恶性肿瘤患者住院期间营养风险变化的动态调查  

Dynamic investigation of nutritional risk in patients with malignant tumor during hospitalization

作　　者：朱明炜[1] 韦军民[1] 陈伟[2] 杨鑫[1] 崔红元[1] 朱赛楠[3] 张片红[4] 熊剑[5] 郑堵奋 宋洪江 梁晓宇 张丽[9] 许武英[10] 王鸿波[11] 苏国强[12] 冯丽君[13] 陈婷[14] 吴咏冬[15] 李卉[16] 孙建琴[17] 石燕[18] 童本德[19] 周苏明[20] 王新颖[21] 黄乙欢 张博淼 徐键[24] 张红雨[25] 常桂林[26] 贾震易[27] 陈胜芳[28] 胡景[29] 张晓伟[30] 王慧 李占东 高艳艳[33] 桂冰[34] Zhu Mingwei, Wei Junmin, Chen Wei, Yang Xin, Cui Hongyuan, Zhu Sainan , Zhang Pianhong, Xiong Jian, Zheng Dufen, Song Hongjiang, Liang Xiaoyu, Zhang Li,Xu Wuying, Wang Hongbo, Su Guoqiang, Feng Lijun, Chen Ting, Wu Yongdong, Li Hui, Sun Jianqin, Shi Yah, Tong Bende, Zhou Suming, Wung Xinying, Huang Yihuan, Zhang Bomiao, Xu Jian, Zhang Hongyu, Chang Gui lin, Jia Zhenyi, Chen Shengfang, Hu Jing, Zhang Xiaowei, Wang Hui, Li Zhandong, Gao Yanyan, Gui Bing(Department of General Surgery, Beijing Hospital, Beijing 100730, Chin)

机构地区：[1]北京医院普外科,100730 [2]北京协和医院肠外肠内营养科 [3]北京大学第一医院统计教研室 [4]浙江大学医学院附属第二医院 [5]沈阳军区总医院 [6]浙江医院 [7]哈尔滨医科大学附属肿瘤医院 [8]天津医科大学总医院 [9]南京脑科医院 [10]新疆医科大学附属第一医院 [11]第四军医大学西京医院 [12]厦门大学附属第一医院 [13]浙江大学医学院附属邵逸夫医院 [14]河南省人民医院 [15]首都医科大学附属北京友谊医院 [16]武警总医院 [17]复旦大学附属华东医院 [18]解放军总医院 [19]第二军医大学长征医院 [20]江苏省人民医院 [21]南京军区南京总医院 [22]重庆医科大学附属第一医院 [23]哈尔滨医科大学附属第二医院 [24]大连医科大学附属中山医院 [25]山东大学齐鲁医院 [26]复旦大学附属中山医院 [27]上海市第六人民医院 [28]同济大学附属同济医院 [29]首都医科大学附属复兴医院 [30]河北省人民医院 [31]四川大学华西医院 [32]北京大学肿瘤医院 [33]广州市第一人民医院 [34]大连市中心医院

出　　处：《中华医学杂志》2018年第14期1093-1098,共6页National Medical Journal of China

摘　　要：目的应用营养风险筛查（NRS2002）工具，前瞻性动态调查恶性肿瘤住院患者住院期间营养状态变化，分析与临床结局的相关性。方法在2014年6—9月期间，对国内30家大医院进行前瞻、平行和多中心的调查研究；在消化内科、呼吸内科、肿瘤内科、普通外科、胸外科和老年科等多个临床科室，研究对象为各种恶性肿瘤住院患者，住院时间在7～30d，年龄≥18岁，于人院和出院24h内记录其临床资料、进行人体物理指标测量和实验室检查，应用营养风险筛查（NRS2002）工具；记录住院期间营养支持情况和临床结局指标，分析住院患者是否存在营养风险与临床结局的相关性。结果有2402例恶性肿瘤患者进人本研究，淘汰74例没有完成NRS2002的患者，最终纳入2328例；其主要疾病诊断病例数居前五位的包括结直肠肿瘤587例、肺肿瘤567例、胃肿瘤564例、食管肿瘤146例、肝肿瘤119例；与入院时的检查相比，患者在出院时的体质指数（BMI）、体重、握力和小腿围均显著降低（P〈0．05）；总蛋白、白蛋白、前白蛋白、血红蛋白均明显低于入院时水平（P〈0．05）；本组2328例患者入院时完成了营养风险筛查，其中入院时营养不足发生率为11．1％（BMI≤18．5，258／2328例）；出院时营养不足发生率为10．9％（BMI≤18．5，254／2328例），前后结果相似（X2=0．0197，P=0．888）。入院时NRS2002评分≥3分（存在营养风险）有1204例（51．7％）；出院时NRS2002评分≥3分有1352例（58．1％），前后比较x2值=49．9，P〈0．001；其中结直肠、胃、肺等肿瘤患者出院时的营养风险发生率显著高于入院时（P〈0．05）；入院时和出院时存在营养风险的恶性肿瘤住院患者，其感染并发症和其他并发症明显多于没有营养风险者；与没有营养风险者比较，入院时存在营养风险者，其ICU住院时问显著�Objective To prospectively investigate the changes in nutritional status of patieuts with malignant tumors during hospitalization by using nutritional risk screening （ NRS2002 ） , and to analyze the correlation between the nutritional status and clinical outcomes . Methods This was a prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014. Hospitalized patients with malignant tumors inthese departments （ Department of Gastroenterology, respiratory medicine, oncology, general surgery-, thoracic surgery＂ and geriatrics）were investigated. Only the patients with age I〉 18 years and hospitalization time between 7 -30 days were included. During hospitalization, the physical indexes of human bodywere measured, and the NRS 2002 scores, and monitored the nutritional support at the time points of admission and 24 hours before discharge were recorded. And whether there was a nutritional risk in hospitalized patients and its association with clinical outcomes were investigated. Results A total of 2 402 patients with malignancies were enrolled in this study. Seventy fourpatients who did not complete NRS2002 were eliminated, and 2 328 patients were included. The number of the main diseases was the top five, including 587 cases of colorectal cancer, 567 cases of lung cancer, 564 cases of gastric cancer, 146 cases of esophageal cancer, and 119 cases of liver tumor. At the time of discharge, compared with admission, the BMI, body weight, grip and calf circumferences of patients with malignant tumor weze significantly decreased （P 〈 0. 05 ）. The total protein, albumin, prealbumin and hemoglobin weze significantly lower than those at admission （P 〈 0. 05 ）. In 2 328 patients who were completed nutritional risk screening, the rate of malnutrition at admission was 11.1% （BMI = 18. 5,258/ 2 328） and the rate of malnutrition at discharge was 10. 9% （BMI = 18. 5,254/2 328）, there were no significant differences （X2 = 0. 019 7, P= 0. 888

关 键 词：恶性肿瘤 动态营养调查 出院患者营养状态 营养风险筛查 临床结局 

分 类 号：R459.3[医药卫生—治疗学]