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

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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.	孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
7.	Bordes J, Cardinal M, Kaiser E. Prehabilitation versus rehabilitation. Anesthesiology, 2015, 122(6): 1438.
8.	陈强谱, 冀海斌, 魏强. 加速康复外科理念下围手术期营养管理. 中华普通外科学文献(电子版), 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.	周静, 陈伟, 胡汝均, 等. 脊髓损伤营养筛查量表和营养不良通用筛查量表在脊髓损伤患者早期康复中的应用比较. 中国脊柱脊髓杂志, 2017, 27(9): 829-831.
11.	中华医学会肠外肠内营养学分会, 中国医药教育协会加速康复外科专业委员会. 加速康复外科围手术期营养支持中国专家共识(2019版). 中华消化外科杂志, 2019, 18(10): 897-902.
12.	中华医学会糖尿病学分会, 国家基层糖尿病防治管理办公室. 国家基层糖尿病防治管理指南(2018). 中华内科杂志, 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. 加速康复外科: 现状及今后需要关注的问题. 中华医学杂志, 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.	黎介寿. 营养支持治疗与加速康复外科. 肠外与肠内营养, 2015, 22(2): 65-67.
17.	邱远, 杨桦. 浅析加速康复外科时代的术前营养支持与预康复. 外科理论与实践, 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.	张丽河, 洪毅, 王方永. 脊髓损伤后营养代谢状况及干预的研究进展. 中国康复理论与实践, 2018, 24(9): 1039-1042.
21.	张颐, 蒋朱明. 营养筛查、评定与干预是成人营养诊疗的关键步骤: 美国肠外肠内营养学会(ASPEN)2011年临床指南. 中华临床营养杂志, 2012, 20(5): 261-268.
22.	董芳芳, 赵书敏, 鲁华鹏, 等. 基于加速康复外科的全程营养管理模式在胰十二指肠切除术患者中的应用. 西部医学, 2019, 31(12): 1952-1956.
23.	中华医学会肠外肠内营养学分会. 成人围手术期营养支持指南. 中华外科杂志, 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.	袁洁, 倪艳. 基于营养风险评估的营养干预对住院脊髓损伤伴截瘫患者营养状况及并发症的影响. 医学临床研究, 2019, 36(2): 411-412.
27.	梁志雄, 岳签, 蔡燕. 加速康复理念在脊柱手术患者围术期中的应用. 国际护理学杂志, 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. 孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
7. Bordes J, Cardinal M, Kaiser E. Prehabilitation versus rehabilitation. Anesthesiology, 2015, 122(6): 1438.
8. 陈强谱, 冀海斌, 魏强. 加速康复外科理念下围手术期营养管理. 中华普通外科学文献(电子版), 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. 周静, 陈伟, 胡汝均, 等. 脊髓损伤营养筛查量表和营养不良通用筛查量表在脊髓损伤患者早期康复中的应用比较. 中国脊柱脊髓杂志, 2017, 27(9): 829-831.
11. 中华医学会肠外肠内营养学分会, 中国医药教育协会加速康复外科专业委员会. 加速康复外科围手术期营养支持中国专家共识(2019版). 中华消化外科杂志, 2019, 18(10): 897-902.
12. 中华医学会糖尿病学分会, 国家基层糖尿病防治管理办公室. 国家基层糖尿病防治管理指南(2018). 中华内科杂志, 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. 加速康复外科: 现状及今后需要关注的问题. 中华医学杂志, 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. 黎介寿. 营养支持治疗与加速康复外科. 肠外与肠内营养, 2015, 22(2): 65-67.
17. 邱远, 杨桦. 浅析加速康复外科时代的术前营养支持与预康复. 外科理论与实践, 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. 张丽河, 洪毅, 王方永. 脊髓损伤后营养代谢状况及干预的研究进展. 中国康复理论与实践, 2018, 24(9): 1039-1042.
21. 张颐, 蒋朱明. 营养筛查、评定与干预是成人营养诊疗的关键步骤: 美国肠外肠内营养学会(ASPEN)2011年临床指南. 中华临床营养杂志, 2012, 20(5): 261-268.
22. 董芳芳, 赵书敏, 鲁华鹏, 等. 基于加速康复外科的全程营养管理模式在胰十二指肠切除术患者中的应用. 西部医学, 2019, 31(12): 1952-1956.
23. 中华医学会肠外肠内营养学分会. 成人围手术期营养支持指南. 中华外科杂志, 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. 袁洁, 倪艳. 基于营养风险评估的营养干预对住院脊髓损伤伴截瘫患者营养状况及并发症的影响. 医学临床研究, 2019, 36(2): 411-412.
27. 梁志雄, 岳签, 蔡燕. 加速康复理念在脊柱手术患者围术期中的应用. 国际护理学杂志, 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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