本文關(guān)鍵詞： 老年 心血管內(nèi)科患者 營養(yǎng)狀況 營養(yǎng)支持 微型營養(yǎng)評估表 歐洲營養(yǎng)風險篩查法　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:應用微型營養(yǎng)評估表(MNA)和住院患者營養(yǎng)風險篩查表(NRS2002)評估老年心血管內(nèi)科住院患者營養(yǎng)狀況,研究營養(yǎng)不良影響因素,觀察其對臨床預后的影響,了解目前老年心血管內(nèi)科住院患者的營養(yǎng)支持現(xiàn)況。方法:本研究選取河北醫(yī)科大學第二醫(yī)院心血管內(nèi)科自2016年1月至2016年12月期間住院的患者,采用系統(tǒng)抽樣方法最終入選485例患者。對入選患者于入院72小時內(nèi)完成NRS2002營養(yǎng)風險篩查、微型營養(yǎng)評定量表(MNA)問卷、患者基本資料及臨床檢查資料的調(diào)查。通過病歷收集患者住院期間是否接受營養(yǎng)支持治療以及營養(yǎng)支持方式。于患者出院前再次對該患者進行微型營養(yǎng)評定量表問卷調(diào)查,掌握患者出院前的營養(yǎng)狀況。本研究統(tǒng)計學處理均運用SPSS 13.0統(tǒng)計軟件進行分析。計量資料的統(tǒng)計描述結(jié)果以x±s表示,進行方差分析或秩轉(zhuǎn)換的非參數(shù)檢驗。計數(shù)資料采用率、頻數(shù)或構(gòu)成比表示,進行X2檢驗。兩種量表評定營養(yǎng)風險與實驗室標準的結(jié)果比較采用一致性檢驗。以a=0.05為檢驗水準,P0.05為差異有統(tǒng)計學意義。結(jié)果:1兩種量表評估法評定的營養(yǎng)不良風險與實驗室營養(yǎng)不良結(jié)果比較。對所有患者均進行MNA、NRS 2002與實驗室檢查,結(jié)果顯示實驗室檢查評分方法營養(yǎng)不良檢出率為48.7%,應用MNA量表評分方法營養(yǎng)異常檢出率為44.3%,兩者相比存在差異(X2=4.846,P=0.028)。應用NRS 2002量表評分方法存在營養(yǎng)風險檢出率為34.0%,與實驗室檢查方法相比差異顯著(X2=27.546,P0.001)。2兩種量表與實驗室指標檢查營養(yǎng)不良發(fā)生率一致性的比較。NRS2002量表檢查存在營養(yǎng)不良風險與實驗室指標檢查營養(yǎng)不良的一致率為62.3%,Kappa值為0.25,表明NRS 2002量表檢查一致性較差。MNA量表檢查營養(yǎng)異常與實驗室指標檢查一致率為81.2%,Kappa值為0.62,表明MNA量表與實驗室指標對營養(yǎng)狀況檢查存在中、高度一致。3分年齡段、性別和bmi的營養(yǎng)狀況比較。以下分析均使用mna量表評分對入選的老年心血管內(nèi)科患者的營養(yǎng)狀況進行評判。分年齡段比較,60-69歲組、70-79歲組及≥80歲組患者發(fā)生營養(yǎng)異常分別占該組患者的27.5%、35.6%和56.6%,年齡大者營養(yǎng)異常發(fā)生率明顯高于年齡小者(p0.001)。分性別比較,男性患者和女性患者營養(yǎng)異常發(fā)生率分別為43.6%和46.2%,男女患者之間比較無明顯差異(p=0.737)。按bmi分組比較,偏瘦組患者(18.5kg/m2)、正常組患者(18.5-23.9kg/m2)、超重及肥胖組患者(24.0kg/m2)發(fā)生營養(yǎng)異常分別占該組患者的100%、47.0%和30.6%,bmi越小患者營養(yǎng)異常發(fā)生率明顯升高(p0.001)。4生活習慣和疾病史對營養(yǎng)狀況影響。吸煙及不吸煙組患者營養(yǎng)異常發(fā)生率分別為46.9%和42.4%,兩組之間無明顯差異(p=0.337)。飲酒及不飲酒組患者營養(yǎng)異常發(fā)生率分別為65.8%和40.1%,飲酒明顯增高營養(yǎng)異常發(fā)生率(p0.001)。有相關(guān)個人疾病史組及無疾病史組患者營養(yǎng)異常發(fā)生率分別為60.0%和38.3%,存在個人疾病史明顯增高營養(yǎng)異常發(fā)生率(p0.001)。5不同營養(yǎng)狀況組患者實驗室指標及體測指標比較。使用mna量表評分將入選的患者分為營養(yǎng)正常、潛在營養(yǎng)不良和營養(yǎng)不良三組。三組患者的白蛋白水平和血紅蛋白水平均存在明顯差異(p0.05)三組患者的上臂中點周徑、非利手握力和小腿最大周徑均存在明顯差異(p0.05)。三組患者的肱三頭肌皮摺厚度之間無明顯差異(p=0.068),三組患者的上臂肌肉周徑之間無明顯差異(p=0.073)。6不同營養(yǎng)狀況患者營養(yǎng)支持現(xiàn)狀分析。營養(yǎng)正常組患者中營養(yǎng)支持者2例,全部為腸內(nèi)營養(yǎng)支持;潛在營養(yǎng)不良組患者中營養(yǎng)支持者15例;營養(yǎng)不良組患者中營養(yǎng)支持者31例,三組患者的營養(yǎng)支持狀況存在顯著差異(x2=105.9,p0.001)。7患者出院時與入院時營養(yǎng)狀況比較。入院時,營養(yǎng)正常組患者270例,營養(yǎng)異常組患者215例;患者出院時,營養(yǎng)正常組患者284例,營養(yǎng)異常組患者201例,患者出院與入院時營養(yǎng)狀況無明顯差異(x2=0.921,p=0.631)。結(jié)論:1mna量表與實驗室指標判定營養(yǎng)不良的發(fā)生率相似,且一致性較好,對老年心血管內(nèi)科住院患者營養(yǎng)不良檢測效果明顯優(yōu)于NRS2002量表。2老年心血管內(nèi)科住院患者的營養(yǎng)異常發(fā)生率受到年齡、BMI、飲酒史和個人疾病史的影響。3老年心血管內(nèi)科住院患者營養(yǎng)不良發(fā)生率偏高,且營養(yǎng)不良患者營養(yǎng)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緇勫強鏃犵柧鐥呭彶緇勬?zhèn)ｈ�呰惀鍏誨紓甯稿彂鐢熺巼鍒嗗埆涓，

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