我国大型医院老年患者住院期间营养风险及营养不良发生率变化的多中心调查

Q4 Nursing

中华临床营养杂志 Pub Date : 2019-04-30 DOI:10.3760/CMA.J.ISSN.1674-635X.2019.02.001

Jie Pan, H. Cui, Mingwei Zhu, Wei Chen, Xin Yang, Pian-hong Zhang, X. Liang, Jianqin Sun, Yan Shi, Hong-yu Zhang, Ya-Jie Gao, Sai-nan Zhu

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引用次数: 2

摘要

目的利用2002年营养风险筛查(NRS 2002)和主观总体评价(SGA)，动态了解我国各大医院老年患者住院期间营养状况的变化。方法对2014年6月至2014年9月在国内9家大型医院消化内科、呼吸内科、普外科、老年科、胸外科、神经内科、骨科、肿瘤内科住院7-30天的65岁以上老年患者进行前瞻性、多中心调查。入院时及出院后24小时内记录临床资料，测量体格指标，并进行实验室检查。采用NRS 2002和SGA进行评价。同时记录营养支持和临床结果，分析营养状况与临床结果的相关性。结果共纳入2558例65岁以上患者。出院时握力、上臂围、脚围较入院时明显降低(P<0.05)。总蛋白、白蛋白、血红蛋白水平均显著低于入院时(P<0.05)。入院时营养风险(NRS 2002评分≥3分)和营养不良(SGA B+ C)发生率低于出院时(51.1% vs 53.0%， 32.6% vs 35.6%)。营养不良患者入院时的住院时间和医疗费用均高于营养摄入正常的患者。出院时营养状况与住院时间、医疗费用呈负相关。61.3%有营养风险的患者在住院期间未接受营养支持，接受营养支持的患者肠外营养使用率高于肠内营养使用率(19.6% vs 11.9%)。结论老年患者入院时面临营养风险或营养不良的可能性较大，临床预后较差，出院时营养状况不会明显改善。因此，应对老年患者住院期间的营养状况进行筛查和评估，规范其营养干预，以提高临床疗效。关键词:老年患者;动态营养调查;出院患者营养状况;营养风险筛查;主观全局评价;住院时间;医疗费用

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A multicenter survey on changes in nutritional risk and malnutrition incidence of elderly patients in Chinese large hospitals during hospitalization

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization. Methods A prospective, multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology, respiratory medicine, general surgery, geriatrics, thoracic surgery, neurology, orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014. On admission and within 24 hours after discharge, the clinical data were recorded, physical indices were measured, and laboratory examination were conducted. NRS 2002 and SGA were used to make an evaluation. The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed. Results A total of 2558 patients above 65 years old were included into the study. Compared with their status on admission, their grip strength, upper arm circumference and crural circumference were reduced significantly at discharge (P<0.05). The total protein, albumin and hemoglobin levels were significantly lower than those on admission (P<0.05). The incidence of nutritional risk (NRS 2002 score≥3)and malnutrition (SGA B+ C) on admission were lower than those at discharge (51.1% vs 53.0%, 32.6% vs 35.6%). The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes. The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses. 61.3% patients having nutritional risk did not take nutritional support during the hospital stay, while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6% vs 11.9%). Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission, these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge. Therefore, the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes. Key words: Elderly patients; Dynamic nutrition survey; Nutritional status of discharged patients; Nutritional risk screening; Subjective global assessment; Length of hospital stay; Medical expenses

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来源期刊

中华临床营养杂志 Nursing-Nutrition and Dietetics

CiteScore

0.20

自引率

0.00%

发文量

2282

期刊介绍： The Chinese Journal of Clinical Nutrition was founded in 1993. It is the first professional academic journal (bimonthly) in my country co-sponsored by the Chinese Medical Association and the Chinese Academy of Medical Sciences to disseminate information on clinical nutrition support, nutrient metabolism, the impact of nutrition support on outcomes and "cost-effectiveness", as well as translational medicine and nutrition research. It is also a professional journal of the Chinese Medical Association's Parenteral and Enteral Nutrition Branch. The purpose of the Chinese Journal of Clinical Nutrition is to promote the rapid dissemination of knowledge on nutrient metabolism and the rational application of parenteral and enteral nutrition, focusing on the combination of multidisciplinary and multi-regional field investigations and clinical research. It mainly reports on nutritional risk screening related to the indications of parenteral and enteral nutrition support, "cost-effectiveness" research on nutritional drugs, consensus on clinical nutrition, guidelines, expert reviews, randomized controlled studies, cohort studies, glycoprotein and other nutrient metabolism research, systematic evaluation of clinical research, evidence-based case reports, special reviews, case reports and clinical experience exchanges, etc., and has a special column on new technologies related to the field of clinical nutrition and their clinical applications.