营养不良GLIM诊断标准第一步是营养筛查及按中国疾病代码填写营养风险、营养不良于出院病案首页等注意事项  

Three steps of Global Leadership(nutritional field)Initiative on Malnutrition(GLIM)and fill the diseases name(Chinese version ICD-10 listed)"nutritional risk"and"malnutrition"on front page of discharge medical record for letting big-data to find it to design the DRG contents for China

作　　者：蒋朱明 张献娜 王怡 吴河水[2] 李乃适 赵彬 康维明 于康 潘宏铭[3] 朱明炜[4] 许静涌[4] 杨剑 伍晓汀[6] 潘勤[3] 吴燕[3] 郝春满[7] 谢浩芬[8] 路潜[9] 岳向峰 李卫[11] 李小萌[11] 成小如[11] 赵延延 王杨[11] 蔡威 王莹 吴江[13] 杨桦[14] 许红霞 陈鄢津[16] 叶欣 李卓 郭淑丽 孙文彦 赵敏[17] 孙海岚 曾敏婕[19] 关珂[20] 王岩 张明[22] 贾晓巍[23] 高素婷 Jiang Zhuming;Zhang Xianna;Wang Yi;Wu Heshui;LI Naishi;Zhao Bin;Kang Weiming;Yu Kang;Pan Hongming;Zhu Mingwei;Xu Jingyong;Yang Jian;Wy Xiaoding;Pan Qin;Wu Yan;Hao Chuman;Xie Haofen;Lu Qian;Xue Xiangfeng;Li Wei;Li Xiaomeng;Cheng Xiaoru;Zhao Yanyan;Wang Yang;Cai Wei;Wang Ying;Wu Jiang;Yang Hua;Xu Hongxia;Chen Yanjin;Ye Xin;Li Zhuo;Guo Shuli;Sun Wenyan;Zhao Ming;Sun Hailan;Zeng Mingjie;Guan Ke;Wang Yan;Zhang Min;Jia Xiaowei;Gao suting(Departments of General Surgery,Medical Record,Endocrine Pharmacy,Clinical Nutrition,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pancreatic Surgery,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of oncology and pharmacy,Run Run Shaw Hospital,School of Medicine of Zhejiang University,Hangzhou 310016,China;Department of General Surgery,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of clinical nutrition,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of clinical nutrition,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Nursing Department of Ningbo First Hospital,Ningbo 315010,China;Department of Epidemiology and Biostatistics,School of Public Health,Peking University,Beijing 100191,China;Department of pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Medical research and Statistics Center of Fuwai Hospital,National Cardiovascular Center,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Pediatrics,Department of Gastroenterology,Xinhua Hospital,Shanghai Jiaotong University,Shanghai 200092,China;Department of clinical nutrition,Shanghai Huadong Hospital,Fudan University,Shanghai 200040;Department of General Surgery,Xinqiao Hospital,Third Military Medical Univ

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科、病案科、内分泌科、药科、临床营养科,100730 [2]华中科技大学同济医学院附属协和医院胰腺外科,武汉430022 [3]浙江大学医学院附属邵逸夫医院肿瘤内科、药科,杭州310016 [4]北京医院普通外科,100730 [5]重庆医科大学附属第三医院临床营养科,401120 [6]四川大学华西医院胃肠外科,成都610041 [7]首都医科大学附属北京天坛医院消化内科、临床营养科,100070 [8]浙江宁波市第一医院护理部,315010 [9]北京大学护理学院内外科护理学教研室,100191 [10]郑州大学第一附属医院药学部,450052 [11]中国医学科学院北京协和医学院国家心血管病中心阜外医院医学研究统计中心,100037 [12]上海交通大学新华医院儿科研究所、消化内科、儿外科,200092 [13]复旦大学上海华东医院临床营养科,200040 [14]第三军医大学新桥医院普外科,400037 [15]陆军特色医学中心临床营养科,重庆400042 [16]天津南开医院胃肠外科,300100 [17]解放军总医院第六医学中心营养科,北京100048 [18]重庆市妇幼保健院营养科,401147 [19]湖南省人民医院消化内科,长沙410021 [20]河南省人民医院临床营养科,郑州450003 [21]首都医科大学良乡教学医院,北京100069 [22]北京大学深圳医院临床营养科,深圳518035 [23]人民卫生出版社智数科技公司,北京100021 [24]全国名词审定委员会编辑部,北京100717

