牙颌面畸形正颌手术患者营养状况变化轨迹及其影响因素分析

doi:10.19438/j.cjoms.2026.03.007

摘要/Abstract

摘要： 目的: 分析牙颌面畸形正颌手术患者营养状况变化轨迹及其影响因素,为制订个性化营养干预方案提供指导。方法: 采用便利抽样法,选择2023年12月—2024年12月在上海交通大学医学院附属第九人民医院接受正颌手术的241例牙颌面畸形患者,收集一般人口学资料、口腔及营养相关资料和实验室指标,使用营养风险筛查表（Nutritional Risk Screening 2002,NRS2002）进行营养评估,并根据全球营养不良评定标准共识及营养状况变化轨迹对患者进行分组。采用单因素和多元logistic回归分析患者营养状况变化轨迹的影响因素。结果: 241例牙颌面畸形患者术前、出院、术后2周、术后1个月和术后3个月的营养风险发生率分别为18.26%、100.00%、100.00%、69.71%和25.31%,其中术后2周和术后1个月,重度营养不良患者均有73例（30.29%）;出院和术后2周,轻度/中度营养不良患者分别有176例（73.03%）和168例（69.70%）。输纤维蛋白原、输血、术后摄入量、术前增重计划、出院饮食计划者是牙颌面畸形正颌手术患者营养状况变化的主要影响因素（P<0.05）。结论: 牙颌面畸形正颌手术患者营养风险变化波动较大,医护人员应持续监测患者营养状况,严格规范围术期输注纤维蛋白原、输血指征,加强营养宣教,协助患者合理计划饮食,从而有效改善牙颌面畸形患者全周期营养难题。

关键词: 牙颌面畸形, 正颌手术, 营养评估, 营养不良, 变化轨迹, 影响因素

Abstract: PURPOSE: To analyze the trajectory of nutritional status changes and their influencing factors in patients with dento-maxillofacial deformities during orthognathic surgery, so as to provide guidance for the formulation of personalized nutritional intervention plans in clinical practice. METHODS: A convenience sampling method was adopted to select 241 patients with dento-maxillofacial deformities who underwent orthognathic surgery at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2023 to December 2024. General demographic data, oral and nutrition-related information, and laboratory indicators were collected. Nutritional monitoring was performed using the Nutritional Risk Screening 2002 (NRS2002) scale. The nutritional status of patients with dento-maxillofacial deformities was evaluated at 5 time points (preoperatively, at discharge, 2 weeks postoperatively, 1 month postoperatively, and 3 months postoperatively) based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Univariate analysis and multivariate logistic regression analysis were conducted. RESULTS: Among the 241 patients with dentomaxillofacial deformities, the incidence rates of nutritional risk before surgery, at discharge, 2 weeks after surgery, 1 month after surgery, and 3 months after surgery were 18.26%, 100.00%, 100.00%, 69.71% and 25.31%, respectively. Specifically, totally 73 patients (30.29%) had severe malnutrition both at 2 weeks and 1 month after surgery, while 176 patients (73.03%) and 168 patients (69.70%) had mild/moderate malnutrition at discharge and 2 weeks after surgery, respectively. Preoperative weight gain plans, fibrinogen transfusions, blood transfusions, postoperative intake, and discharge dietary plans were the primary factors influencing nutritional status changes in patients undergoing orthognathic surgery for dento-maxillofacial deformities (P<0.05). CONCLUSIONS: Patients undergoing orthognathic surgery for dento-maxillofacial deformities present with considerable fluctuations in nutritional risk. In this regard, medical staff should strictly standardize the perioperative indications for fibrinogen infusion and blood transfusion, strengthen nutritional education, assist patients in formulating a rational diet plan, and thus effectively resolve the full-cycle nutritional challenges faced by these patients.

Key words: Dento-maxillofacial deformities, Orthognathic surgery, Nutritional assessment, Malnutrition, Change trajectory, Influencing factor

中图分类号:

R782.2

俞瑾娴, 刘婷, 王璧霞, 蒋恋田, 袁卫军, 顾芬. 牙颌面畸形正颌手术患者营养状况变化轨迹及其影响因素分析[J]. 中国口腔颌面外科杂志, 2026, 24(3): 247-254.

Yu Jinxian, Liu Ting, Wang Bixia, Jiang Liantian, Yuan Weijun, Gu Fen. Analysis of changes in nutritional status and its influencing factors in patients undergoing orthognathic surgery for dento-maxillofacial deformities[J]. China J Oral Maxillofac Surg, 2026, 24(3): 247-254.

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