老年心血管内科住院病人营养现状调查及营养支持现况分析

发布时间：2018-02-14 15:41

  本文关键词： 老年 心血管内科患者 营养状况 营养支持 微型营养评估表 欧洲营养风险筛查法　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用微型营养评估表(MNA)和住院患者营养风险筛查表(NRS2002)评估老年心血管内科住院患者营养状况,研究营养不良影响因素,观察其对临床预后的影响,了解目前老年心血管内科住院患者的营养支持现况。方法:本研究选取河北医科大学第二医院心血管内科自2016年1月至2016年12月期间住院的患者,采用系统抽样方法最终入选485例患者。对入选患者于入院72小时内完成NRS2002营养风险筛查、微型营养评定量表(MNA)问卷、患者基本资料及临床检查资料的调查。通过病历收集患者住院期间是否接受营养支持治疗以及营养支持方式。于患者出院前再次对该患者进行微型营养评定量表问卷调查,掌握患者出院前的营养状况。本研究统计学处理均运用SPSS 13.0统计软件进行分析。计量资料的统计描述结果以x±s表示,进行方差分析或秩转换的非参数检验。计数资料采用率、频数或构成比表示,进行X2检验。两种量表评定营养风险与实验室标准的结果比较采用一致性检验。以a=0.05为检验水准,P0.05为差异有统计学意义。结果:1两种量表评估法评定的营养不良风险与实验室营养不良结果比较。对所有患者均进行MNA、NRS 2002与实验室检查,结果显示实验室检查评分方法营养不良检出率为48.7%,应用MNA量表评分方法营养异常检出率为44.3%,两者相比存在差异(X2=4.846,P=0.028)。应用NRS 2002量表评分方法存在营养风险检出率为34.0%,与实验室检查方法相比差异显著(X2=27.546,P0.001)。2两种量表与实验室指标检查营养不良发生率一致性的比较。NRS2002量表检查存在营养不良风险与实验室指标检查营养不良的一致率为62.3%,Kappa值为0.25,表明NRS 2002量表检查一致性较差。MNA量表检查营养异常与实验室指标检查一致率为81.2%,Kappa值为0.62,表明MNA量表与实验室指标对营养状况检查存在中、高度一致。3分年龄段、性别和bmi的营养状况比较。以下分析均使用mna量表评分对入选的老年心血管内科患者的营养状况进行评判。分年龄段比较,60-69岁组、70-79岁组及≥80岁组患者发生营养异常分别占该组患者的27.5%、35.6%和56.6%,年龄大者营养异常发生率明显高于年龄小者(p0.001)。分性别比较,男性患者和女性患者营养异常发生率分别为43.6%和46.2%,男女患者之间比较无明显差异(p=0.737)。按bmi分组比较,偏瘦组患者(18.5kg/m2)、正常组患者(18.5-23.9kg/m2)、超重及肥胖组患者(24.0kg/m2)发生营养异常分别占该组患者的100%、47.0%和30.6%,bmi越小患者营养异常发生率明显升高(p0.001)。4生活习惯和疾病史对营养状况影响。吸烟及不吸烟组患者营养异常发生率分别为46.9%和42.4%,两组之间无明显差异(p=0.337)。饮酒及不饮酒组患者营养异常发生率分别为65.8%和40.1%,饮酒明显增高营养异常发生率(p0.001)。有相关个人疾病史组及无疾病史组患者营养异常发生率分别为60.0%和38.3%,存在个人疾病史明显增高营养异常发生率(p0.001)。5不同营养状况组患者实验室指标及体测指标比较。使用mna量表评分将入选的患者分为营养正常、潜在营养不良和营养不良三组。三组患者的白蛋白水平和血红蛋白水平均存在明显差异(p0.05)三组患者的上臂中点周径、非利手握力和小腿最大周径均存在明显差异(p0.05)。三组患者的肱三头肌皮摺厚度之间无明显差异(p=0.068),三组患者的上臂肌肉周径之间无明显差异(p=0.073)。6不同营养状况患者营养支持现状分析。营养正常组患者中营养支持者2例,全部为肠内营养支持;潜在营养不良组患者中营养支持者15例;营养不良组患者中营养支持者31例,三组患者的营养支持状况存在显著差异(x2=105.9,p0.001)。7患者出院时与入院时营养状况比较。入院时,营养正常组患者270例,营养异常组患者215例;患者出院时,营养正常组患者284例,营养异常组患者201例,患者出院与入院时营养状况无明显差异(x2=0.921,p=0.631)。结论:1mna量表与实验室指标判定营养不良的发生率相似,且一致性较好,对老年心血管内科住院患者营养不良检测效果明显优于NRS2002量表。2老年心血管内科住院患者的营养异常发生率受到年龄、BMI、饮酒史和个人疾病史的影响。3老年心血管内科住院患者营养不良发生率偏高,且营养不良患者营养支持率偏低。
[Abstract]:Objective: the application of mini nutritional assessment (MNA) and patients with nutritional risk screening scale (NRS2002) assessment of nutritional status of hospitalized patients with senile cardiovascular medicine, factors of malnutrition, and observe its effects on clinical prognosis, understand the current elderly cardiovascular hospital patients with nutritional support status. Methods: This study selected from hospitalized patients during the period of January 2016 to December 2016 of the cardiovascular department of the second hospital of Hebei Medical University, were selected by systematic sampling method in 485 patients. The patients in the hospital within 72 hours of the completion of NRS2002 nutrition risk screening, Mini Nutritional Assessment Scale (MNA) questionnaire survey, basic data of patients and clinical examination. Data collected from medical records of hospitalized patients with whether or not to accept the nutritional support therapy and nutritional support. In patients before discharge to the patients with mini nutritional