老年综合评估及干预对老年住院患者营养指标及生存质量的影响

发布时间：2018-04-24 00:09

本文选题：营养不良 + 营养风险　；参考：《华北理工大学》2015年硕士论文

【摘要】：目的通过在改善老年住院患者营养状态的过程中引入老年综合评估(Comprehensive Geriatric Assessment,CGA),探讨在临床基本诊疗的基础上进行CGA及干预对老年住院患者营养指标及生存质量的影响,为更好地改善老年患者的营养状态、疾病预后及生活质量提供临床和实践依据。方法收集2013年5月~2014年5月在华北理工大学附属医院老年病科住院治疗的老年患者共768例,选取符合纳入标准者141例作为研究对象,其中男性70例,女性71例。纳入标准:①年龄在60~90岁之间;②微型营养评定量表得分小于23.5分;③意识清楚;④住院时间超过48h以上;⑤多种慢性疾病共存(同时合并2种及以上疾病);⑥知情并且愿意参加本次临床研究。将研究对象随机分成干预组71例和对照组70例,研究前所有入选患者均详细询问基本资料、疾病史、家族史、个人史和空腹8小时以上抽取外周静脉血检查前白蛋白、白蛋白、血红蛋白及淋巴细胞系数等血液营养指标,测量身高、体重、上臂肌围及小腿周径,并计算体质指数。所有入选患者入院3天内均完成营养风险评估、老年综合评估及生存质量评估各1次,对照组给予常规疾病治疗、营养指导、营养教育及营养支持,干预组同时实施CGA,针对CGA发现地问题,进行科学地干预。所有入选患者均给予4次营养风险评估,出院后1个月复查血液营养指标、3个月后复查生存质量评估。所有研究资料采用Excel 2003建立数据库,应用SPSS17.0统计软件进行统计学分析。计数资料用百分比表示,两组间比较采用卡方检验;计量资料用均数±标准差(x±s)表示,组内比较采用配对样本t检验,两组间比较采用秩和检验,P0.05为差异有统计学意义,P0.01为差异有显著统计学意义。结果1两组研究对象在性别、婚姻、文化程度、职业及年龄等基础资料、体重、体质指数、上臂肌围及小腿周径等人体测量学数据及老年综合评估等基础资料方面,两组间无明显差异(P0.05)。2入院第1天,两组研究对象在前白蛋白、白蛋白、血红蛋白及淋巴细胞计数等血液营养指标方面,两组间无明显差异(P0.05),1个月后复查血液营养指标,两组研究对象在血液营养指标上均有不同程度升高,干预组各项血液营养指标改善好于对照组(P0.05)。3入院后第1天,两组研究对象在MNA得分方面比较,两组间无明显差异(P0.05),入院第7天、第14天时,两组研究对象的MNA得分均有轻度升高,但两组间比较无明显差异(P0.05)。出院后第3个月复测发现干预组的MNA得分明显高于对照组,差异有显著统计学意义(P0.01)。4入院第1天时,两组研究对象在生存质量评估得分方面,两组间无明显差异(P0.05)。出院后3个月后,两组研究对象的生存质量评分均有所改提高(P0.05),且干预组在躯体疼痛,社会功能、精力、生理职能4个方面改善更为明显(P0.01)。结论1在临床常规诊疗老年营养不良的基础上引入CGA可以发现与老年营养不良发生密切相关的潜在问题。2在传统诊疗的基础上应用CGA并对所发现的问题进行合理干预,可进一步改善老年患者的血液营养指标及提高营养风险评估得分。3 CGA及干预在改善老年住院患者营养指标的同时能改善其生存质量,尤其是在躯体疼痛、社会功能、精力、生理职能等方面效果明显。
[Abstract]:Objective through the introduction of Comprehensive Geriatric Assessment (CGA) in improving the nutritional status of elderly hospitalized patients, the effect of CGA and intervention on the nutritional index and quality of life in elderly hospitalized patients on the basis of clinical basic diagnosis and treatment is discussed in order to better improve the nutritional status of the elderly patients and the disease precondition. A total of 768 elderly patients who were hospitalized in the Department of Geriatrics, North China University of science and technology, May 2013 ~2014, were collected in a total of 768 cases of elderly patients in the Department of Geriatrics, North China University of science and technology. 141 cases were selected as subjects, including 70 males and 71 females. The score of the assessment scale was less than 23.5 points; (3) consciousness clearly; (4) the time of hospitalization was more than 48h; (5) a variety of chronic diseases coexisted (at the same time combined with 2 or more diseases); 6. The subjects were informed and willing to participate in this clinical study. The subjects were randomly divided into 71 cases and 70 cases in the control group. All the patients who were selected before the study were asked the basic capital in detail. Materials, history of disease, family history, personal history, and fasting more than 8 hours of extraction of blood nutrition indexes, such as albumin, albumin, hemoglobin and lymphocyte coefficient, measured the height, body weight, upper arm muscle circumference and the circumference of the leg, and calculated the body mass index. All the selected patients completed the nutritional risk assessment within 3 days and the elderly healed. The evaluation and quality of life assessment were 1 times. The control group was given routine disease treatment, nutrition instruction, nutrition education and nutritional support. The intervention group carried out CGA at the same time. In view of the problems found in CGA, the intervention group was scientifically intervened. All the selected patients were given 4 nutritional risk assessment. After 1 months of discharge, the blood nutrition index was rechecked, and the survival was rechecked after 3 months. Quality assessment. All the research data were made up of Excel 2003 to establish a database, and SPSS17.0 statistical software was used for statistical analysis. The percentage of counting data was expressed as a percentage, and the two groups were compared with the chi square test; the measurement data were expressed with the mean standard deviation (x + s), and the t test of the matched pairs was used in the group, and the rank sum test was adopted between the two groups, P0.05 The difference was statistically significant, and there was significant statistical significance for the difference between the 1 groups. Results there were no significant differences between the two groups in the two groups, such as gender, marriage, education, occupation and age, body weight, body mass index, upper arm muscle circumference and lower leg circumference and other basic data, such as the comprehensive assessment of old age and so on. There was no significant difference between the two groups (P0.05). 2 on the first day of admission, there was no significant difference between the two groups in the blood nutrition indexes of the two groups, such as prealbumin, albumin, hemoglobin and lymphocyte count. The blood nutrition indexes were rechecked after 1 months, and the two groups were different in the blood nutrition index, and the blood nutrition indexes of the intervention group improved better than those in the two groups. First days after admission to the control group (P0.05).3, there was no significant difference between the two groups in the MNA score (P0.05), seventh days in the hospital and fourteenth days, the MNA scores of the two groups were slightly higher, but there was no significant difference between the two groups (P0.05). The score of MNA in the intervention group was significantly higher than that of the control group after third months of admission. The difference has significant statistical significance (P0.01) first days when.4 admission, the two groups of subjects in the quality of life assessment score, there is no significant difference between the two groups (P0.05). After 3 months after discharge, the two groups of subjects have improved quality of life score (P0.05), and the dry pregroup in the body pain, social function, energy, physiological functions of 4 aspects of the change The good is more obvious (P0.01). Conclusion 1 on the basis of clinical routine diagnosis and treatment of malnutrition, the introduction of CGA can find the potential problem that is closely related to the malnutrition of the elderly.2. The application of CGA on the basis of traditional diagnosis and the rational intervention on the problems found can further improve the blood nutrition index and improvement of the elderly patients. The nutritional risk assessment score.3 CGA and intervention can improve the quality of life of elderly hospitalized patients, especially in physical pain, social function, energy, physiological functions and so on.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.3

【参考文献】