普外科入出院患者营养状态调查与临床结局分析
发布时间：2019-03-02 18:15
【摘要】：目的:在天津医科大学总医院普外科,使用NRS2002和SGA、MNA、NRI四种工具对入院患者进行营养状态调查,比较四种工具的适用性和一致性以及每种工具所得筛查结果和临床结局的关系,并使用NRS2002和SGA对出院患者进行营养状态调查,了解住院期间患者营养风险和营养不良比例的变化,同时分析患者住院期间营养状态变化和临床结局的关系。方法:当患者入院第2天分别应用NRS2002和SGA、MNA、NRI进行营养筛查和评估,出院前2天应用NRS2002和SGA进行营养筛查和评估,并测定体重、手握力、上臂围、小腿围以及临床生化检验指标,使用SPSS 21.0系统对研究资料进行统计学分析,比较四种工具筛查结果的一致性,同时分析筛查结果和临床结局的关系。结果:1.入院NRS2002、SGA及MNA适用性91.91%,NRI适用性91.18%,出院NRS2002适用性90.44%,SGA适用性88.97%,NRS2002及SGA出入院双重评价适用性88.97%。四种方法对患者营养风险的评价具有一致性。将BMI≤18.5或ALB≤30g/L作为营养不良的一个标准,四种评价工具与该标准的一致性较差。2.出入院时不同年龄层营养评分比较,年龄≥65岁的患者评分结果与年龄65岁的患者评分结果差异有统计学意义,年龄≥65岁的患者的得分结果较差。出入院时不同年龄层有营养风险(营养不良)比例比较,差异有统计学意义。可认为年龄越大的患者营养风险(或营养不良)的可能性更大。3.是否恶性肿瘤患者营养状况的比较应用卡方检验,差异具有统计学意义,即恶性肿瘤患者营养风险及营养不良的比例更高。4.比较患者出入院时的体重、握力、上臂围、小腿围指标发现,各指标间的差异无统计学意义。使用NRS2002及SGA比较入院前后患者营养风险比例和营养不良比例的变化,我们发现出院时患者营养风险比例和营养不良比例和入院时比较均下降。5.住院期间营养支持情况:临床无营养支持者占28%,有营养支持者单独PN占57.6%,单独EN占2.4%,PN联合EN占12%,NRS2002工具评价对有营养风险的患者营养支持率为80%,SGA工具评价对有营养不良的患者营养支持率为83.3%。6.临床结局指标:四种营养筛查工具筛查结果均显示给予有营养风险(或营养不良)的患者营养支持治疗不仅能改善患者的营养状态,而且能够明显缩短患者住ICU的时间及总住院时间。结论:1.四种营养评价工具均适用于普外科营养不足的筛查,NRS2002还可以同时筛查患者的营养风险,四种方法对患者营养风险的评价具有一致性。NRS2002、SGA筛查结果和临床结局的关系最为密切,所以临床工作中,建议联合应用NRS2002和SGA,及时发现营养风险,提高预测不良临床结局的能力。2.以年龄≥65岁为分界,年龄越大的患者出现营养风险或营养不良的几率越大。恶性肿瘤患者和良性疾病患者比较营养风险及营养不良的比例增高。有营养风险的患者总的住院时间延长,且在ICU时间延长,这也使得住院花费随之增高。营养支持治疗对于有营养风险的患者的作用不仅在于可以改善患者营养状态,更重要的是可以改善临床结局,规范应用,效益更佳。3.出院时患者营养风险比例和营养不良比例均较入院时下降,但仍有较高的营养风险和营养不良比例,出院患者的营养状态应该引起足够重视。出院时的营养状态评估为出院后继续给予营养干预提供依据,并建议开设营养门诊,定期为出院患者制定营养计划,推荐合理的膳食和健康生活方式,有利于患者疾病的早期恢复。
[Abstract]:Objective: To investigate the nutritional status of the patients admitted to the general hospital of Tianjin Medical University, using the NRS2002 and SGA, MNA and NRI tools to compare the applicability and consistency of the four tools and the relationship between the results of the screening and the clinical outcome of each tool. NRS2002 and SGA were used to investigate the nutritional status of the discharged patients, to understand the changes of the nutritional risk and the rate of malnutrition during the hospitalization, and to analyze the relationship between the changes of the nutritional status and the clinical outcome during the hospital stay. Methods: NRS2002 and SGA, MNA and NRI were used for nutrition screening and evaluation on the second day of admission, and NRS2002 and SGA were applied for nutrition screening and assessment for 2 days before discharge. The indexes of body weight, hand grip, upper arm circumference, lower leg circumference and clinical biochemical test were measured. Using the SPSS 21.0 system to make a statistical analysis of the study data, the consistency of the screening results of the four tools was compared, and the relationship between the results of the screening and the clinical outcome was also analyzed. Results:1. The applicability of NRS2002, SGA and MNA was 91.91%, the applicability of NRI was 91.18%, the applicability of NRS2002 was 90.44%, the applicability of SGA was 88.97%, and the applicability of NRS2002 and SGA was 88.97%. The four methods are consistent with the evaluation of the nutritional risk of the patients. As a standard for malnutrition, BMI-18.5 or ALB-30 g/ L was used as a standard for malnutrition and the consistency of the four evaluation tools with that standard was poor. The scores of the aged 65-year-old patients were significantly different from those of the 65-year-old patients, and the score of the 65-year-old patients was lower than that of the 65-year-old patients. There was a significant difference in the proportion of nutritional risk (malnutrition) in different age groups at the time of access to the hospital. A greater risk of nutritional risk (or malnutrition) for patients with a greater age may be considered. The comparison of the nutritional status of the patients with malignant tumors is the chi-square test, which is of statistical significance, that is, the proportion of nutritional risk and malnutrition in the patients with malignant tumors is higher. The body weight, the holding force, the upper arm circumference and the lower leg circumference index of the patient were compared, and the difference between the indexes was not statistically significant. The proportion of nutritional risk and the rate of malnutrition in the patients before and after