assessment scale Q Survey, grasp the nutritional status of the patients before discharge. The statistical analysis was analyzed using SPSS 13 statistical software. Measurement data of the statistical description of the results with x + s, nonparametric test for variance analysis or rank transformation. Count data using rate, frequency or constituent ratio, two X2 test. Assessment of nutritional risk and laboratory results were compared with the standard consistency test. In order to test the level of a=0.05 P0.05, the difference was statistically significant. Results: 1 two kinds of assessment method to evaluate the nutritional risk and malnutrition results compared to laboratory. All patients were MNA, 2002 NRS and laboratory examination results according to laboratory examination scoring method of detection rate of malnutrition was 48.7%, the application of MNA score method of nutrition abnormal rate was 44.3%, compared with the differences (X2=4.846, P=0.028). With NRS 2002. Nutritional risk score method detection rate was 34%, compared with the laboratory test showed significant difference (X2=27.546, P0.001).2 two scale and laboratory indexes were malnutrition rate consistent.NRS2002 scale were examined for the presence of nutritional risk and malnutrition laboratory indicators check the consistency rate is 62.3%, Kappa value 0.25, show that the NRS 2002 scale to examine the poor consistency of.MNA scale examination and laboratory indicators of abnormal nutritional consistency check rate was 81.2%, Kappa was 0.62, that of MNA scale and laboratory indexes of the nutritional status of the inspection, highly consistent.3 ages, compared the nutritional status of gender and BMI. Use the following analysis MNA scores of nutritional status for selected elderly patients with cardiovascular medicine were compared. Evaluation of age, 60-69 years old group, occurrence of abnormal nutrition accounted for 70-79 age group and over 80 years old patients The groups were 27.5%, 35.6% and 56.6%, the older the incidence of abnormal nutrition was significantly higher than that of the younger (p0.001). Sex between male and female patients with nutritional abnormal rate were 43.6% and 46.2%, there were no significant difference between male and female patients (p=0.737). According to the comparison with BMI group, the lean patients (18.5kg/m2), normal group (18.5-23.9kg/m2), overweight and obese patients (24.0kg/m2) had abnormal nutrition accounted for 100% of the patients in this group, 47% and 30.6%, the smaller the BMI patients with abnormal nutrition significantly increased the incidence of.4 (p0.001) habits and history of disease on the nutritional status of smoking and non-smoking group. Nutritional status of patients with abnormal rate were 46.9% and 42.4%, no significant differences between the two groups (p=0.337). Drinking and non drinking group nutrition in patients with abnormal rate were 65.8% and 40.1%, significantly increased the incidence of abnormal drinking high nutrition (p0.001) phase. 鍏充釜浜虹柧鐥呭彶缁勫強鏃犵柧鐥呭彶缁勬偅鑰呰惀鍏诲紓甯稿彂鐢熺巼鍒嗗埆涓，

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