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

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住院时问显著增加（P=0．042）相关；出院时存在营养风险者，其住院费用显著增多（P〈0．01）。结论恶性肿瘤患者入院时营养风险发生率较高，与不良临床结局相关；合理进行营养干预，预防体重丢失可提高生活质量。

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）. There were 1 204 patients with nutritional risk at admission （51.7% ,NRS2002 score/〉3） and 1 352 patients with nutritional risk at discharge （58. 1%, NRS2002 score ≥3）, with significant differences （ X2 = 49. 9, P 〈 0. 001 ）. The incidence of nutritional risk in patients with eolorectal, stomach, and lung tumors at discharge was significantly higher than that at admission （P 〈 0. 05 ）. The infective complications and other complications of patients with nutritional risk were significantly greater than those without nutritional risk at admission and at discharge. ICU hospitalization stay of patients with nutritional risk was increased significantly than those without nutritional risk at admission （ P = 0. 042 ）. Hospitalization expenses of patients with nutritional risk was increased significantly than those of patients without nutritional risk at discharge（P 〈 0. 01 ）. Conclusion The patients with malignant tumor have a higher incidence rate of malnutrition at both admission and discharge and malnutritionhas correlation with adverse clinical outcomes. The aboveindicators did not improve significantly at discharge. Doctors should pay more attention to the nutritional status （ screening and evaluation） of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.