慢性阻塞性肺疾病急性加重期患者营养风险与临床结局的关系研究  

Nutritional risk and clinical outcome in acute exacerbation of chronic obstructive pulmonary disease patients

作　　者：黄蕾[1] 何烨颖[2] 田德兴[2] 文才[2] 

机构地区：[1]成都军区总医院营养科,610083 [2]成都军区总医院呼吸科,610083

出　　处：《中华临床医师杂志（电子版）》2012年第16期4638-4641,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者营养风险与临床结局的关系,以期利用较准确方法进行营养风险评估,及时实施营养干预,改善临床结局。方法测定177例AECOPD患者入院时体质指数(BMI)、血清白蛋白(Alb)、前清蛋白(PA)、血红蛋白含量(Hb)及淋巴细胞计数(LY),记录机械通气、死亡或出院情况、住院时间(LOS)。采用NRS2002营养风险筛查工具进行营养风险筛查评分,进行AECOPD患者不同营养风险状态与机械通气、病情转归和LOS关系分析;LOS与NRS2002评分以及各营养指标的相关性分析。结果重度营养风险组患者实施机械通气概率和死亡率高于轻微营养风险组患者,差异具有统计学意义(χ2=5.657,P=0.017;χ2=10.413,P=0.001),其机械通气和死亡的概率比(OR)分别为轻微营养风险组的6.093和9.792倍(95%CI:1.18～31.446,1.985～48.298),重度营养风险与机械通气概率和死亡率有较强关联度。中度营养风险患者LOS延长(≥13d)概率较轻微营养风险组患者高,有统计学意义(χ2=6.701,P=0.001),其OR为轻微营养风险组的2.618倍(95%CI:1.252～5.477);中度营养风险状态与LOS延长有较强关联度。患者LOS与NRS2002评分、年龄及BMI具有相关关系(r=0.319,P=0.000;r=0.182,P=0.022;r=-0.165,P=0.039)。结论 NRS2002评分所示的营养风险状态与临床结局具有较好的关联性,可用于入院AECOPD患者的营养风险筛查。Objective To examine the relation between the nutrional risk and the clinical outcome in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients so as to choose an accurate method of evaluating the nutrional risk,enforce a nutrion intervention in time and improve the clinical outcome.Methods BMI,Alb,PA,Hb content,and LY count on admission were determined and mechanical ventilation,deaths or discharge,and the length of stay(LOS)recorded in 177 AECOPD patients.The nutritional risk was screened by using the Nutrition Risk Screening2002(NRS2002).The relation between different states of nutritional risk and mechanical ventilation,pathocure and LOS was analyzed.The correlativity of NRS2002 scoring and all nutritive indexes was analyzed.Results The probability of the mechanical ventilation and death rates were higher in the great nutritional risk group than in the small nutritional risk group,which was statistically significant(χ2=5.657,P=0.017;χ2=10.413,P=0.001).The OR of the mechanical ventilation and death rate of the great nutritional risk group were 6.093 and 9.792 times that of the small nutritional risk group respectively(95% CI:1.18-31.446,1.985-48.298).The great nutritional risk had strong relevance to the probability of the mechanical ventilation and death rate.The probability of prolongation of LOS(≥13 d)was higher in the moderate nutritional risk group than in the small nutritional group,which was statistically significant(χ2=6.701,P=0.001).Its OR was 2.618 times that of the small nutritional group(95% CI:1.252-5.477).The state of the moderate nutritional risk had strong relevance to the prolongation of LOS.LOS was correlate with NRS2002 scoring,age,and BMI(r=0.319,P=0.000;r=0.182,P=0.022;r=-0.165,P=0.039).Conclusions The state the nutritional risk showed by NRS2002 scoring has a better relevance to the clinical outcome,which may be used for nutrition risk screening in AECOPD patients admitted.

关 键 词：肺疾病 慢性阻塞性 营养调查 住院时间 

分 类 号：R563.9[医药卫生—呼吸系统]