老年普外科住院患者发生营养风险的危险因素及接受营养支持情况分析

The risk factors of nutritional risk and receiving nutritional support in elderly inpatients of department of geriatric general surgery

目的探讨老年普外科住院患者发生营养风险的危险因素及接受营养支持情况。方法回顾性分析2017年6月至2019年12月在昆明医科大学第一附属医院老年普外科住院的1174例老年患者临床资料,入院24 h内均接受营养风险筛查及营养不良评估,根据营养风险筛查结果将患者分为营养风险组和无营养风险组,比较2组患者的临床资料,分析老年住院患者存在营养风险的危险因素和2组患者接受营养支持情况。结果1174例老年住院患者中,存在营养风险416例(营养风险组),无营养风险758例(无营养风险组),营养不良186例(15.8%),均为营养不足。营养风险组男性、年龄≥80岁、独居、伴恶性肿瘤、胃肠类疾病、多重用药、基础疾病≥3个比例均高于无营养风险组[60.6%(252/416)比54.7%(415/758),46.9%(195/416)比24.7%(187/758),10.1%(42/416)比8.0%(61/758),14.4%(60/416)比8.7%(66/758),45.9%(191/416)比36.9%(280/758),46.6%(194/416)比40.6%(308/758),56.7%(236/416)比40.9%(310/758)](均P<0.05),2组合并2型糖尿病比例比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,年龄≥80岁、独居、伴恶性肿瘤、胃肠类疾病、多重用药、基础疾病≥3个均为老年普外科住院患者存在营养风险的危险因素(比值比=2.675、1.600、1.527、1.389、1.318、1.419,均P<0.05)。营养风险组患者接受营养支持率为59.1%(246/416),其中采用肠内营养107例、肠外营养41例,二者联合98例;有营养风险而未接受营养支持者170例(40.9%),为营养支持使用不足。无营养风险组者行营养支持179例(23.6%),为营养支持使用过度。结论年龄≥80岁、独居、伴恶性肿瘤、胃肠类疾病、多重用药、基础疾病≥3个均为本院老年普外科住院患者存在营养风险的危险因素。存在营养风险者未接受营养干预以及无营养风险患者接受营养干预的不合理性需要临床改进。

Objective To explore the risk factors of nutritional risk and receiving nutritional support in elderly inpatients of department of geriatric general surgery.Methods From June 2017 to December 2019,1174 elderly patients admitted to the Department of Geriatric General Surgery,First Affiliated Hospital of Kunming Medical University were selected.All patients received nutritional risk screening and malnutrition assessment within 24 h after admission.According to the results of nutritional risk screening,the patients were divided into nutritional risk group and non nutritional risk group.The clinical data between the two group were compared.The risk factors of nutritional risk in elderly inpatients and nutritional support of the two groups were analyzed.Results Among 1174 elderly inpatients,there were 416 cases with nutritional risk(nutritional risk group),758 cases without nutritional risk(non nutritional risk group).There were 186 cases with malnutrition(15.8%),and they were undernutrition.The proportions of male,age≥80 years,living alone,with malignant tumor,gastrointestinal diseases,multiple drug uses and basic diseases≥3 in nutritional risk group were higher than those in non nutritional risk group[60.6%(252/416)vs 54.7%(415/758),46.9%(195/416)vs 24.7%(187/758),10.1%(42/416)vs 8.0%(61/758),14.4%(60/416)vs 8.7%(66/758),45.9%(191/416)vs36.9%(280/758),46.6%(194/416)vs 40.6%(308/758),56.7%(236/416)vs 40.9%(310/758)](all P<0.05).There was no significant difference in the proportion of type 2 diabetes mellitus between the two groups(P>0.05).Multivariate Logistic regression analysis showed that age≥80 years,living alone,with malignant tumor,gastrointestinal diseases,multiple drug uses,and basic diseases≥3 were the risk factors of nutritional risk in elderly inpatients of department of geriatric general surgery(odds ratio=2.675,1.600,1.527,1.389,1.318,1.419,all P<0.05).The nutritional support rate of patients in nutritional risk group was 59.1%(246/416),including 107 cases of enteral nutrition,41 cases of parenteral nutrition and 98 cases of combination of enteral and parenteral nutrition.There were 170 cases(40.9%)of insufficient nutrition support(48.1%)who had nutritional risk but did not received nutritional support,and 179 cases(23.6%)of excessive use of nutritional support who had no nutritional risk but received nutritional support.Conclusions Age≥80 years,living alone,with malignant tumor,gastrointestinal diseases,multiple drug uses,basic diseases≥3 were the risk factors of nutritional risk in elderly inpatients of department of geriatric general surgery of our hospital.The irrationality of patients with nutritional risk who did not received nutritional intervention and patients without nutritional risk who received nutritional intervention needs clinical improvement.