老年住院患者营养风险、营养不足发生率及营养支持应用状况的调查

Prevalence of nutritional risk and malnutrition and nutrition support in elderly hospitalized patients

目的调查老年住院患者营养风险、营养不足发生率以及营养支持应用状况。方法以2007年4月～2009年6月在北京医院住院的2517例老年患者（≥65岁）为研究对象，入院后第2天早晨进行营养风险筛查2002（NRS2002），营养不足判断标准为体质量指数（BMI）〈18．5kg／m^2、血清白蛋白〈35g／L。结果2386例研究对象完成NRS2002筛查，其适用率为94．8％，其中包括呼吸内科466例，普通外科580例，神经内科549例，肾内科180例，消化内科301例，胸外科310例。营养风险（NRS≥3分）的发生率为28．2％，其中呼吸内科、普通外科、神经内科、肾内科、消化内科和胸外科分别为27．5％、30．3％、28．5％、29．4％、25．9％和25．4％；营养不足的发生率为26．4％，呼吸内科、普通外科、神经内科、肾内科、消化内科和胸外科分别为26．2％、29．8％、26．9％、28．3％、22．3％和22．9％。具有营养风险获得营养支持的比例为48．1％，其中呼吸内科、普通外科、神经内科、肾内科、消化内科和胸外科的支持率分别为30．1％、85．2％、26．1％、18．2％、73．8％、64．9％。没有营养风险而获得营养支持的比例（NRS〈3分）的比例为15．1％，呼吸内科、普通外科、神经内科、肾内科、消化内科和胸外科的支持率分别为10．6％、25．2％、6．3％、3．8％、34．2％、17．4％。肠外营养和肠内营养的比例大于4：1。结论老年住院患者营养风险和营养不良发生率较高。临床上仍存在不合理的营养支持现象，应推广应用基于证据的肠外、肠内营养指南以改善此状况。

Objective To investigate the prevalence of nutritional risk and malnutrition, and nutritional support in elderly hospitalized patients. Methods 2386 elderly hospitalized patents （aged ≥65 years） in Beijing Hospital from April 2007 to June 2009 were consecutively enrolled. Nutritional Risk Screening 2002 （NRS 2002） was performed on the next morning after admission. Body mass index （BMI） lower than 18.5 kg/m^2 or serum albumin lower than 35 g/L was diagnosed as malnutrition. Results Among 2517 enrolled patients, NRS 2002 was completed by 94.8%, including 466 cases in Department of Respiratory, 580 cases in Department of General surgery, 549 cases in Department of Neurology, 180 cases in Department of Nephrology, 301 cases in Department of Gastroenterology and 310 cases in Department of Thoracic Surgery in Beijing Hospital. The prevalence of nutrition risk was 28.2% （673/2 386）, and the ratioes of nutrition risk in Department of Respiratory, General Surgery, Neurology, Nephrology, Gastroenterology and Thoracic Surgery were 27.5%, 30.3%, 28.5%, 29.4%, 25.9% and 25.4%, respectively. The prevalence of malnutrition was 26.4%, and the ratios of malnutrition in Department of Respiratory, General surgery, Neurology, Nephrology, Gastroenterology and Thoracic Surgery were 26.2%, 29.8%, 26.9%, 28.3%, 22.3% and 22.9%, respectively. Among 48. 1% of patients with nutrition risk who received nutritional support, the proportions of nutritional support in Department of Respiratory, General Surgery, Neurology, Nephrology, Gastroenterology and Thoracic Surgery were 30.1%, 85.2%, 26.1%, 18.2% 73.8% and 64.9%, respectively. Among 15.1% of patients without nutrition risk （NRS〈3） who received nutritional support, the proportions of nutritional support in Department of Respiratory, General Surgery, Neurology, Nephrology, Gastroenterology and Thoracic Surgery were 10.6%, 25.2%, 6.3%, 3.8 %, 34.2% and 17.4%, respectively. The ratio of parenteral nutrition （PN） over enteral nutrition（EN） was more than 4：1. Conclusions A large proportion of elderly hospitalized patients are at nutrition risk and malnutrition. And nutritional support is somehow inappropriately applied. Evidence-based guideline of PN or EN is needed to improve this situation.