华北和华中11家三甲医院小于90岁老年冠心病诊断相关组患者营养风险和营养不足发生率横断面调查及营养支持情况回顾性分析  

An 11-site cross-section survey on the prevalence of nutritional risk, malnutrition （undernutrition） and nutrition support among the diagnosis-related group of elderly inpatients younger than 90 years old with coronary heart disease in North and Central China

作　　者：许静涌[1] 王艳[2] 唐普贤[3] 朱明炜[1] 韦军民[1] 陈伟[4] 王化虹[5] 吴咏冬[6] 王新颖[7] 章黎[7] 周苏明[8] 孙建琴[9] 董碧蓉[10] 陈鄢津[11] 陈怀红[12] 楼慧玲[13] Xu Jingyong, Wang Yan, Tang Puxian, Zhu Ming-wei, Wei Junmin, Chen Wei, Wang Huahong, Wu Yongdong, Wang Xinying, Zhang Li, Zhou Suming, Sun Jianqin, Dong Birong, Chen Yanjin, Chen Huaihong, Lou Huiling.(Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, Chin)

机构地区：[1]北京医院国家老年医学中心普通外科,100730 [2]北京医院国家老年医学中心心血管内科,100730 [3]北京医院国家老年医学中心重症医学科,100730 [4]中国医学科学院北京协和医学院,北京协和医院肠外肠内营养科,100730 [5]北京大学第一医院消化内科,100035 [6]首都医科大学附属北京友谊医院消化内科,100050 [7]南京军区南京总医院普通外科,210002 [8]江苏省人民医院老年科,南京210029 [9]上海华东医院营养科,200040 [10]四川大学华西医院老年科,成都610041 [11]天津南开医院胃肠外科,300100 [12]浙江大学医学院附属第二医院神经内科,杭州310009 [13]广州市第一人民医院老年科,510180

出　　处：《中华临床营养杂志》2018年第3期149-155,共7页Chinese Journal of Clinical Nutrition

摘　　要：目的通过对11家三甲医院心内科老年冠心病患者营养风险、营养不足及营养支持应用情况调查资料进行基于诊断相关组的再分析，了解该诊断相关组营养风险和营养不足的发生率和营养支持情况。方法在11家医院的心内科病房，采用连续采样的方法，收集登记全部入院患者。按＂诊断相关组文件＂将冠心病组中的90岁以下老年患者为入组标准。对2012年3至5月入组患者，在入院后24 h内用营养风险筛查工具2002（NRS 2002）进行营养风险筛查，调查营养风险和营养不足发生率以及回顾性分析住院期间营养支持应用状况。结果符合冠心病诊断的老年患者1 279例，平均年龄74.0岁，营养风险发生率28.14%（360/1 279）。按年龄分层（65-69岁、70-79岁、80-89岁），营养风险发生率（12.88%比30.08%比42.28%）和营养风险≥5分的发生率（10.86%比18.61%比27.78%）均随年龄增长而升高。体质量指数（BMI）以超重及肥胖（BMI≥24 kg/m^2）为主，占53.0%，其营养风险发生率为15.12%（96/635），而BMI正常的人群营养风险发生率为34.24%。若从BMI〈18.5 kg/m^2伴一般状况差来评估营养不足，发生率为4.25%。若从NRS 2002营养状态受损评分＝3分来判定营养不良（不足），发生率为7.58%。在有营养风险的患者中营养支持应用率16.6%（57/344）；而无营养风险的919例患者中有21例接受了营养支持（2.29%），其中16例为肠外营养（76.2%）。将有营养风险组分为有营养支持和无营养支持亚组，其年龄[（79.46±7.19）岁比（76.40±6.16）岁]、营养风险≥5分比例（35.1%比17.1%）差异有统计学意义（P＝0.001，P＝0.002），营养风险差异主要来源于营养状态受损情况（P＝0.019）。两组基线不具有可比性，无法进一步进行结局指标的对照分析。结论老年冠心病患者营养风险发生率28.14%，营养不良（不足）发生率7.58%。超重�Objective To investigate the prevalence of nutritional risk, undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China. Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government. Results A total of 1 279 consecutive cases were recruited with the average age 74 years old （65-89）. The total nutritional risk prevalence was 28. 14% （360/1 279 ）. The prevalence of nutritional risk and nutritional risk score /〉 5 increased with age. The prevalence of nutritional risk （ 12.88% vs. 30.08% vs. 42.28%） and nutritional risk scored ≥5 （ 10.86% vs. 18.61% vs. 27.78%） increased with age. Judging from BMI, most patients were overweight or obese （ BMI/〉 24 kg/m^2） , ac- counting for 53.0% of the total, and prevalence of nutritional risk in this subgroup was 15. 12% （96/ 635 ）. The prevalence of nutritional risk in patients with normal BMI was 34.24%. The prevalence of un- dernutrition defined as BMI〈18.5 kg/m^2 was 4.25% （51/1 279） , among which patients with score i〉5 account for 64.7% （33/51）. The prevalence of undernutrition defined as nutritional impairment score= 3 was 7.58% （97/1 279）. In patients with nutritional risk, 57 were administrated nutrition support （16.6%） ; in patients without nutritional risk, 21 received nutrition support, mostly parenteral nutrition （16 cases, 76.2%）. In patients with nutritional risk [ （79.46±7. 19） years vs. （76.40±6. 16） years ] , there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 （35. 1% vs. 17. 1% ） （ P= 0. 001, P= 0. 002） . Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high. The preval

关 键 词：营养风险筛查2002 诊断相关组 冠心病 营养风险 营养支持 

分 类 号：R459.3[医药卫生—治疗学] R541.4[医药卫生—临床医学]