文章摘要
刘晔,欧阳晓俊,蔡晓真,陈吉海,胡健,陆冰,傅坤发.内科老年住院患者营养状况及其影响因素分析[J].中国临床保健杂志,2019,22(2):174-178.
内科老年住院患者营养状况及其影响因素分析
Nutritional status and influencing factors of elderly inpatients in internal medicine department
投稿时间:2018-11-19  
DOI:10.3969/J.issn.1672-6790.2019.02.008
中文关键词: 老年人营养生理学现象  营养评价  营养不良  营养调查  危险因素
英文关键词: Elder nutritional physiological phenomena  Nutrition assessment  Malnutrition  Nutrition surveys  Risk factors 〖FL
基金项目:江苏省卫计委科研项目(BJ15025,BJ17026)
作者单位E-mail
刘晔 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
欧阳晓俊 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
蔡晓真 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
陈吉海 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
胡健 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
陆冰 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
傅坤发 南京医科大学附属老年医院老年衰弱与营养代谢研究室,南京 210024 xiaojun_ouyang@aliyun.com 
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中文摘要:
      目的 比较不同筛查工具评估282例内科老年住院患者营养状况差异,探讨营养筛查量表与患者临床指标、日常生活能力及疾病状况关系,分析影响老年营养状况的可能危险因素。 方法 采用营养风险筛查表(NRS2002)及微营养评定法简表(MNA-SF)对282例年龄≥65岁的住院患者进行营养筛查。同时测定血液营养代谢指标,对患者进行日常生活能力评估(Barthel指数),记录患者基础疾病情况、有无感染及住院天数等信息。 结果(1)NRS2002评估有营养风险169例(59.9%);MNA-SF评估为营养不良38例(13.5%),营养不良风险100例(35.4%)。NRS2002与MNA-SF诊断营养异常结果基本一致(Kappa=0.47,P<0.001),NRS2002诊断阳性率高于MNA-SF(P<0.001)。(2)NRS2002与MNA-SF评分结果均提示有营养风险组或营养不良/营养风险组相对无营养风险组的年龄较大,体质指数(BMI)、血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)、总胆固醇(TC)及Barthel指数较低,住院天数较长,同时患急性感染、认知功能障碍的比例较高。(3)急性感染、卒中、认知功能障碍是营养风险的危险因素,OR分别为4.776(95%CI:2.293~9.950)、8.747(95%CI:4.450~17.193)、7.205(95%CI:2.289~22.677);急性感染、认知功能障碍是营养不良/营养不良风险的危险因素,OR分别为2.021(95%CI:1.158~3.527)、6.046(95%CI:2.717~13.453)。63.48%的内科老年住院患者合并3种及以上基础疾病,其NRS2002评分低于合并0~2种基础疾病组,而MNA-SF评分较高。 结论 内科老年住院患者约半数存在营养问题,NRS2002、MNA-SF两种营养筛查方法诊断结果基本一致,NRS2002更适于内科住院老年患者。急性感染、卒中及认知功能障碍是内科老年住院患者营养不良的危险因素,合并3种及以上基础疾病的老年内科住院患者营养状况较差。
英文摘要:
      Objective To analyze the relationship between the nutritional screening scale and the patients′ daily living ability and disease status,the possible risk factors influencing the nutritional status of the elderly were analyzed. Methods A total of 282 in the department of Geriatric inpatients were scored by nutritional risk screening(NRS2002) and mini nutritional assessment-short form (MNA-SF).At the same time,blood nutrition and metabolism indexes were measured,Barthel index was used to evaluate the patients′ daily living ability,and information such as infection status and length of stay were recorded. Results 1.One hundred and sixty-nine (59.9%) were diagnosed as nutritional risk by the NRS2002,while 38 (13.5%) and 100 (35.4%) patients were diagnosed as malnutrition or malnutrition risk tassessed by MNA-SF,respectively.The results of NRS2002 were consistent with those of MNA-SF(Kappa=0.47,P<0.001).The diagnostic positive rate of NRS2002 was higher than that of MNA-SF (P<0.001).2.The patient′s age in nutritional risk group was older than the non-nutritional risk group,with lower body mass index (BMI),hemoglobin (Hb),albumin (ALB),prealbumin (PA),total cholesterol (TC) and Barthel indexes;longer hospital stay,and a higher proportion of patients with acute infection and cognitive impairment.3.Acute infection,stroke and cognitive impairment were major risk factors of nutrition risk,which OR were 4.776 (95%CI:2.293-9.950),8.747 (95%CI:4.450-17.193),7.205 (95%CI:2.289-22.677),respectively.Acute infection and cognitive impairment were major risk factors of malnutrition/malnutrition risk,which OR were 2.021(95%CI:1.158-3.527),6.046(95%CI:2.717-13.453).The 63.48% of elderly inpatients in internal medicine concomitant with 3 or more basic diseases,their NRS2002 scores were lower than those patients with 0-2 basic diseases and MNA-SF scores were higher. Conclusions There are about nearly half of geriatric inpatients have nutritional problems.Diagnostic results of NRS2002 and MNA-SF are consistent.NRS2002 more suitable for medical hospitalized elderly patients.Acute infection,stroke and cognitive impairment are major risks for malnutrition in elderly inpatients.Inpatients with 3 or more underlying diseases have poorer nutritional state.
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