| 陈小妹,吴小芳,赵 娜,钟玉霞,黄爱文,林冬颜.术前合理准备对老年下肢骨折全麻手术患者营养状态、糖代谢、应激反应及机体免疫功能的影响[J].,2021,(16):3175-3179 |
| 术前合理准备对老年下肢骨折全麻手术患者营养状态、糖代谢、应激反应及机体免疫功能的影响 |
| Effect of Preoperative Reasonable Preparation on Nutritional Status, Glucose Metabolism, Stress Response and Immune Function of Elderly Patients with Lower Extremity Fracture under General Anesthesia |
| 投稿时间：2020-12-03 修订日期：2020-12-28 |
| DOI：10.13241/j.cnki.pmb.2021.16.036 |
| 中文关键词: 术前合理准备 麻醉 下肢骨折 营养状态 免疫功能 应激反应 老年 糖代谢 |
| 英文关键词: Preoperative reasonable preparation Anesthesia Lower extremity fracture Nutritional status Immune function Stress response Elderly Glucose metabolism |
| 基金项目:海南省卫生计生行业科研项目（17A211399） |
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| 中文摘要: |
| 摘要 目的：探讨术前合理准备对老年下肢骨折全麻手术患者营养状态、糖代谢、应激反应及机体免疫功能的影响。方法：将2017年6月至2019年6月我院收治的120例下肢骨折老年患者随机分为对照组和观察组，各60例。对照组采取常规准备及麻醉管理，观察组采取术前合理准备及麻醉管理，统计两组患者术后反流误吸、恶心、呕吐、口渴、饥饿发生率，对比两组术前12小时 (T0)、术后即刻(T1)、术后24小时(T2) 的营养状态指标（血清前白蛋白、白蛋白、转铁蛋）水平，糖代谢指标[空腹血糖、胰岛素抵抗指数(IRI)]、应激反应指标[皮质醇 (Cor)、肾素(Rn)、促肾上腺皮质激素 (ACTH)]及免疫功能指标[免疫球蛋白（IgA、IgM、IgG）和T淋巴亚群（CD4+、CD8+、CD4+/ CD8+）]水平。结果：观察组术后反流误吸、口渴、饥饿发生率显著低于对照组（P＜0.05）。T1、T2时点两组患者血清前白蛋白、白蛋白、转铁蛋白水平均较T0时点显著降低，观察组T1、T2时点血清前白蛋白、白蛋白、转铁蛋白水平显著高于对照组（P＜0.05）。T1、T2时点两组患者血清空腹血糖、IRI、Cor、Rn、ACTH水平均较T0时点显著升高，观察组T1、T2时点血清空腹血糖、IRI、Cor、Rn、ACTH水平显著低于对照组（P＜0.05）。T1、T2时点两组患者IgA、IgM、IgG、CD4+、CD4+/ CD8+水平均较T0时点显著降低，CD8+ 较T0时点显著升高，观察组IgA、IgM、IgG、CD4+、CD4+/ CD8+水平显著高于对照组，CD8+显著低于对照组（P＜0.05）。结论：术前合理准备能够降低老年下肢骨折全麻手术患者应激反应，减少全麻手术对患者术后营养状态、糖代谢机体免疫功能的影响，值得临床推广应用。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effect of preoperative reasonable preparation on nutritional status, glucose metabolism,stress response and immune function of elderly patients with lower extremity fracture under general anesthesia. Methods: 120 elderly patients with lower extremity fracture from June 2017 to June 2019 were randomly divided into control group and observation group, 60 cases each. Routine preparation and anesthesia management were adopted in the control group, and reasonable preparation and anesthesia management were adopted in the observation group. The incidence of regurgitation, aspiration, nausea, vomiting, thirst and hunger in the two groups were calculated. Nutritional status indicators (serum prealbumin, albumin, transferrin), glucose metabolism indicators [fasting blood glucose, insulin resistance index (IRI)], stress response indicators [cortisol (Cor), renin (Rn), adrenocorticotropic hormone (ACTH)], immune function indicators [immunoglobulin (IGA, IgM, IgG) and T-lymphoid subsets (CD4+, CD8+, CD4+/ CD8+)] at 12 hours before operation (T0), immediately after operation (T1), 24 hours after operation (T2) between the two groups were compared. Results: The incidence rate of reflux aspiration, thirst and hunger in the study group were significantly lower than those in the control group (P<0.05). When T1 and T2 time point, the levels of serum prealbumin, albumin and transferrin in the two groups were significantly lower than those in the T0 time point. The levels of serum prealbumin, albumin and transferrin in the observation group at T1, T2 time point were significantly higher than those in the control group (P<0.05). The levels of fasting blood glucose, IR index, Cor, Rn and ACTH in the two groups at T1, T2 time point were significantly higher than those in the T0 time point. The levels of fasting blood glucose, IR index, Cor, Rn and ACTH in the observation group at T1, T2 time point were significantly lower than those in the control group(P<0.05). The levels of IgA, IgM, IgG, CD4+ and CD4+/ CD8+ in the two groups at T1, T2 time point were significantly lower than those in the T0 time point, CD8+ were significantly higher than those in the T0 time point. The levels of IgA, IgM, IgG, CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group, CD8+ were significantly lower than those in the control group (P<0.05). Conclusion: Preoperative reasonable preparation can reduce the stress response of elderly patients with lower extremity fracture under general anesthesia, and reduce the influence of operation on nutritional status, glucose metabolism and and immune function of patients after operation, which is worthy of clinical application. |
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