营养状况对慢性阻塞性肺疾病急性加重期严重程度及预后的评估

The relationship between evaluation of nutritional status and the prognosis of elderly patients with AECOPD

目的探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)患者营养状况与病情严重程度及预后的关系。方法选取入院治疗的AECOPD老年男性患者153例,按患者简化急性生理学评分Ⅱ(SAPSⅡ)评分值将患者分为Ⅰ组91例(20～29分),Ⅱ组38例(30～39分),Ⅲ组24例(≥40分),分析3组患者营养状况水平和预后;再根据疾病转归将患者分为生存组和死亡组,分析2组患者营养状况水平和SAPSⅡ评分值。结果Ⅱ、Ⅲ组患者营养状况各项指标体质量指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂肌围(AMC)、血清白蛋白(ALB)、血清前白蛋白(PAB)、血淋巴细胞计数(TLC)和病死率与Ⅰ组比较差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组比较,TSF、血ALB及病死率差异也有统计学意义(P<0.05)。死亡组营养状况各项指标BMI、TSF、AMC、ALB、PAB、TLC较生存组差,SAPSⅡ评分值较生存组高,差异均有统计学意义。结论营养状况水平对评估AECOPD患者的病情和预后具有一定的临床意义,其营养状况差者病情较重,病死率较高。

Objective To explore the correlation between evaluation of nutritional status and the prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Simplified acute phy-siology score(SAPS)Ⅱ of 153 elderly patients with AECOPD were calculated and nutritional status [The indexes included body mass index(BMI), the triceps skinfold thickness(TSF), arm muscle circumference(AMC), albumin(ALB), prealbumin(PAB), total lymphocyte count(TLC)] was evaluated on the first day.153 patients were divided into group Ⅰ(SAPS Ⅱ 20-29),group Ⅱ(SAPS Ⅱ 30-39)and group Ⅲ(SAPS Ⅱ,≥40).The correlation between nutritional status and prognosis was analyzed.Then the patients were divided into survivors and nonsurvivors according to the prognosis.Nutritional status and SAPS Ⅱ score were compared between these two groups. Results Compared with group Ⅰ, levels of nutritional status (BMI,TSF,AMC,ALB,PAB,TLC) were lower (P<0.05) in group Ⅱ and group Ⅲ; And levels of TSF and ALB were lower in group Ⅲ than those in group Ⅱ. The group with higher SAPS Ⅱ had higher mortality rate.Then the SAPS Ⅱof nonsurvivors was higher than that of survivors,and the nutritional status of nonsurvivors was worse than that of survivors. Conclusions Evaluation of nutritional status has clinical significance in evaluating the prognosis of AECOPD in elderly.The patients with worse nutritional status has higher mortality rate.