摘要
目的 调查不同疾病患者住院期间营养状态变化.方法 2014年6月至9月在国内34家医院进行研究;按以下标准纳入6 638例住院患者：（1）所患疾病为恶性肿瘤（2 487例）,消化系统良性疾病（1 358例）,神经系统良性疾病（1 043例）,骨性良性疾病（451例）,呼吸系统良性疾病（395例）,心血管系统良性疾病（227例）,甲状腺乳腺良性疾病（179例）,内分泌系统疾病（149例）等进行调查;（2）住院时间7.30 d;（3）年龄≥18岁.于入院和出院24h内记录患者临床资料、进行人体体格测量,应用营养风险筛查（NRS-2002）和主观全面营养评定（SGA）工具评估营养状况;记录住院期间营养支持情况.计量资料组间比较采用t检验或Wilcoxon秩和检验,计数资料和等级资料组间比较采用x2检验或Fisher确切概率法.结果 共纳入住院患者6 638例,男性3 861例,女性2 777例,男女比例为1.4∶1.0;中位年龄为60岁;中位身高为1.66 m;中位体重为62 kg;中位体重指数（BMI）为22.9 kg/m^2.与入院时相比,恶性肿瘤患者出院时的体重、BMI、握力、上臂围和小腿围较入院时均显著降低（t=20.15.259.67,P值均＜0.01）;消化系统良性疾病患者的体重和小腿围显著下降（沪35.27、60.40,P＜0.01）;骨性良性疾病患者的体重显著下降（t=2.12,P=0.033）;甲状腺乳腺疾病患者的体重、握力和上臂围均显著下降（t=2.79.～ 10.18,P值均＜0.01）;恶性肿瘤患者出院时营养风险（NRS-2002）发生率显著升高（x^2=21.275,P=0.000）;恶性肿瘤和骨性疾病患者,出院时中度以上营养不良（SGA）发生率显著升高（x^2=62.318,P=0.000;x^2=11.312,P＜0.01）;其他类型疾病患者出入院结果比较差异无统计学意义;本组存在营养风险的患者,除消化系统良性疾病患者外,其他病患接受营养支持的比例不超过50％,并且肠外营养的应用比例较高.结论 恶性肿瘤住院患者营养问题尤为突出,其入院时营养风险或营养不良发生率较高,出院时有恶化表现;应规范住院期间的营养治疗,重视出院患者的营养状况筛查和评价,合理干预,预防体重丢失,提高生活质量.
Objective To evaluate changes in nutritional status of hospitalized patients with different diseases by subjective global assessment （SGA） and nutritional risk screening （NRS-2002）.Methods A prospective and parallel rcscarch done by multi-center collaboration from 34 hospitals in China from June to September 2014.Hospitalized patients with the following diseases were investigated：malignant tunor （2 487 cases）,benign disease of the digestive system （1 358 cases）,benign disease of the nervous system （1 043 cases）,benign bone disease （451 cases）,benign disease of the respiratory system （395 cases）,cardiovascular disease （227 cases）,benign thyroid and breast disease （179 cases）,and endocrine disease （149 cases）.Patients above the age of 18 and hospitalization time between 7-30 days were included.Physical indexes were measured,the NRS-2002 and SGA scores were recorded,the nutritional support were recorded during hospitalization and 24 hours after discharge from hospital.Measurement data between groups were analyzed using t test or Wilcoxon rank sum test,enumeration data and ranked data between groups were analyzed using chi-square test or Fisher exact test.Results There were 6 638 cases of hospitalized patients,3 861 cases were males and 2 777 were females,the male/female ratio was 1.4 ∶ 1.0;the median age was 60 years;the median height was 1.66 m;the median weight was 62 kg;the median body mass index （BMI）was 22.89 kg/m^2.At discharge,compared with that of admission,the body weight,BMI,grip strength,upper arm and calf circumferences of patients with malignant tumor were significantly decreased （t=20.15-259.67,all P〈0.01）;the body weight and calf circumference were significantly decreased （t =35.27,60.40,P 〈 0.01） of patients with digestive benign disease;the body weight of patients with benign bone diseases was decreased （t =2.12,P =0.033）;the body weight,grip strength and upper arm circumference were decreased in patients with benign thyroid and breast disease （t =2.79-10.18,all P〈0.01）;nutritional risk incidence rate （from NRS-2002） of patients with malignant tumor was significantly higher （x2 =21.275,P =0.000）;moderate malnutrition （from SGA） incidence rate was significantly higher （x^2 =62.318,P =0.000;x^2 =11.312,P〈 0.01） in patients with malignant tumor and with orthopedics diseases.Compared with that of admission,records of the patients with other diseases had no statistically difference at discharge,no more than 50% of the patients under risk of nutritional deficiency （except those with digestive benign diseases） received nutritional support,while the proportion of non-parenteral nutrition application was higher.Conclusion The patients with malignant tumor have higher incidence rate of malnutrition on admission and at discharge.Doctors should pay more attention to the nutritional status（screening and evaluation） of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2017年第4期297-302,共6页
Chinese Journal of Surgery
关键词
营养调查
住院病人
出院患者营养状态
营养风险筛查
主观全面营养
评定
Nutrition surveys
Inpatients
Nutritional status of patients at discharged
Nutritional risk screening 2002
Subjective global assessment
