3种营养筛查工具在老年压疮高危患者中的应用比较

Comparison of Application of Three Nutrition Screening Methods in Elderly Patients with High Risk of Bedsore

目的明确微型营养评价法(mini-nutritional assessment,MNA)、微型营养评价精法(short-form mini-nu-tritional assessment,MNA-SF)和营养风险筛查方案(nutrition risk screening2002,NRS2002)对老年压疮高危患者进行营养风险筛查的适用性。方法应用3种营养筛查工具对684例消化科老年压疮高危患者进行营养风险筛查,2χ检验比较3种营养筛查工具评定结果及应用营养支持组间压疮发生率的差异;用Kappa值、敏感性及特异性分析比较3种营养筛查工具的评定效果。结果 MNA、MNA-SF、NRS2002对684例老年住院患者营养风险检出率分别为74.9%、71.1%和53.5%,3种营养筛查评定结果及应用营养支持压疮发生率组间差异均有统计学意义。以传统营养评价为标准,MNA、MNA-SF、NRS2002的灵敏性分别为92.6%、87.2%和80.1%;特异性分别为42.2%、44.5%和72.1%;Kappa值分别为0.35、0.32和0.52。以压疮发生为标准,MNA、MNA-SF和NRS2002的灵敏性分别为97.5%、94.3%和90.2%;特异性分别为30.1%、34.0%和54.5%;Kappa值分别为0.13、0.12和0.25。结论在判别营养与压疮关系方面,3种量表灵敏性相差不显著,准确性以NRS2002最高,适用于老年压疮高危患者营养风险筛查。

Objective To identify the applicability of mini-nutritional assessment（MNA）,short-form mini-nutritional assessment（MNA-SF） and nutrition risk screening 2002（NRS 2002） on screening nutrition risk in elderly patients with high risk of bedsore.Methods The nutrition risks of 684 elderly patients with high risk of bedsore in Department of Gastroenterology were screened by the above screening instruments.The differences of bedsore occurrences among nutrition support groups and the evaluation results by the three nutrition screening methods were tested by χ2 analysis.The evaluation effects of the three methods were compared by Kappa value,sensitivity and specificity.Results The detection rates of nutrition risks of elderly in-hospital patients by MNA,MNA-SF and NRS 2002 were 74.9%,71.1% and 53.5% respectively.The differences of bedsore occurrences among nutritional support groups and the evaluation results by the three methods had statistical significance.Taking traditional nutrition evaluation as the standard,the sensitivities of MNA,MNA-SF and NRS 2002 were 92.6%,87.2%,80.1%,the specificities were 2.2%,44.5% and 72.1%,and the Kappa values were 0.35,0.32 and 0.52 respectively.Taking bedsore occurrence as the standard,the sensitivities of MNA,MNA-SF and NRS 2002 were 97.5%,94.3% and 90.2%,the specificities were 30.1%,34.0% and 54.5%,and the Kappa values were 0.13,0.12 and 0.25 respectively.Conclusion There is no significant difference among the sensitivities of the three scales on evaluation of the relationship between nutrition and bedsore.NRS 2002 has the highest accuracy and is applicable to the screening of nutrition risks in elderly patients with high risk of bedsore.