摘要
目的 探讨微型营养评价法（MNA）评分用于老年人营养状况评定的可行性,以及老年人营养状况对人工股骨头置换术后隐性失血的影响.方法 回顾性分析2010年1月—2015年5月在南京中医药大学附属八一医院行人工股骨头置换术的202例老年股骨颈骨折患者的临床资料.其中男74例,女128例;年龄70～95（81.3±8.5）岁.根据MNA评分将患者分为营养良好组、潜在营养不良组和营养不良组,对比各组血清营养学指标白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TRA）和淋巴细胞百分比（TLP）测量值的变化情况,依据ALB、PA、TRA、TLP评估各组营养不良的发生率,进一步比较各组营养不良发生率的变化情况.分析MNA评分与血清营养学指标之间的相关性.根据患者身高、体质量、术中和术后出血量、手术前后红细胞比容和输血量,计算所有患者的总失血量及总隐性失血量,按照总隐性失血量占总失血量比例将患者分为低隐性失血量组和高隐性失血量组,分析不同营养状态组术后高隐性失血率的发生情况.结果 营养良好组PA、TLP,潜在营养不良组TRA、TLP,以及营养不良组PA、TRA、TLP术后测量值均低于术前,差异均有统计学意义（P值均〈0.05）;随着营养状态的恶化,术前、术后ALB、PA、TRA、TLP均依次明显降低,差异均有统计学意义（P值均〈0.05）.不同营养状况组营养不良发生率组内比较：营养良好组和潜在营养不良组术后营养不良的发生率与术前比较差异均无统计学意义（P值均〉0.05）,而营养不良组术后营养不良的发生率均明显高于术前,差异均有统计学意义（P值均〈0.05）;组间比较：各组随着营养状态的恶化,术前、术后营养不良的发生率均依次增高,差异均有统计学意义（P值均〈0.05）.202例患者MNA评分10～27（18.62±3.25）分,MNA评分与ALB、PA、TRA和TLP呈正相关关系,差异均有统计学意义（
Objective To investigate the viability of mini nutritional assessment （ MNA） score on the nutritional status, and to observe the effects of nutritional status on hidden blood loss （ HBL） . Methods A retrospective study of 202 elderly patients with hip fractures aged 70-95（81. 3 ± 8. 5） from January 2010 to May 2015 was performed at the 81th Hospital Affiliated Nanjing University of Chinese Medicine. By MNA, patients were randomly divided into three groups： well-nourishment group, malnourishment at risk group and malnourishment group. The variation of serological examinations in each group was compared, and the variation of malnutrition incidence was compared via nutritional evaluation results assessed by serological examinations albumin （ ALB ） , prealbumin （ PA ） , transferring albumen （ TRA ） , and the lymphocyte percentage（ TLP） . The results were also used to analyze the correlations among MNA score and serological examinations. The true total blood loss and its proportion on original blood volume, the HBL and its proportion on total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre-and post-operative hematocrit, and blood transfused. According to the proportion of mean hidden blood loss（ HBL） on total blood loss, patients were divided into low and high HBL group, and the occurrence of post-operative high HBL was analyzed in each group. Results The PA and TLP in well-nourishment group, TRA and TLP in malnourishment at risk group, and PA, TRA, TLP in malnourishment group were all significantly lower than those in the preoperative results （all P values 〈0. 05）. Group comparison of nutritional status average value：the ALB in postoperative results, and the PA, TRA, TLP in preoperative and postoperative results were reduced with the deterioration of nutritional status （ all P values〈0. 05）. Intra-group comparison of malnutrition incidence： there was no statistically significant difference between the
作者
刘国印
琚泽友
张勇
鲍磊
徐院生
王进
孙小草
蒋文丽
冷楠楠
陈建民
Liu Guoyin;Ju Zeyou;Zhang Yong;Bao Lei;Xu Yuansheng;Wang Jin;Sun Xiaocao;Jiang Wenli;Leng Nannan;Chen Jianmin(Department of Orthopaedics,the 81th Hospital Affiliated Nanjing University of Chinese Medicine,Nanjing 210000,China)
出处
《中华解剖与临床杂志》
2018年第4期311-317,共7页
Chinese Journal of Anatomy and Clinics
基金
南京市科技计划项目（201303039）
南京军区科技创新项目（MS055）
关键词
股骨颈骨折
营养不良
关节成形术
置换
围术期
隐性失血
Femoral neck fractures
Malnutrition
Arthroplasty
replacement
Perioperative
Hidden blood loss.
