Abstract：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 preoperative and the postoperative incidence of malnutrition in well-nourishment group and malnourishment at risk group (all P values＞0.05), while the postoperative incidence of malnutrition in malnourished patients was obviously higher than that in the preoperative Results (all P values＜0.05). Group comparison of malnutrition incidence: the preoperative and postoperative incidence of malnutrition assessed by serological examinations was increased with the deterioration of nutritional status (all P values＜0.05). The MNA score varied from 10-27 points with an average of (18.62 ± 3.25) points, and showed strong correlations with nutritional evaluation Results assessed by serological examinations ALB, PA, TRA, and TLP (all P values＜0.05). The true total blood loss, the dominant blood loss, the HBL and its proportion on total blood loss, and the prevalence of high HBL were all increased with the deterioration of nutritional status (all P values＜0.05). Conclusions The MNA is the reliable method for evaluating the nutrition status of the elderly hip fracture patients, and the lower the MNA score, the higher the perioperative incidence of malnutrition, and the incidence of perioperative high HBL will be increased in elderly hip fractures patients with poor nutritional status when they are performed the hemiarthroplasty.
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,. 老年人营养状况与人工股骨头置换围术期隐性失血间相关性研究[J]. 中华解剖与临床杂志, 2018, 23(4): 311-317.
Liu Guoyin, Ju Zeyou, Zhang Yong, Bao Lei, Xu Yuansheng, Wang Jin, Sun Xiaocao, Jiang Wenli, Leng Nannan, Chen Jianmin.. The impact of nutritional status variation on perioperative hidden blood loss in elderly patients with hemiarthroplasty. Chinese Journal of Anatomy and Clinics, 2018, 23(4): 311-317.
Cereda E, Pedrolli C, Klersy C, et al. Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA?[J]. Clin Nutr, 2016, 35(6): 1282-1290. DOI:10.1016/j.clnu.2016.03.008
[2]
Carpintero P, Lopez P, Leon F, et al. Men with hip fractures have poorer nutritional status and survival than women: a prospective study of 165 patients[J]. Acta Orthop, 2005, 76(3): 331-335. DOI:10.1080/00016470510030788
[3]
García-Casanova MC, Estevez-Pereda MI, Valverde-Quintairos MI, et al. Nutritional status in patients older than 65 after a hip fracture[J]. Enferm Clin, 2011, 21(2): 75-83. DOI:10.1016/j.enfcli.2011.01.005
[4]
Gómez Valiente da Silva H, Fonseca de Andrade C, Bello Moreira AS. Dietary intake and nutritional status in cancer patients; comparing adults and older adults[J]. Nutr Hosp, 2014, 29(4): 907-912. DOI:10.3305/nh.2014.29.4.7131
[5]
Izawa KP, Watanabe S, Oka K. Relationship of thresholds of physical performance to nutritional status in older hospitalized male cardiac patients[J]. Geriatr Gerontol Int, 2015, 15(2): 189-195. DOI:10.1111/ggi.12257
[6]
Lægreid IK, Aasarød K, Bye A, et al. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients[J]. Ren Fail, 2014, 36(1): 9-16. DOI:10.3109/0886022X.2013.830206
[7]
Fiatarone Singh MA. Exercise, nutrition and managing hip fracture in older persons[J]. Curr Opin Clin Nutr Metab Care, 2014, 17(1): 12-24. DOI:10.1097/MCO.0000000000000015
[8]
Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture[J]. J Bone Joint Surg Br, 2006, 88(8): 1053-1059. DOI:10.1302/0301-620X.88B8.17534
[9]
Rogowski l, Kusztal M, Gołebiowski T, et al. Nutritional assessment of patients with end-stage renal disease using the MNA scale[J]. Adv Clin Exp Med, 2018 . DOI: 10.17219/acem/75604
[10]
Toniazzo MP, Amorim PS, Muniz FWMG, et al. Relationship of nutritional status and oral health in elderly: systematic review with meta-analysis[J]. Clin Nutr, 2018, 37(3): 824-830. DOI:10.1016/j.clnu.2017.03.014
[11]
Freeman MC, Garn JV, Sclar GD, et al. The impact of sanitation on infectious disease and nutritional status: a systematic review and meta-analysis[J]. Int J Hyg Environ Health, 2017, 220(6): 928-949. DOI:10.1016/j.ijheh.2017.05.007
Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the mini-nutritional assessment short form with changes in mobility, institutionalization and death after hip fracture[J]. Eur J Clin Nutr, 2016, 70(3): 393-398. DOI:10.1038/ejcn.2015.174
[14]
Nikkel LE, Fox EJ, Black KP, et al. Impact of comorbidities on hospitalization costs following hip fracture[J]. J Bone Joint Surg Am, 2012, 94(1): 9-17. DOI:10.2106/JBJS.J.01077
[15]
Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States[J]. JAMA, 2009, 302(14): 1573-1579. DOI:10.1001/jama.2009.1462
[16]
Boddaert J, Raux M, Khiami F, et al. Perioperative management of elderly patients with hip fracture[J]. Anesthesiology, 2014, 121(6): 1336-1341. DOI:10.1097/ALN.0000000000000478
[17]
Boddaert J, Cohen-Bittan J, Khiami F, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture[J]. PLoS One, 2014, 9(1): e83795. DOI:10.1371/journal.pone.0083795
[18]
Goisser S, Schrader E, Singler K, et al. Malnutrition according to mini nutritional Assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture[J]. J Am Med Dir Assoc, 2015, 16(8): 661-667. DOI:10.1016/j.jamda.2015.03.002
[19]
Gumieiro DN, Rafacho BP, GonÇalves AF, et al. Mini nutritional assessment predicts gait status and mortality 6 months after hip fracture[J]. Br J Nutr, 2013, 109(9): 1657-1661. DOI:10.1017/S0007114512003686
[20]
Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture[J]. J Bone Joint Surg Br, 2006, 88(8): 1053-1059. DOI:10.1302/0301-620X.88B8.17534
[21]
Singla A, Malhotra R, Kumar V, et al. A randomized controlled study to compare the total and hidden blood loss in computer-assisted surgery and conventional surgical technique of total knee replacement[J]. Clin Orthop Surg, 2015, 7(2): 211-216. DOI:10.4055/cios.2015.7.2.211
[22]
Miao K, Ni S, Zhou X, et al. Hidden blood loss and its influential factors after total hip arthroplasty[J]. J Orthop Surg Res, 2015, 10: 36. DOI:10.1186/s13018-015-0185-9
[23]
Gao F, Sun W, Guo W, et al. Topical application of tranexamic acid plus diluted epinephrine reduces postoperative hidden blood loss in total hip arthroplasty[J]. J Arthroplasty, 2015, 30(12): 2196-2200. DOI:10.1016/j.arth.2015.06.005
2018, Vol. 23 