出　　处：《中华临床营养杂志》2020年第5期257-267,共11页Chinese Journal of Clinical Nutrition

摘　　要：多年来,全球肠外肠内营养学界同道们都在寻求营养不良诊断标准的统一,既需要确定营养不良诊断标准,也需要考虑营养不良指标在不同国家、不同种族的正常值和按临床研究得到的切割点(cut-off point)。全球(营养)领导层倡议营养不良(Global Leadership Initiative on Malnutrition,GLIM)诊断标准于2018年9月在美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)和欧洲临床营养和代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站发表。2019年初在纸质版杂志《JPEN》及《Clinical Nutrition》发表。GLIM在《全国科学技术名词审定委员会-肠外肠内营养学分名词-2019》有记载。GLIM中的某些阈值可能会随着时间的推移而有演变,但是从主观评定营养不良(如SGA、PG-SGA),发展到用表现型指标、病因型指标诊断营养不良的方向是正确的。高质量的前瞻性临床有效性验证报告和前瞻性多中心临床应用数据分析,将是GLIM改进的基础。2016年《疾病分类与代码》GB/T(中国ICD-10扩充版)及2019年《关于全国三级公立医院绩效考核通知〔2019〕》以及国家医保局信息业务数据库等三个方面文件均收录了营养风险、营养不良、重度(严重)营养不良作为疾病名称。目前临床各学科都在推行个体化医疗,但是临床各科室的实际情况不同。对肠外肠内营养支持疗法的临床应用来说,与对癌症患者的精准医疗、靶向治疗是有很大的距离。2004年12月,中华医学会肠外肠内营养学分会(Chinese Society for Parenteral and Enteral Nutritional,CSPEN)常委会组建营养风险-不足-营养支持-结局-成本效果比(Nutritional risk-undernutrition-support-outcome-cost effectiveness ratio,NUSOC)多中心分享数据库协作组,该协作组的目标是分出哪些患者需要肠外肠内营养支持疗法,合理应用前提下让患者受益。中国的疾病诊断相关分组Global leading scholars in the field of parenteral and enteral nutrition have been seeking for the criteria of diagnosis of malnutrition.In determining the diagnostic criteria for malnutrition,it is also necessary to take into account the normal values and clinically obtained cut-off points of different countries and races.The Global Leadership(nutrition field)Initiative on Malnutrition,GLIM)diagnostic criteria published online on Sep.2&Sep.32018.In January&February 2019,the[American Society for Parenteral and Enteral Nutrition,ASPEN]and the[European Society for Clinical Nutrition and Metabolism,ESPEN]published in print.The GLIM criteria has also been recorded in[National terminology of parenteral and enteral nutrition of China-2019].In 2016"Disease Classification and Code(Chinese expanding version of ICD-10)"having"nutritional risk"and"malnutrition"items officially listed.In 2019"Notice on National Tertiary Public Hospitals"and in the"National Medical Insurance Administration-coding standard"also include the items of"nutritional risks"and"malnutrition"as diseases name.Although promoting individualized medical therapy in China now,but the actual situation of each clinical department is different.As far as parenteral and enteral nutrition is concerned,it was far from"precision medicine"or"targeted therapy"in clinical practice nowadays.The current aim is to identify which patients need nutrition support therapy for reasonable application-benefit to patient.China's DRG being developed by"big data survey system".Therefore,it is necessary for"this system"can find nutritional risk and malnutrition as diseases name with the codes from Chinese expanding version of ICD-10.So,nutritional risk and malnutrition need to be filled in the cover page of discharged medical record.

关 键 词：营养风险 NRS 2002 营养风险筛查 营养不良 GLIM、营养不良诊断 转化医学3T模式 肠外肠内营养学转化医学T3转化 

分 类 号：R459.3[医药卫生—治疗学]