【摘要】：[目的] 1對(duì)慢性肝病住院患者進(jìn)行營養(yǎng)調(diào)查,評(píng)價(jià)其營養(yǎng)狀況及其對(duì)正常營養(yǎng)需要的滿足程度。 2使用NRS2002對(duì)慢性肝病住院患者進(jìn)行營養(yǎng)風(fēng)險(xiǎn)篩查,為早期發(fā)現(xiàn)和治療營養(yǎng)不良提供證據(jù)。 3探討營養(yǎng)支持對(duì)慢性肝病住院患者的治療作用。 [研究對(duì)象與方法] 采用定點(diǎn)連續(xù)抽樣方法納入我院肝膽胰內(nèi)科2013年7月至2013年10月慢性肝病住院患者共217例,收集217例患者的臨床資料,包括性別、年齡、診斷、身高、體重、三頭肌皮褶厚度、上臂圍、血清總蛋白、白蛋白、前白蛋白、血紅蛋白、淋巴細(xì)胞計(jì)數(shù)、總膽紅素、凝血酶原時(shí)間、影像學(xué)資料(腹水情況)、所有患者均在入院24小時(shí)內(nèi)完成24小時(shí)膳食回顧及NRS2002評(píng)分。24小時(shí)膳食回歸分析結(jié)果與中國居民膳食營養(yǎng)素參考攝入量中的標(biāo)準(zhǔn)供給量作對(duì)比,結(jié)合人體測量及實(shí)驗(yàn)室指標(biāo),評(píng)價(jià)患者的營養(yǎng)狀況及正常營養(yǎng)需要的滿足程度,分析營養(yǎng)狀況與病因、疾病嚴(yán)重程度的關(guān)系。NRS2002評(píng)分≥3分判定為有營養(yǎng)風(fēng)險(xiǎn),并回顧患者營養(yǎng)支持情況,研究慢性肝病住院患者營養(yǎng)風(fēng)險(xiǎn)的發(fā)生率,營養(yǎng)風(fēng)險(xiǎn)與病因、疾病嚴(yán)重程度、肝功能Child-Pugh分級(jí)以及臨床相關(guān)因素的關(guān)系,以及營養(yǎng)支持對(duì)慢性肝病住院患者的治療作用。 [結(jié)果] 1217例慢性肝病住院患者中,148例患者存在營養(yǎng)不良,營養(yǎng)不良發(fā)生率為68.20%。 2營養(yǎng)不良發(fā)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,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。不同性別營養(yǎng)不良發(fā)生率差異無統(tǒng)計(jì)學(xué)意義,病毒性及酒精性慢性肝病患者營養(yǎng)不良發(fā)生率相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 3營養(yǎng)不良患者的平均住院時(shí)間為(14.46±7.70)d,長于營養(yǎng)狀況良好的患者的平均住院時(shí)間(12.01±5.45)d,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；營養(yǎng)狀況良好的患者的臨床結(jié)局優(yōu)于營養(yǎng)不良的患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 4慢性肝病住院患者每日能量、蛋白質(zhì)、脂肪、碳水化合物、VitA、VitB1、 VitB2、煙酸、VitE、鈉、鉀、鈣等營養(yǎng)素?cái)z入量均低于中國居民膳食營養(yǎng)素參考攝入量中的標(biāo)準(zhǔn)供給量,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 5217例慢性肝病住院患者中,87例患者存在營養(yǎng)風(fēng)險(xiǎn),營養(yǎng)風(fēng)險(xiǎn)發(fā)生率為40.09%。 6營養(yǎng)風(fēng)險(xiǎn)的發(fā)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；并隨著肝功能Child-Pugh分級(jí)的升高而升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。營養(yǎng)風(fēng)險(xiǎn)發(fā)生率性別相比差異無統(tǒng)計(jì)學(xué)意義,在病毒性與酒精性之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 7NRS≥3的患者M(jìn)AC、TSF、AMC、TP、ALB、Hb、TLC測量值分別為(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測量值P25=6、P50=31、P75=100,均低于NRS3的患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 8NRS≥3的患者的平均住院時(shí)間(15.23±7.20)d長于NRS3的患者(12.65±6.94)d,臨床結(jié)局差于NRS3的患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 9NRS≥3的CLD患者的營養(yǎng)支持使用率為43.68%,方式全部為腸外營養(yǎng)。營養(yǎng)支持治療后TP、ALB、Hb、TLC測量值分別為(57.34±7.59)、(25.8±3.96)、(93.21±22.42)、(0.89±0.51),PA測量值P25=13, P50=26.5, P75=64.25,較治療前明顯升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。而MAC、TSF、AMC的變化差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 10營養(yǎng)支持治療的患者平均住院時(shí)間為(15.45±7.42)d,未給予營養(yǎng)支持治療的患者的平均住院時(shí)間為(15.06±7.09)d,兩組患者的平均住院時(shí)間及臨床結(jié)局差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 [結(jié)論] 1慢性肝病患者營養(yǎng)不良發(fā)生率及營養(yǎng)風(fēng)險(xiǎn)發(fā)生率高,且與年齡、病因、疾病嚴(yán)重程度、住院時(shí)間及臨床結(jié)局相關(guān),應(yīng)重視其營養(yǎng)調(diào)查及營養(yǎng)風(fēng)險(xiǎn)篩查,為早期制定營養(yǎng)支持提供依據(jù)。 2慢性肝病住院患者日能量及營養(yǎng)素?cái)z入量低于中國膳食營養(yǎng)素參考攝入量中的標(biāo)準(zhǔn)供給量,需對(duì)營養(yǎng)不良患者給予營養(yǎng)支持治療。 3NRS2002簡單易操作,可有效應(yīng)用于慢性肝病住院患者的營養(yǎng)風(fēng)險(xiǎn)篩查,但應(yīng)注意胸、腹水對(duì)評(píng)分結(jié)果的影響。 4營養(yǎng)支持治療可改善存在營養(yǎng)風(fēng)險(xiǎn)患者的多項(xiàng)實(shí)驗(yàn)室指標(biāo),需及時(shí)、有效應(yīng)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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575

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