胃癌住院患者营养风险及临床营养支持现状调查

Research on Nutritional Risk and Application of Nutrition Support in Hospitalized Patients with Gastric Cancer

目的应用营养风险筛查(NRS)2002方法对胃癌住院患者营养风险状况、营养不良发生率和营养支持现状进行调查。方法对2009年6月至2010年2月期间在我院胃肠外科中心住院的胃癌患者进行营养风险筛查。根据患者疾病严重程度、营养状况〔包括体重指数(BMI)、近期体重和进食情况〕及年龄3个方面,评定营养风险。NRS≥3分为有营养风险,NRS<3分为无营养风险;BMI<18.5 kg/m2或白蛋白<30 g/L并结合临床情况判定是否营养不良(不足)。结果本研究共纳入386例患者,其中329例成功完成筛查。有营养风险者165例(50.15%),无营养风险者164例(49.85%)。329例患者中营养不良者57例(17.33%);按照性别:231例男性胃癌患者中营养不良(不足)38例,所占比例为16.45%,有营养风险者111例,占48.05%;98例女性胃癌患者中营养不良(不足)19例,所占比例为19.39%,有营养风险者54例,占55.10%。329例胃癌患者中有237例实施了临床营养支持(72.04%),其中有营养风险患者165例中,实施临床营养支持者115例(69.70%),无营养风险患者164例中实施临床营养支持122例(74.39%)。结论目前胃癌住院患者营养不良发生率及有营养风险者比例均较高,并且临床营养支持存在不合理性,这需要进一步推广和应用基于证据的临床营养支持指南以改善此状况。

Objective To investigate the nutritional risk,incidence of malnutrition,and clinical application of nutrition support in hospitalized patients with gastric cancer by the nutritional risk screening（NRS） 2002 score summary table.Methods From June 2009 to February 2010,nutritional risk screen and application of clinical nutritional support were carried out in the hospitalized patients with gastric cancer in this hospital.Nutritional risk was assessed case-by-case according to the severity of illness,nutritional status（including body mass index（BMI）,recent changes in body weight and eating） and patients＇ age.NRS ≥3 was accepted as nutritionally at-risk,while NRS 3 no nutritional risk;BMI 18.5 kg/m2（or albumin 30 g/L） combined with clinical conditions was judged to be malnourished.Results Three hundreds and eighty-six patients were included,329 of which completed the NRS2002 screening.One hundred and sixty-five patients（50.15%） were at nutritional risk,while another 164（49.85%） were no nutritional risk.Malnutrition was found in 57 patients（17.33%）.By gender,male malnourished patients and nutritionally at-risk patients were accounting for 16.45%（38/231） and 48.05%（111/231） respectively,while female nutritionally at-risk patients and malnourished patients were accounting for 55.1%（54/98） and 19.39%（19/98） respectively,72.04%（237/329） of the screened patients accepted clinical nutrition support,among which,115 patients were at nutritional risk,accounting for 69.70% in that group,and 122 patients were no nutritional risk,accounting for 74.39% in that group. Conclusions The incidences of malnutrition and nutritionally at-risk in hospitalized gastric cancer patients are high.And irrationality of clinical nutrition support exists.Evidence-based guidelines are required to improve the nutritional status of support.