普通外科病人住院期间营养风险和营养不良动态变化的多中心横断面调查  

Dynamic change in nutritional risk and malnutrition of general surgical patients during hospitalization:a multicenter cross-sectional survey

作　　者：杨鑫[1] 崔红元[1] 陈伟[2] 石汉平 唐云[4] 陈鄢津 朱赛楠[6] 朱明炜[1] 韦军民[1] YANG Xin;CUI Hong-yuan;CHEN Wei;SHI Han-ping;TANG Yun;CHEN Yan-jin;ZHU Sainan;ZHU Ming-wei;WEI Jun-min(Department of General Surgery,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Clinical nutrition department,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Gastrointestinal Surgery,Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of General Surgery,First Medical Center,PLA General Hospital,Beijing 100853,China;Department of General Surgery,Tianjin Nankai Hospital,Beijing 300100,China;Department of Statistics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京医院普通外科国家老年医学中心,北京100730 [2]中国医学科学院北京协和医院临床营养科,北京100730 [3]首都医科大学附属世纪坛医院胃肠外科,北京100038 [4]解放军总医院第一医学中心普通外科,北京100853 [5]天津南开医院普通外科,天津300100 [6]北京大学第一医院统计学教研室,北京100034

出　　处：《肠外与肠内营养》2020年第5期270-273,279,共5页Parenteral & Enteral Nutrition

基　　金：北京市科委重点项目(D18110ff300218004)。

摘　　要：目的:调查普通外科病人入院时及出院时营养风险和营养不良的动态变化。方法:在2014年6月至2015年5月期间,对5家三甲医院普通外科住院病人进行前瞻性调查;在入院和出院时分别应用营养风险筛查(NRS 2002)和主观全面营养评定(SGA)对病人进行一次营养状态评估,并收集体质量、BMI、握力、臂围、血清蛋白、血脂等营养相关指标,分析病人营养状态在住院期间的变化情况。结果:共纳入普通外科住院病人1818例,其中良性疾病病人806例,恶性肿瘤病人1012例;出院时NRS 2002筛查营养风险的发生率为56.71%,显著高于入院时的52.48%(χ^2=6.578,P=0.010);出院时SGA评定轻度以上营养不良发生率为42.01%,也显著高于入院时的31.02%(χ^2=47.256,P<0.001);分层分析发现恶性疾病营养风险和营养不良比例的差异更显著(P<0.001),而良性疾病出院时和入院时的营养状态没有显著改变(P>0.05)。出院时病人体质量、握力、臂围、总蛋白、白蛋白、前白蛋白和血红蛋白均较入院时均显著降低(P<0.05)。结论:普通外科住院病人出院时营养状态劣于入院时,尤其在恶性肿瘤病人中;营养不良是导致不良临床结局的重要因素。Objective:To investigate dynamic change in nutritional risk and malnutrition of general surgical patients during hospitalization.Methods:A prospective,multi-center survey was conducted in department of general surgery from 5 hospital,during June 2014 to May 2015.Anthropometric measuring and laboratory examination were recorded after admission and before discharge respectively.NRS 2002 and SGA were used to assess patients’nutritional status.Results:A total of 1835 patients included into the study,806 patients with benign diseasesand 1012 patients with malignant tumor.Compared with admission,patients’weight,BMI,grip,upper circumference and some main proteins were reduced significantly at discharge(P<0.05).The incidence of nutritional risk at discharge was 56.71%,higher than 52.48%on admission(χ2=6.578,P=0.010).The incidence of malnutrition(SGA B+C)at discharge was 42.01%,higher than 31.02%on admission(χ2=47.256,P<0.011).The incidence of nutritional risk and malnutrition during hospitalization had a significant change in patients with malignant tumor(P<0.0001)and no change in patients with benign diseases(P>0.05).Conclusion:Nutritional status of general surgery patients at discharge was worse than that on admission,particularly on patients with malignant tumor.Malnutrition was an important factor leading to adverse clinical outcomes.

关 键 词：普通外科 营养风险 营养不良 动态调查 临床结局 

分 类 号：R459.3[医药卫生—治疗学]