普外科入出院患者營養(yǎng)狀態(tài)調(diào)查與臨床結局分析
發(fā)布時間：2019-03-02 18:15
【摘要】：目的:在天津醫(yī)科大學總醫(yī)院普外科,使用NRS2002和SGA、MNA、NRI四種工具對入院患者進行營養(yǎng)狀態(tài)調(diào)查,比較四種工具的適用性和一致性以及每種工具所得篩查結果和臨床結局的關系,并使用NRS2002和SGA對出院患者進行營養(yǎng)狀態(tài)調(diào)查,了解住院期間患者營養(yǎng)風險和營養(yǎng)不良比例的變化,同時分析患者住院期間營養(yǎng)狀態(tài)變化和臨床結局的關系。方法:當患者入院第2天分別應用NRS2002和SGA、MNA、NRI進行營養(yǎng)篩查和評估,出院前2天應用NRS2002和SGA進行營養(yǎng)篩查和評估,并測定體重、手握力、上臂圍、小腿圍以及臨床生化檢驗指標,使用SPSS 21.0系統(tǒng)對研究資料進行統(tǒng)計學分析,比較四種工具篩查結果的一致性,同時分析篩查結果和臨床結局的關系。結果:1.入院NRS2002、SGA及MNA適用性91.91%,NRI適用性91.18%,出院NRS2002適用性90.44%,SGA適用性88.97%,NRS2002及SGA出入院雙重評價適用性88.97%。四種方法對患者營養(yǎng)風險的評價具有一致性。將BMI≤18.5或ALB≤30g/L作為營養(yǎng)不良的一個標準,四種評價工具與該標準的一致性較差。2.出入院時不同年齡層營養(yǎng)評分比較,年齡≥65歲的患者評分結果與年齡65歲的患者評分結果差異有統(tǒng)計學意義,年齡≥65歲的患者的得分結果較差。出入院時不同年齡層有營養(yǎng)風險(營養(yǎng)不良)比例比較,差異有統(tǒng)計學意義。可認為年齡越大的患者營養(yǎng)風險(或營養(yǎng)不良)的可能性更大。3.是否惡性腫瘤患者營養(yǎng)狀況的比較應用卡方檢驗,差異具有統(tǒng)計學意義,即惡性腫瘤患者營養(yǎng)風險及營養(yǎng)不良的比例更高。4.比較患者出入院時的體重、握力、上臂圍、小腿圍指標發(fā)現(xiàn),各指標間的差異無統(tǒng)計學意義。使用NRS2002及SGA比較入院前后患者營養(yǎng)風險比例和營養(yǎng)不良比例的變化,我們發(fā)現(xiàn)出院時患者營養(yǎng)風險比例和營養(yǎng)不良比例和入院時比較均下降。5.住院期間營養(yǎng)支持情況:臨床無營養(yǎng)支持者占28%,有營養(yǎng)支持者單獨PN占57.6%,單獨EN占2.4%,PN聯(lián)合EN占12%,NRS2002工具評價對有營養(yǎng)風險的患者營養(yǎng)支持率為80%,SGA工具評價對有營養(yǎng)不良的患者營養(yǎng)支持率為83.3%。6.臨床結局指標:四種營養(yǎng)篩查工具篩查結果均顯示給予有營養(yǎng)風險(或營養(yǎng)不良)的患者營養(yǎng)支持治療不僅能改善患者的營養(yǎng)狀態(tài),而且能夠明顯縮短患者住ICU的時間及總住院時間。結論:1.四種營養(yǎng)評價工具均適用于普外科營養(yǎng)不足的篩查,NRS2002還可以同時篩查患者的營養(yǎng)風險,四種方法對患者營養(yǎng)風險的評價具有一致性。NRS2002、SGA篩查結果和臨床結局的關系最為密切,所以臨床工作中,建議聯(lián)合應用NRS2002和SGA,及時發(fā)現(xiàn)營養(yǎng)風險,提高預測不良臨床結局的能力。2.以年齡≥65歲為分界,年齡越大的患者出現(xiàn)營養(yǎng)風險或營養(yǎng)不良的幾率越大。惡性腫瘤患者和良性疾病患者比較營養(yǎng)風險及營養(yǎng)不良的比例增高。有營養(yǎng)風險的患者總的住院時間延長,且在ICU時間延長,這也使得住院花費隨之增高。營養(yǎng)支持治療對于有營養(yǎng)風險的患者的作用不僅在于可以改善患者營養(yǎng)狀態(tài),更重要的是可以改善臨床結局,規(guī)范應用,效益更佳。3.出院時患者營養(yǎng)風險比例和營養(yǎng)不良比例均較入院時下降,但仍有較高的營養(yǎng)風險和營養(yǎng)不良比例,出院患者的營養(yǎng)狀態(tài)應該引起足夠重視。出院時的營養(yǎng)狀態(tài)評估為出院后繼續(xù)給予營養(yǎng)干預提供依據(jù),并建議開設營養(yǎng)門診,定期為出院患者制定營養(yǎng)計劃,推薦合理的膳食和健康生活方式,有利于患者疾病的早期恢復。
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.3
本文編號：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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.3
【參考文獻】
相關期刊論文 前1條
1 崔紅霞;趙彥玲;董艷芹;;出院患者營養(yǎng)干預的可行性和必要性調(diào)查[J];中國社區(qū)醫(yī)師(醫(yī)學專業(yè));2013年03期
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