admission were compared using the NRS2002 and SGA, and we found that the proportion of nutritional risk and the rate of malnutrition and the time of admission were reduced at the time of discharge. Nutrition support during the hospitalization:28% of the clinical non-nutritional support, 57.6% of the nutritional support, 2.4% of the individual EN,12% of the PN combination, and 80% of the nutritional support for patients with nutritional risk in the NRS2002 tool evaluation. The SGA tool evaluated the nutritional support rate of 83.3% for patients with malnourished. Clinical outcome measures: The screening results for four nutritional screening tools show that the nutritional support treatment for patients with nutritional risk (or malnutrition) not only improves the nutritional status of the patient, but also significantly reduces the time and total hospital stay in the ICU. Conclusion:1. The four kinds of nutrition evaluation tools are suitable for the screening of the undernutrition of the general surgery, and the NRS2002 can also screen the nutrition risk of the patients at the same time, and the four methods have the consistency of the evaluation of the nutritional risk of the patients. NRS2002, SGA screening results and clinical outcomes are the most closely related, so in clinical work, it is recommended that NRS2002 and SGA be used in combination to find the nutritional risk in time and to improve the ability to predict adverse clinical outcomes. The greater the age of 65 years of age, the greater the risk of nutritional risk or malnutrition among patients with greater age. The proportion of nutritional risk and malnutrition among patients with malignant and benign diseases is increased. The total hospital stay in patients with nutritional risk was extended and prolonged in the ICU, which also led to an increase in the cost of hospitalization. The role of nutritional support in the treatment of patients with nutritional risk is not only to improve the nutritional status of the patient, but also to improve the clinical outcome, to standardize the application, and to benefit more effectively. At the time of the discharge, the proportion of the nutritional risk and the proportion of the malnutrition in the patients decreased, but there was still a higher proportion of nutrition and malnutrition, and the nutrition status of the discharged patients should be given enough attention. The nutritional status of the discharge is assessed as the basis for continued nutritional intervention after discharge, and it is recommended to open a nutrition clinic, to regularly prepare a nutrition plan for the discharged patient, to recommend a reasonable diet and healthy lifestyle, and to facilitate the early recovery of the patient's disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.3
本文编号：2433330
[Abstract]:Objective: To investigate the nutritional status of the patients admitted to the general hospital of Tianjin Medical University, using the NRS2002 and SGA, MNA and NRI tools to compare the applicability and consistency of the four tools and the relationship between the results of the screening and the clinical outcome of each tool. NRS2002 and SGA were used to investigate the nutritional status of the discharged patients, to understand the changes of the nutritional risk and the rate of malnutrition during the hospitalization, and to analyze the relationship between the changes of the nutritional status and the clinical outcome during the hospital stay. Methods: NRS2002 and SGA, MNA and NRI were used for nutrition screening and evaluation on the second day of admission, and NRS2002 and SGA were applied for nutrition screening and assessment for 2 days before discharge. The indexes of body weight, hand grip, upper arm circumference, lower leg circumference and clinical biochemical test were measured. Using the SPSS 21.0 system to make a statistical analysis of the study data, the consistency of the screening results of the four tools was compared, and the relationship between the results of the screening and the clinical outcome was also analyzed. Results:1. The applicability of NRS2002, SGA and MNA was 91.91%, the applicability of NRI was 91.18%, the applicability of NRS2002 was 90.44%, the applicability of SGA was 88.97%, and