全部无肠外肠内营养干预的老年髋部骨折手术患者营养风险评分与结局关系的前瞻性队列研究  

Impact of nutritional risk scores on clinical outcomes in elderly patients with hip fracture without PN EN support： a prospective cohort study

作　　者：金占萍[1] 朱迎春[1] 王哲洋 谢浩芬[2] 付建飞[3] 冯波[4] 刘飞舞[1] 叶姗妮 李小萌[5] 王杨[5] 蒋朱明[6] Jin Zhanping Zhu Yingchun Wang Zheyang Xie Haofen Fu Jianfei Feng Bo Liu Feiwu Ye Shanni Li Xiaomeng Wang Yang Jiang Zhuming(Department of Orthopedic, Ningbo First Hospital, Ningbo, Zhefiang 315010, China)

机构地区：[1]宁波市第一医院骨科, 浙江省315010 [2]宁波市第一医院护理部, 浙江省315010 [3]宁波市第一医院病案统计室, 浙江省315010 [4]宁波市第一医院营养膳食科, 浙江省315010 [5]中国医学科学院北京协和医学院阜外医院医学统计室,100037 [6]中国医学科学院 北京协和医学院 北京协和医院基本外科,100730

出　　处：《中华临床营养杂志》2017年第3期135-140,共6页Chinese Journal of Clinical Nutrition

基　　金：宁波市医学科技计划项目（2011A03）

摘　　要：目的 探讨骨科老年髋部骨折患者营养风险与营养不足发生情况,分析营养风险评分与结局的关系.方法 本研究为前瞻性队列研究设计,采用定点连续抽样方法,调查2013年11月至2015年12月宁波市第一医院骨科病房235例老年髋部骨折患者的营养风险、营养不足情况,并收集其感染性并发症、住院天数（实际住院日和理想住院日）等情况.分析不同年龄段（60～69岁、70～79岁、≥80岁）、不同营养风险得分（〈3分、3～4分、≥5分）患者的感染性并发症、术后住院天数.结果 235例老年髋部骨折患者营养风险发生率为62.98％.其中,根据营养风险筛查2002中营养缺失部分评分得出营养不足20例,根据体质量指数判断存在营养不足15例;关节置换组患者营养风险明显高于内固定组（74.04％比54.20％）,差异有统计学意义（P=0.002）;有伴随疾病的老年髋部骨折患者营养风险明显高于无伴随疾病患者（71.56％比55.56％）,差异有统计学意义（P=0.011）;不同营养风险、营养不足患者的术后感染性并发症发生率（2.30％比3.91％比50.00％）、术后理想及实际住院天数[（6.35±0.87）d比（8.12±1.13）d比（10.85±1.52）d,（8.66 ±2.06）d比（10.45 ±2.43）d比（13.25 ±3.65）d]差异有统计学意义（P=0.000）.结论 老年髋部骨折患者营养风险较高,有营养风险患者的术后并发症多、住院天数长.Objective To investigate the prevalence of nutritional risk and undernutrition of geriatric patients with hip fracture in the department of orthopaedics and analyze the relationship between nutritional risk scores and clinical outcomes.Methods In this prospective cohort study,the baseline demographic data of 235 elderly patients with hip fracture in the department of orthopaedics of Ningbo First Hospital were consecutively recorded from November 2013 to December 2015.The prevalence of nutritional risk and undernutrition,infectious complications,and length of hospital stay were also recorded.The infectious complications and length of hospital stay in patients in different age groups（60-69 years,70-79 years,and ≥80 years）and those with different nutritional risks（＆lt;3 points,3-4 points,and ≥5 points）were analyzed.Results All patients without PN EN support during hospitalized durations.The incidence of nutritional risk was 62.98%in 235 elderly patients with hip fracture,twenty patients were undernutritioned by multi-item standard based on Nutritional Risk Screening 2002 nutrition disorder score,and 15 patients were undernutritioned by one-item standard with body mass index.Hip arthroplasty patients had significantly higher nutritional risk than those who had undergone internal fixation（74.04%vs.54.20%,P=0.002）.Patients with comorbidities had significantly higher nutritional risk than patients without comorbidities（71.56%vs.55.56%,P=0.011）.There were significant differences in infectious complications（2.30%vs.3.91%vs.50.00%）and length of hospital stay[（6.35±0.87）d vs.（8.12±1.13）d vs.（10.85±1.52）d,（8.66±2.06）d vs.（10.45±2.43）d vs.（13.25 ±3.65）d] among patients with different nutritional risks（＆lt;3 points,3-4 points,and ≥5 points）（P=0.000）.Conclusions Elderly patients with hip fracture has relatatively high nutritional risk.These patients tend to have more complications and longer hospital stay.

关 键 词：老年髋部骨折 营养风险筛查2002 营养风险 营养不足 临床结局 

分 类 号：R459.3[医药卫生—治疗学] R687.3[医药卫生—临床医学]