山东地区部分医院住院患者营养风险筛查和营养支持应用状况

Nutritional risk screening and nutritional supports in some hospitals in Shandong Province

目的 调查山东省部分地区不同规模医院住院患者营养风险、营养不良（不足）发生率及营养支持应用状况及相关并发症发生率.方法 以山东地区部分大、中、小医院2792例新住院患者为研究对象,进行营养风险筛查2002（NRS 2002）,记录患者营养支持应用情况、住院时间、感染性及非感染性并发症发生率.以NRS 2002≥3分为有营养风险,体重指数＜18.5 kg/m^2并结合患者临床情况判定为营养不足.结果 大、中、小医院新住院患者营养不足发生率分别为5.6%、1.6%、2.7%,差异有统计学意义（P=0.000）;营养风险发生率分别为27.3%、15.4%、18.3%,差异有统计学意义（P=0.000）;存在营养风险患者营养支持的应用率分别为51.5%、30.8%、20.9%,差异有统计学意义（P=0.000）;营养支持以肠外营养应用最多,大、中、小医院分别为72.9%、95.1%、100%,差异有统计学意义（P=0.000）.大医院483例新人院患者中无营养风险者并发症的发生率明显低于有营养风险的患者（P=0.000）;在有营养风险的患者中,接受营养支持患者的感染性并发症发生率明显低于无营养支持者（P=0.043）;在无营养风险的患者中,接受营养支持患者与无营养支持患者之间总并发症发生率差异无统计学意义（P＞0.05）.结论 采用NRS 2002对我国住院患者进行营养风险筛查是可行的,营养支持可以减少有营养风险患者并发症的发生.

Objective To investigate the prevalence of undernutrition, nutritional risks, and the application of nutrition supports in different hospitals in Shandong province, and to estimate the related complication rate.Methods Totally 2792 patients from different hospitals in Shandong were enrolled, and their nutritional risks were assessed using Nutritional Risk Screening （NRS） 2002. The application of nutritional supports, the length of hospital stay, and the incidences of infectious and non-infectious complications were documented. Results The incidences of undernutrition and nutritional risk among patients in large hospitals were significantly higher than those in middle and small hospitals （5.6%, 1.6%, 2. 7%; 27.3%, 15.4%, 18.3%; P =0. 000）. The overall rate of nutritional support was 43. 60%, and there were significant difference among patients in different hospitals （51.5 %, 30. 8 %, 20.9 %, P = 0. 000）. Parenteral nutrition was most widely applied. Among the 483 patients in large hospitals, the incidence of complication in patients with nutritional risks was significantly higher than those without nutritional risks （31.3% versus 13.7%, P =0. 000）. Of the ＂with nutritional risk＂ patients, the infectious complications were significantly lower in the nutritional support group （P = 0. 000）. Of the patients without nutritional risks, there was no statistical difference between the nutritional support group and the non-support group. （P 〉 0. 05）. Conclusions NRS 2002 is a useful tool for the assessment of nutritional status among inpatients. Proper nutritional support can reduce the incidence of complications for patients with nutritional risks.