| ObjectiveTo investigate and analyze the perioperative fasting duration and energy intake in severe burn patients,thus providing reference for rational perioperative nutritional support.MethodsRecords of severe burn patients,admitted to the department of plastic and burn surgery of Tianjin First Central Hospital from January 2014 to December 2018 and meeting inclusion criteria,were retrospectively reviewed.Perioperative fasting duration and energy intake from the preoperative Day 1 to the postoperative Day 3were recorded according to critical care records and anesthesia notes.The perioperative fasting time consists of 3 parts:preoperative fasting duration,anesthesia duration and postoperative fasting duration.Based on the energy intake on the Day 1before operation,the energy intake on the day of surgery and overall perioperative period was evaluated.The potential influencing factors of fasting duration and energy intake during perioperative period were explored.The effect of different fasting time on serum biochemical indices during perioperative period were analyzed.The measurement data were either expressed as mean±standard deviation or median(interquartile range),for which t test,one-way ANOVA,or rank sum test,rank correlation analysis were performed respectively.Chi square test or Fisher's exact probability were performed for categorical data.Results1.Twenty-five patients[22 males and 3 females,(40.6±17.1)y,(68±20)%TBSA]with a total of 57 surgeries were included.ICU recording days was 24(14,48)days and LOS was 90(42,182)days.Patients started drinking water in 6(5,8)h after injury,and feeding was initiated within 13(7,28)h postburn.2.The fasting duration was 10(8,12)hours before and 8(6,9)hours after surgery,68%of the preoperative fasting time and 65%of postoperative fasting time were up to 6~12 hours.The anesthesia duration was(4.6±1.0)h.The perioperative fasting time was 23(20,27)h,without one less than 12 h in 57 surgeries.There was a positive correlation between the perioperative fasting time and the operation start time(r_s=0.433,P=0.001).The later the operation began,the longer the perioperative fasting time was.3.The energy intake of burn patients with 31%~50%,51%~70%,70%~100%TBSA burn on the day of operation was(1057±845)kcal,(582±428)kcal,401(296,743)kcal respectively.The energy intake of 25 severe burn patients on the day of operation was 30.8%(11.7%,58.8%)of the preoperative day,and 70.2%derived from parenteral nutrition,80.0%provided by carbohydrate.For patients suffered from30%~70%TBSA burn,the energy intake was negatively correlated with the burn area on the day of operation(r_s=-0.409,P=0.038).The average daily energy intake during the perioperative period was(1922±773)kcal.Sixty-three point two percent of the energy intake during perioperative period was affected by fasting,and postoperative intake failed to compensate for the deficits of energy intake on the day of operation.4.The average of perioperative daily energy intake was negatively correlated with age(r_s=-0.589,P<0.001)and perioperative fasting time(r_s=-0.358,P=0.008),while positively correlated with postburn time to surgery(r_s=0.359,P=0.006).No correlation was found between it with sex(r=0.064,P=0.636),weight(r_s=-0.225,P=0.102)or TBSA involved(r_s=-0.078,P=0.563).5.The average daily energy intake in the perioperative fasting 19~21h group was more than that in the 21~24h fasting group(t=3.385,P=0.003).Differences in blood glucose,triglyceride,prealbumin,urea,creatinine levels between the two groups were not statistically significant.Conclusions1.Patients with severe burns had a long time of fasting before operation,so the operation should be arranged reasonably to avoid unnecessary fasting and relieve the stress reaction resulting from starvation.2.The energy intake of severe burn patients was low on the day of operation,most of which derived from parenteral nutrition preparations and were provided by carbohydrates.Energy intake and proportion of fat and amino acid should be properly increased through enteral and parenteral nutrition support.3.The perioperative energy intake in extensive burns,elderly patients and early postburn days was low and merits attention. |
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