营养支持改善危重肾脏病患者营养状况的前瞻性研究  

Nutritional support treatment in critically ill patients with kidney disease: a prospective study

作　　者：桂兰兰[1,2] 许书添[2] 何群鹏[2] 柳晶[2] 杨柳[2] 郭锦洲[2] 刘志红[2] 谢红浪[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2013年第3期207-212,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家十二五支撑计划课题(2011BA110B07)

摘　　要：目的:调查危重肾脏病患者营养风险及营养不良发生率,前瞻性研究短期营养支持后危重肾脏病患者营养状况的变化。方法:应用营养风险筛查2002量表(NRS2002)对2011年8月至2012年6月南京军区南京总医院全军肾脏病研究所ICU的患者进行筛查。对NRS2002评分≥3分患者行营养支持,同时测量和检测营养评价指标。结果:466例患者完成NRS2002筛查,其中营养风险发生率87.3%,营养不良发生率25.1%。137(33.7%)例患者进入营养支持研究,其中男性76例(55.4%),女性61例(44.6%),平均年龄(40.0±17.3)岁。营养支持方式包括食物添加营养素23例(16.8%),肠内营养97例(70.8%),肠外营养2例(1.5%),肠内营养+肠外营养15例(10.9%)。入院第1天、第3天、第7天,摄入热卡分别为15.4±7.3 kcal/kg、20.9±8.2 kcal/kg、22.3±8.5 kcal/kg(P=0.001);蛋白质摄入量分别为0.5±0.2g、0.6±0.3g、0.7±0.3g(P=0.001)。入院第7天与第1天相比,血清白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数升高明显(P=0.001);男性及女性患者细胞内水/细胞外水比值(I/E)有不同程度提高。结论:危重肾脏病患者营养风险发生率高达87.3%,营养不良发生率25.1%。短期营养支持后血清白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数及体内水分分布异常较前改善。To investigate the prevalence of nutritional risk and malnutrition in critically ill patients with kidney disease and prospectively observe the clinical efficacy of short-term nutritional support. Methodology： Adult patients in renal ICU were enrolled from August, 2011 to June, 2012. Nutritional Risk Screening 2002 （NRS2002） was performed in all patients. The patients with a total score of ≥3 were decided to receive nutritional support therapy. Their nutritional parameters including BMI, the changes of body weight, and the serum concentrations of Alb, PA, TF and LC were examined. Results： Four hundred sixty six patients underwent NRS2002, Overall prevalence of nutritional risk was 25.1% and malnutrition was 87.3%. 137 patients, who were 76 males and 61 females with a mean age of 40.0±17.3 years old, received nutritional support therapy. Among them, food fortification in 23 cases （16.8%）, enteral nutrition in 97cases （70.8%）, parenteral nutrition in 2 cases （1.5%）, enteral nutrition plus parenteral nutrition in 15 cases （10.9%）.The energy intake were （15.4±7.3） Kcal/kg in first day, （20.9±8.2） Kcal/Kg in third day, and （22.3±8.5） Kcal/Kg in seventh day （P=0.001）. The protein intake were 0.5±0.2g, 0.6±0.3g, and 0.7±0.3g respectively （P=0.001）. After a week of nutritional support therapy, the serum concentrations of Alb, PA, TF and LC were increased significantly （p=0.001）. The I/E of male and female were also increased respectively （P=0.044 and 0.248）. Conclusion： The prevalence of nutritional risk and malnutrition was 87.3%, 25.1% respectively in critically ill patients with kidney disease. After short-term nutritional support therapy, the serum concentrations of Alb, PA,TF and LC as well as abnormal distribution of body water were improved.

关 键 词：危重肾脏病 营养风险 多频生物电阻抗分析 

分 类 号：R692[医药卫生—泌尿科学]