慢性肝病住院患者的营养调查与营养风险筛查

发布时间：2018-07-26 20:13

【摘要】：[目的] 1对慢性肝病住院患者进行营养调查,评价其营养状况及其对正常营养需要的满足程度。 2使用NRS2002对慢性肝病住院患者进行营养风险筛查,为早期发现和治疗营养不良提供证据。 3探讨营养支持对慢性肝病住院患者的治疗作用。 [研究对象与方法] 采用定点连续抽样方法纳入我院肝胆胰内科2013年7月至2013年10月慢性肝病住院患者共217例,收集217例患者的临床资料,包括性别、年龄、诊断、身高、体重、三头肌皮褶厚度、上臂围、血清总蛋白、白蛋白、前白蛋白、血红蛋白、淋巴细胞计数、总胆红素、凝血酶原时间、影像学资料(腹水情况)、所有患者均在入院24小时内完成24小时膳食回顾及NRS2002评分。24小时膳食回归分析结果与中国居民膳食营养素参考摄入量中的标准供给量作对比,结合人体测量及实验室指标,评价患者的营养状况及正常营养需要的满足程度,分析营养状况与病因、疾病严重程度的关系。NRS2002评分≥3分判定为有营养风险,并回顾患者营养支持情况,研究慢性肝病住院患者营养风险的发生率,营养风险与病因、疾病严重程度、肝功能Child-Pugh分级以及临床相关因素的关系,以及营养支持对慢性肝病住院患者的治疗作用。 [结果] 1217例慢性肝病住院患者中,148例患者存在营养不良,营养不良发生率为68.20%。 2营养不良发生率：老年非老年,肝癌肝硬化非肝硬化,自身免疫性小于病毒性及酒精性,差异具有统计学意义(P0.05)。不同性别营养不良发生率差异无统计学意义,病毒性及酒精性慢性肝病患者营养不良发生率相比差异无统计学意义(P0.05)。 3营养不良患者的平均住院时间为(14.46±7.70)d,长于营养状况良好的患者的平均住院时间(12.01±5.45)d,差异具有统计学意义(P0.05)；营养状况良好的患者的临床结局优于营养不良的患者,差异具有统计学意义(P0.05)。 4慢性肝病住院患者每日能量、蛋白质、脂肪、碳水化合物、VitA、VitB1、 VitB2、烟酸、VitE、钠、钾、钙等营养素摄入量均低于中国居民膳食营养素参考摄入量中的标准供给量,差异具有统计学意义(P0.05)。 5217例慢性肝病住院患者中,87例患者存在营养风险,营养风险发生率为40.09%。 6营养风险的发生率：老年非老年；肝癌肝硬化非肝硬化；病毒性、酒精性高于自身免疫性；并随着肝功能Child-Pugh分级的升高而升高,差异具有统计学意义(P0.05)。营养风险发生率性别相比差异无统计学意义,在病毒性与酒精性之间差异无统计学意义(P0.05)。 7NRS≥3的患者MAC、TSF、AMC、TP、ALB、Hb、TLC测量值分别为(23.39±2.77)、(10.91±5.79)、(19.97±2.44)、(58.33±9.07)、(26.93±6.86)、(101.97±31.82)、(1.13±0.70),PA测量值P25=6、P50=31、P75=100,均低于NRS3的患者,差异具有统计学意义(P0.05)。 8NRS≥3的患者的平均住院时间(15.23±7.20)d长于NRS3的患者(12.65±6.94)d,临床结局差于NRS3的患者,差异具有统计学意义(P0.05)。 9NRS≥3的CLD患者的营养支持使用率为43.68%,方式全部为肠外营养。营养支持治疗后TP、ALB、Hb、TLC测量值分别为(57.34±7.59)、(25.8±3.96)、(93.21±22.42)、(0.89±0.51),PA测量值P25=13, P50=26.5, P75=64.25,较治疗前明显升高,差异具有统计学意义(P0.05)。而MAC、TSF、AMC的变化差异无统计学意义(P0.05)。 10营养支持治疗的患者平均住院时间为(15.45±7.42)d,未给予营养支持治疗的患者的平均住院时间为(15.06±7.09)d,两组患者的平均住院时间及临床结局差异无统计学意义(P0.05)。 [结论] 1慢性肝病患者营养不良发生率及营养风险发生率高,且与年龄、病因、疾病严重程度、住院时间及临床结局相关,应重视其营养调查及营养风险筛查,为早期制定营养支持提供依据。 2慢性肝病住院患者日能量及营养素摄入量低于中国膳食营养素参考摄入量中的标准供给量,需对营养不良患者给予营养支持治疗。 3NRS2002简单易操作,可有效应用于慢性肝病住院患者的营养风险筛查,但应注意胸、腹水对评分结果的影响。 4营养支持治疗可改善存在营养风险患者的多项实验室指标,需及时、有效应用于慢性肝病患者。
[Abstract]:[Objective]
1 a nutritional survey was conducted among hospitalized patients with chronic liver disease to assess their nutritional status and their satisfaction with normal nutritional needs.
2 use NRS2002 to screen nutritional risk for hospitalized patients with chronic liver disease, so as to provide evidence for early detection and treatment of malnutrition.
3 to explore the therapeutic effect of nutritional support on hospitalized patients with chronic liver disease.
[object and method of research]
A total of 217 patients with chronic liver disease in the hepatobiliary and pancreatic Medicine Department of our hospital from July 2013 to October 2013 were enrolled in this study. The clinical data of 217 patients were collected, including sex, age, diagnosis, height, weight, triceps skin fold thickness, upper arm circumference, serum total egg white, albumin, prealbumin, hemoglobin, lymphocyte count, and the total number of patients. Bilirubin, prothrombin time, imaging data (ascites), all patients completed a 24 hour diet review within 24 hours and a NRS2002 score of.24 hour diet regression analysis compared with the standard supply of dietary nutrient reference intake in Chinese residents, combined with anthropometric and laboratory indicators to evaluate patients The nutritional status and the satisfaction degree of normal nutrition needs, analysis of the relationship between nutritional status and etiology, the relationship between the severity of the disease and the.NRS2002 score of more than 3 to determine the nutritional risk, and review the nutritional support of the patients, study the incidence of nutritional risk in the patients with chronic liver disease, the nutritional risk and the cause of disease, the severity of the disease, the liver function Child-Pugh The relationship between grading and clinical factors, as well as the effect of nutritional support on hospitalized patients with chronic liver disease.
[results]
Among the 1217 hospitalized patients with chronic liver disease, malnutrition occurred in 148 patients, and the incidence of malnutrition was 68.20%.
