開心手術病人手術前後營養狀況與手術後預後相關性之探討

Exploring the Relationships of Pre- and Post-Operative Nutritional Status with the Prognosis of Patients after Open Heart Surgery

劉慧玲(Huey-Ling Liou) ； 邱艷芬(Yann-Fen(Chiou)Chao)

《護理研究》 5卷3期 (1997/06) Pp. 267-278

https://doi.org/10.7081/NR.199706.0267

摘要

本研究以某醫學中心的心臓血管外科病房及加護單位之病人共72位爲對象，於接受開心手術前一日及開刀後住院期間週期性地評估其營養指標及預後指標。研究目的探討開心手術病人手術前後營養狀況及其改變手術後預後之相關性。研究結果發現：(1)72位開心手術病人手術後一週的血清中白蛋白、血紅素、血比容、淋巴球總數、三頭肌皮膚摺層厚度、上臂中點肌肉環圍皆明顯的降低。(2)4位手術前營養不良者，手術後死亡率爲25%；手術後33位低白蛋白血症者，手術後死亡率爲3.03%，手術後合併症爲6.06%。(3)手術前後營養指標與手術後預後具有顯著之相關。(4)可預測手術後預後之營養指標及控制變項是：年齡、美國紐約心臓協會心臓功能分類可解釋氣管內管留置時數變異之10%；手術前血比容、美國紐約心臓協會心臓功能分類及性別可解釋住加護單位天數變異之26%；手術後一週之血清白蛋白及手術前血比容可解釋手術後住院天數變異之20%；手術後一週身體活動度變異之21%可爲體外循環心肺機使用時間及手術後一週血比容所解釋。建議爲開心手術病患進行術前、術後營養評估，並對術前術後營養指標低於正常值者進一步探討適切之營養措施，及評估營養措施之效果，使對營養不良之開心手術的病人的預後有實際之幫助。

關鍵字

開心手術 ； 營養狀況 ； 手術後預後

並列摘要

The objective was to investigate the nutritional status of open-heart surgery patients prior to the operation and the correlation between the change of status and post-operative prognosis. A total of 72 patients from the cardiovascular surgery ward and intensive care unit (ICU) of a medical center were enrolled for study. These patients were evaluated periodically with respect to their nutritional index and prognostic index one day prior to open-heart surgery and during the post-operative hospitalization period. The study results indicated: (1) all 72 open-heart surgery patients exhibited marked decrease in serum albumin, hemoglobin, total lymphocyte count, hematocrit, skin fold thickness of the triceps muscle and mid-arm muscle circumference one week post-operation; (2) the mortality rate of 4 pre-operative malnourished patients was 25%, that of 33 patients with post-operative hypoalbuminemia was 3.03%, and the post-operative complication rate was 6.06%; (3) the correlation between the pre-operative nutritional index and post-operative prognosis was statistically significant; (4) nutritional indices and control variables that could predict post-operative prognosis were as follows: age and the cardiac function classification of New York American Heart Association could explain 10% of the variation of endotracheal tube intubating time; pre-operative hematocrit and cardiac function classification of New York American Heart Association could explain 26% of the variation of hospitalization days in ICU; serum albumin one week post-operatively and pre-operative hematocrit could account for 20% of variation in post-operative hospitalization days; 21% of the variation of physical activity one week post-operatively could be explained by extracorporeal cardiac pulmonary bypass time, hematocrit one week post-operatively. The study suggests that clinical nursing staff should make routine pre- and post-operative nutritional assessments of open heart surgery patients. Further, based on the information acquired from the assessment, appropriate nutritional intervention can be provided that might be helpful in improving the post-operative prognosis of malnourished open-heart surgery patients.

並列關鍵字

open-heart surgery ； nutritional status ； post-operative prognosis