, 2016, 54(9): 641-657.
24.	Wang MY, Chang PY, Grossman J. Development of an enhanced recovery after surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine, 2017, 26(4): 411-418.
25.	Fineberg SJ, Nandyala SV, Kurd MF, et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J, 2014, 14(8): 1680-1685.
26.	袁潔, 倪艷. 基于營養風險評估的營養干預對住院脊髓損傷伴截癱患者營養狀況及并發癥的影響. 醫學臨床研究, 2019, 36(2): 411-412.
27.	梁志雄, 岳簽, 蔡燕. 加速康復理念在脊柱手術患者圍術期中的應用. 國際護理學雜志, 2019, 38(8): 1064-1066.

1. Jazayeri SB, Beygi S, Shokraneh F, et al. Incidence of traumatic spinal cord injury worldwide: a systematic review. Eur Spine J, 2015, 24(5): 905-918.
2. Wong S, Derry F, Jamous A, et al. The prevalence of malnutrition in spinal cord injuries patients: a UK multicentre study. Br J Nutr, 2012, 108(5): 918-923.
3. Wong S, Derry F, Jamous A, et al. Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre?. Eur J Clin Nutr, 2014, 68(1): 125-130.
4. Gorgey AS, Dolbow DR, Dolbow JD, et al. Effects of spinal cord injury on body composition and metabolic profile - part I. J Spinal Cord Med, 2014, 37(6): 693-702.
5. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
6. 孫天勝, 沈建雄, 劉忠軍, 等. 中國脊柱手術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2017, 10(4): 271-279.
7. Bordes J, Cardinal M, Kaiser E. Prehabilitation versus rehabilitation. Anesthesiology, 2015, 122(6): 1438.
8. 陳強譜, 冀海斌, 魏強. 加速康復外科理念下圍手術期營養管理. 中華普通外科學文獻(電子版), 2018, 12(5): 289-291.
9. Wong S, Derry F, Jamous A, et al. Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study. Eur J Clin Nutr, 2012, 66(3): 382-387.
10. 周靜, 陳偉, 胡汝均, 等. 脊髓損傷營養篩查量表和營養不良通用篩查量表在脊髓損傷患者早期康復中的應用比較. 中國脊柱脊髓雜志, 2017, 27(9): 829-831.
11. 中華醫學會腸外腸內營養學分會, 中國醫藥教育協會加速康復外科專業委員會. 加速康復外科圍手術期營養支持中國專家共識(2019版). 中華消化外科雜志, 2019, 18(10): 897-902.
12. 中華醫學會糖尿病學分會, 國家基層糖尿病防治管理辦公室. 國家基層糖尿病防治管理指南(2018). 中華內科雜志, 2018, 57(12): 885-893.
13. Oh CH, Ji GY, Yoon SH, et al. Paralytic ileus and prophylactic gastrointestinal motility medication after spinal operation. Yonsei Med J, 2015, 56(6): 1627-1631.
14. 李幼生. 加速康復外科: 現狀及今后需要關注的問題. 中華醫學雜志, 2017, 97(4): 244-247.
15. Mariette C. Role of the nutritional support in the ERAS programme. J Visc Surg, 2015, 152(Suppl 1(1)): S18-S20.
16. 黎介壽. 營養支持治療與加速康復外科. 腸外與腸內營養, 2015, 22(2): 65-67.
17. 邱遠, 楊樺. 淺析加速康復外科時代的術前營養支持與預康復. 外科理論與實踐, 2020, 25(2): 102-105.
18. Dhall SS, Hadley MN, Aarabi B, et al. Nutritional support after spinal cord injury. Neurosurgery, 2013, 72(Suppl 2(2)): 255-259.
19. Wong S, Derry F, Grimble G, et al. How do spinal cord injury centres manage malnutrition? A cross-sectional survey of 12 regional centres in the United Kingdom and Ireland. Spinal Cord, 2012, 50(2): 132-135.
20. 張麗河, 洪毅, 王方永. 脊髓損傷后營養代謝狀況及干預的研究進展. 中國康復理論與實踐, 2018, 24(9): 1039-1042.
21. 張頤, 蔣朱明. 營養篩查、評定與干預是成人營養診療的關鍵步驟: 美國腸外腸內營養學會(ASPEN)2011年臨床指南. 中華臨床營養雜志, 2012, 20(5): 261-268.
22. 董芳芳, 趙書敏, 魯華鵬, 等. 基于加速康復外科的全程營養管理模式在胰十二指腸切除術患者中的應用. 西部醫學, 2019, 31(12): 1952-1956.
23. 中華醫學會腸外腸內營養學分會. 成人圍手術期營養支持指南. 中華外科雜志, 2016, 54(9): 641-657.
24. Wang MY, Chang PY, Grossman J. Development of an enhanced recovery after surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine, 2017, 26(4): 411-418.
25. Fineberg SJ, Nandyala SV, Kurd MF, et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J, 2014, 14(8): 1680-1685.
26. 袁潔, 倪艷. 基于營養風險評估的營養干預對住院脊髓損傷伴截癱患者營養狀況及并發癥的影響. 醫學臨床研究, 2019, 36(2): 411-412.
27. 梁志雄, 岳簽, 蔡燕. 加速康復理念在脊柱手術患者圍術期中的應用. 國際護理學雜志, 2019, 38(8): 1064-1066.

West China Medical Journal

Perioperative nutritional management of patients with spinal cord injury under enhanced recovery after surgery theory

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