2 the incidence of malnutrition: the elderly non elderly, liver cirrhosis, non liver cirrhosis, autoimmune less than viral and alcoholic, the difference was statistically significant (P0.05). There was no statistically significant difference in the incidence of dystrophy in different sexes, and there was no significant difference in the incidence of malnutrition in patients with viral and alcoholic chronic liver disease (P0. 05).
The average hospitalization time of 3 dystrophy patients was (14.46 + 7.70) d, the average time of hospitalization (12.01 + 5.45) d for patients with good nutritional status was (12.01 + 5.45), and the difference was statistically significant (P0.05); the clinical outcomes of patients with good nutritional status were better than those with malnutrition, and the difference was statistically significant (P0.05).
4 the daily energy, protein, fat, carbohydrate, VitA, VitB1, VitB2, nicotinic acid, VitE, sodium, potassium, calcium, and other nutrients in the inpatients of chronic liver disease were all lower than the standard supply of dietary dietary nutrients in Chinese residents, and the difference was statistically significant (P0.05).
Among the 5217 hospitalized patients with chronic liver disease, 87 patients had nutritional risk, and the incidence of nutritional risk was 40.09%.
6 the incidence of nutritional risk: the elderly non elderly, liver cirrhosis and liver cirrhosis, non cirrhosis; viral, alcohol higher than autoimmunity; and with the increase of liver function Child-Pugh grade, the difference has statistical significance (P0.05). The incidence of nutritional risk is not statistically significant between sex and the difference between the virus and alcohol There was no statistical significance (P0.05).
The measured values of MAC, TSF, AMC, TP, ALB, Hb, TLC in patients with 7NRS > 3 were respectively (23.39 + 2.77), (10.91 + 5.79), (19.97 + 2.44), (58.33 + 9.07), (26.93 + 6.86), (101.97 + 31.82), P25=6, P50=31, P75=100, and were all lower than those of the patients. The difference was statistically significant.
The average hospitalization time (15.23 + 7.20) d of patients with 8NRS > 3 was longer than that of NRS3 patients (12.65 + 6.94) d, and the clinical outcome was worse than that of NRS3, and the difference was statistically significant (P0.05).
The use rate of nutritional support for CLD patients with 9NRS > 3 was 43.68%, all of which were parenteral nutrition. The values of TP, ALB, Hb, TLC after nutritional support were respectively (57.34 + 7.59), (25.8 + 3.96), (93.21 + 22.42), (0.89 + 0.51), PA measurement values P25=13, P50=26.5, P75=64.25, and the difference was statistically significant (P0.05). There was no significant difference in the change of AMC (P0.05).
The average hospitalization time of 10 patients with nutritional support was (15.45 + 7.42) d, and the average hospitalization time of the patients without nutritional support was (15.06 + 7.09) d. There was no significant difference in the average hospitalization time and clinical outcome between the two groups (P0.05).
[Conclusion]
1 the incidence of malnutrition and the incidence of nutritional risk in patients with chronic liver disease are high, and they are related to age, etiology, severity of disease, hospitalization time and clinical outcome. The nutritional survey and nutritional risk screening should be paid attention to in order to provide the basis for early nutrition support.
2 the daily energy and nutrient intake of hospitalized patients with chronic liver disease are lower than the standard supply of Chinese dietary nutrition reference intake, and nutritional support should be given to patients with malnutrition.
3NRS2002 is simple and easy to operate, and can be used for nutritional risk screening in hospitalized patients with chronic liver disease.
4 nutritional support therapy can improve the laboratory indicators of patients with nutritional risk, and it should be timely and effectively applied to patients with chronic liver disease.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575

【参考文献】