摘要目的?探讨基于营养支持的加速康复外科理念在老年髋部骨折患者关节置换围手术期护理中的应用.方法?2015年1月—2017年6月采用便利抽样法选取存在营养风险(NRS2002≥3分)的老年髋部骨折患者278例,采用信封法随机分为观察组(n=132)和对照组(n=146).观察组采取营养支持并纳入快速康复护理流程,对照组给予常规围手术期护理,不给予标准营养支持.比较两组患者术后第2天白蛋白水平、术后第2天血红蛋白减少量、ADL评分、首次下床时间、住院时间、并发症发生情况等.结果?观察组患者术后第2天白蛋白(29.16±1.33)g/dl,术后ADL评分(63.90±5.47)分,高于对照组;术后血红蛋白丢失量(1.34±0.30)g/dl,首次下床时间(1.56±0.20)d,术后住院天数(7.08±2.23)d,低于对照组,差异均有统计学意义(t值分别为-3.089、-14.881、-13.640、-15.279、-8.480;P＜0.05).观察组术后并发症发生率为9.09%,低于对照组的19.18%,差异有统计学意义(χ2=3.877,P＜0.05).结论?基于营养支持的快速康复护理可以缩短老年髋部骨折患者住院时间,促进关节置换术后康复,改善患者的临床结局.

abstractsObjective? To explore the effects of enhanced recovery after surgery based on nutritional support in perioperative nursing of elderly patients with hip fracture and joint replacement. Methods? From January 2015 to June 2017, we selected 278 elderly hip fracture patients with nutritional risk (NRS 2002≥3) by convenience sampling. All of the patients were divided into observation group (n=132) and control group (n=146) with the method of envelope. Observation group accepted nutritional support and brought it into enhanced recovery nursing process. Control group applied routine perioperative nursing without standardized nutritional support. We compared the albumin and loss of hemoglobin at the second day after surgery, the score of activity of daily living (ADL), time of getting out from bed for the first time, hospital stay as well as complications of patients between two groups. Results? The albumin at the second day after surgery and score of ADL of patients in observation group were (29.16±1.33) g/dl and (63.90±5.47) respectively higher than those in control group;the loss of hemoglobin after surgery, time of getting out from bed for the first time, hospital stay in observation group were (1.34±0.30) g/dl, (1.56±0.20)d, (7.08±2.23)d respectively lower than those in control group;the differences were all statistical (t=-3.089, -14.881, -13.640, -15.279, -8.480;P＜0.05). The incidence of complications of observation group was 9.09% lower than that of control group (19.18%) with statistical difference (χ2=3.877, P＜0.05). Conclusions? Enhanced recovery nursing based on nutritional support can shorten the hospital stay in elderly patients with hip fracture, promote postoperative rehabilitation after hip joint replacement and improve clinical outcomes of patients.