微型营养评价法评估老年股骨颈骨折营养状况的研究  

Application of Mini Nutritional Assessment to Evaluate the Nutritional Status in Elderly Patients with Femoral Neck Fractures

作　　者：韩璇 王燕萍 程青 

机构地区：[1]解放军武汉总医院急诊科,湖北武汉430070 [2]湖北省荣军医院老年病科

出　　处：《华南国防医学杂志》2017年第12期826-829,833,共5页Military Medical Journal of South China

摘　　要：目的应用微型营养评价法(mini nutritional assessment,MNA)评估老年股骨颈骨折住院患者的营养状况,并明确MNA评分与血清学营养指标[总蛋白(total protein,TP),白蛋白(albumin,ALB),前白蛋白(prealbumin,PA),转铁蛋白(transferrin,TRA),淋巴细胞计数(lymphocyte count,TLC),淋巴细胞百分比(lymphocytes percentage,TLP),血红蛋白(hemoglobin,HGB)]的关系。方法分析2010-01/2015-05月在作者医院行人工股骨头置换术的202例老年股骨颈骨折患者的临床资料,其中男74例,女128例,平均年龄81.27岁。根据MNA的评分结果,将所有住院患者分为营养良好组、潜在营养不良组和营养不良组,研究各组血清学指标的变化情况及其与MNA评分间的相关性。结果经MNA评估发现作者医院老年股骨颈骨折住院患者,入院时的营养良好患者58例(28.71%),潜在营养不良患者62例(30.69%),营养不良患者82例(40.60%)。所有患者入院时血清学营养指标的平均值均随着MNA评分的下降而逐渐降低,3组患者的PA、TRA和TLP平均值比较有统计学差异(P均<0.01);入院时,ALB、PA、TRA和TLP评估的营养不良发生率中,营养不良组>潜在营养不良组>营养良好患者(P均<0.05);而营养不良组术后ALB、PA、TRA、TLP和HGB评估的营养不良发生率均明显高于入院时(P均<0.05)。所有患者的血清营养学指标与MNA评分所反映的营养状态密切相关,且PA、ALB、TRA和TLP在营养状态的检测效能上要优于TP、TLC和HGB。结论 MNA营养风险评估和血清学营养指标(PA、ALB、TRA、TLP和HGB)筛查可作为老年股骨颈骨折住院患者入院营养状况筛查和调整的可靠方法。Objective To investigate the reliability of mini nutritional assessment（MNA）on nutritional status in elderly patients with femoral neck fractures,and analyze the correlation between MNA scores and serological nutritional indicators[total protein（TP）,albumin（ALB）,prealbumin（PA）,transferrin（TRA）,lymphocyte count（TLC）,lymphocytes percentage（TLP）,hemoglobin（HGB）].Methods A prospective study of 202 elderly patients（74 males and 128 females）with femoral neck fractures,aged 70-95 years（average 81.27）,from January 2010 to May 2015 in authors＇ hospital were included.Based on MNA scores,patients were divided into three groups：well-nourishment group,latent malnourishment group,malnourishment group.The MNA scores and serological nutritional indicators of patients were analyzed.Results The nutritional status of elderly femoral neck fracture patients were measured by MNA,and the number of patients in well-nourishment group was 58（28.71%）,latent malnourishment group was 62（30.69%）,malnourishment group was 82（40.60%）.On admission,all the average value of serological nutritional indicators were decreased with reduction of MNA scores.The differences among three groups were found in PA,TRA and TLP（P0.01）.The malnutrition rates evaluated by ALB,PA,TRA,TLP in latent malnourishment group were markedly lower than thos in malnourishment group,and were markedly higher than those in well-nourishment group（P0.01）.And the postoperative malnutrition rates evaluated by ALB,PA,TRA,TLP and HGB in malnourishment group were markedly higher than those on admission（P0.01）.The MNA score showed strong correlations with serological nutritional indicators,and the detection effectiveness of malnutrition by PA,ALB,TRA and TLP were better than TP,TLC and HGB.Conclusion The MNA score and serological nutritional indicators（PA,ALB,TRA,TLP and HGB）can be considered as important indicators for judging nutritional status for elderly patients with femoral neck fractures.

关 键 词：股骨颈骨折 微型营养评价法 血清学营养指标 营养不良 

分 类 号：R683.42[医药卫生—骨科学]