正颌手术中的个体化围手术期营养管理：一个连接上气道变化、进食功能与心理状态的循证分级整合框架。

文献信息

中文摘要

正颌手术可矫正牙颌面畸形，并越来越多地用于处理上气道阻塞，但术后饮食限制可能导致摄入不足、体重下降和瘦体重耗竭。营养照护仍研究不足，且很少被视为一个多维问题。本小型综述综合了术后营养三个相互作用决定因素的证据：上气道形态改变、咀嚼与吞咽的暂时性受损，以及围手术期心理状态。由于证据明显不对称，我们按各领域与所测营养结局的接近程度进行分级。只有进食功能具有直接的纵向支持：摄入量、体重、肌肉量和血清标志物随咀嚼功能恢复而变化，其中摄入量在第一周最低，体重约在4个月时恢复，而肌肉量在6个月时仍未完全恢复。气道和心理路径的证据仍为间接。下颌后退会减小气道容积并可能增加阻塞性睡眠呼吸暂停风险，而下颌前徙则扩大气道；两者均可能改变吞咽力学。焦虑、抑郁和躯体变形障碍也很常见，但尚无研究在该人群中把气道变化或心理状态与摄入量、体重或身体成分联系起来。效应不能从一般人群外推，因为在一般人群中睡眠限制可能增加能量摄入，而抑郁对食欲的影响是双向的。因此，我们提出一个明确的、旨在产生假说的、按风险分层的框架。其进食功能分支可指导实践；其气道和心理分支支持低风险预防措施和针对性研究。我们概述了将推断性联系转化为实测联系所需的最低限度研究设计，并确定了个体化营养管理的优先事项。

英文摘要

Orthognathic surgery corrects dentofacial deformity and increasingly addresses upper-airway obstruction, but postoperative dietary restriction may cause inadequate intake, weight loss, and lean-mass depletion. Nutritional care remains underexamined and rarely treated as a multidimensional problem. This mini-review synthesizes evidence across three interacting determinants of postoperative nutrition: upper-airway morphological change, temporary impairment of mastication and swallowing, and perioperative psychological status. We grade each domain by its proximity to measured nutritional outcomes because the evidence is markedly asymmetric. Only feeding function has direct longitudinal support: intake, weight, muscle mass, and serum markers track masticatory recovery, with intake lowest in week one, weight recovering by about 4 months, and muscle mass remaining incompletely restored at 6 months. Evidence for airway and psychological pathways remains indirect. Mandibular setback reduces airway volume and may increase obstructive sleep apnea risk, whereas advancement enlarges the airway; both may alter swallowing mechanics. Anxiety, depression, and body dysmorphic disorder are also common, but no study has related airway change or psychological status to intake, weight, or body composition in this population. Effects cannot be extrapolated from general populations, where sleep restriction may increase energy intake, and depression affects appetite bidirectionally. We therefore present an explicitly hypothesis-generating, risk-stratified framework. Its feeding-function arm can inform practice; its airway and psychological arms support low-risk precautions and targeted research. We outline minimum study designs needed to convert inferred links into measured ones and identify priorities for individualized nutritional management.