营养干预、营养风险对临床结局影响研究的方法学

Methodology of Research in Influences of Nutritional Intervention and Nutritional Risk on Clinical Outcome

目的探讨营养干预和营养风险对临床结局影响的研究方法。方法检索出PubMed中与营养风险筛查2002(NRS2002)有关的文献,从中选择涉及临床结局的研究,对研究结果和研究方法进行总结和分析。结果共检索出20篇文献与NRS2002有关,其中8项研究涉及临床结局。临床结局包括并发症、住院时间、死亡率和住院费用等终点指标,其中并发症的判断标准和住院时间的研究方法存在差异。与无营养风险(NRS<3分)者相比,有营养风险(NRS≥3分)者的并发症发生率及死亡率增加、住院时间延长、住院费用增加。一项研究显示对有营养风险者进行营养干预可缩短其中有并发症患者的住院时间。结论在有关临床结局的研究中,并发症和住院时间应有明确的判断标准。营养支持对有营养风险者临床结局的影响是进一步研究的方向,目前可采用非随机对照研究,通过多因素分析方法排除营养支持之外的混杂因素的影响。

Objective To summarize the methodology used in research in the influences of nutritional intervention and nutritional risk on clinical outcomes. Methods A computerized literature search was performed using the National Library of Medicine＇s Entrez PubMed. The articles about Nutritional Risk Screening 2002 （ NRS2002 ） and clinical outcome were retrieved for detailed evaluation of the study findings and study methodology. Results Totally 20 studies on the NRS2002 were found in the PubMed, among them 8 studies were on NRS2002 and clinical outcomes. The clinical outcomes included complications, length of hospital stay, mortality, and hospital cost, among which the operational definitions of complication and the length of hospital stay varied in different studies. The study findings revealed the nutritionally at-risk patients had more complications, higher mortality, longer lengths of stay, and more cost than not at-risk patients. One study showed that among patients with complications, the intervention group that received nutritional intervention had a significantly lower length of hospital stay than the control patients. Conclusions Several different operational definitions of complications and length of stay are used in evaluating clinical outcomes. More clinical trials are needed to validate the effect of nutritional support on clinical outcome among nutritionally at-risk patients. The non-randomized study design is applicable when it combines with multivariate analysis to exclude confounding factors.