the applicability of NRS2002 and SGA was 88.97%. The four methods are consistent with the evaluation of the nutritional risk of the patients. As a standard for malnutrition, BMI-18.5 or ALB-30 g/ L was used as a standard for malnutrition and the consistency of the four evaluation tools with that standard was poor. The scores of the aged 65-year-old patients were significantly different from those of the 65-year-old patients, and the score of the 65-year-old patients was lower than that of the 65-year-old patients. There was a significant difference in the proportion of nutritional risk (malnutrition) in different age groups at the time of access to the hospital. A greater risk of nutritional risk (or malnutrition) for patients with a greater age may be considered. The comparison of the nutritional status of the patients with malignant tumors is the chi-square test, which is of statistical significance, that is, the proportion of nutritional risk and malnutrition in the patients with malignant tumors is higher. The body weight, the holding force, the upper arm circumference and the lower leg circumference index of the patient were compared, and the difference between the indexes was not statistically significant. The proportion of nutritional risk and the rate of malnutrition in the patients before and after admission were compared using the NRS2002 and SGA, and we found that the proportion of nutritional risk and the rate of malnutrition and the time of admission were reduced at the time of discharge. Nutrition support during the hospitalization:28% of the clinical non-nutritional support, 57.6% of the nutritional support, 2.4% of the individual EN,12% of the PN combination, and 80% of the nutritional support for patients with nutritional risk in the NRS2002 tool evaluation. The SGA tool evaluated the nutritional support rate of 83.3% for patients with malnourished. Clinical outcome measures: The screening results for four nutritional screening tools show that the nutritional support treatment for patients with nutritional risk (or malnutrition) not only improves the nutritional status of the patient, but also significantly reduces the time and total hospital stay in the ICU. Conclusion:1. The four kinds of nutrition evaluation tools are suitable for the screening of the undernutrition of the general surgery, and the NRS2002 can also screen the nutrition risk of the patients at the same time, and the four methods have the consistency of the evaluation of the nutritional risk of the patients. NRS2002, SGA screening results and clinical outcomes are the most closely related, so in clinical work, it is recommended that NRS2002 and SGA be used in combination to find the nutritional risk in time and to improve the ability to predict adverse clinical outcomes. The greater the age of 65 years of age, the greater the risk of nutritional risk or malnutrition among patients with greater age. The proportion of nutritional risk and malnutrition among patients with malignant and benign diseases is increased. The total hospital stay in patients with nutritional risk was extended and prolonged in the ICU, which also led to an increase in the cost of hospitalization. The role of nutritional support in the treatment of patients with nutritional risk is not only to improve the nutritional status of the patient, but also to improve the clinical outcome, to standardize the application, and to benefit more effectively. At the time of the discharge, the proportion of the nutritional risk and the proportion of the malnutrition in the patients decreased, but there was still a higher proportion of nutrition and malnutrition, and the nutrition status of the discharged patients should be given enough attention. The nutritional status of the discharge is assessed as the basis for continued nutritional intervention after discharge, and it is recommended to open a nutrition clinic, to regularly prepare a nutrition plan for the discharged patient, to recommend a reasonable diet and healthy lifestyle, and to facilitate the early recovery of the patient's disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.3
【参考文献】
相关期刊论文 前1条
1 崔红霞;赵彦玲;董艳芹;;出院患者营养干预的可行性和必要性调查[J];中国社区医师(医学专业);2013年03期
，本文编号：2433330
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