高龄住院患者营养状况分析及评价指标筛选

Analysis of nutritional status and nutrition assessment index in advanced elderly inpatients

目的了解高龄住院患者营养状况及营养不良发生的原因，提出适宜的营养状态评价指标。方法对我院老年病房住院的108例高龄患者，采用微型营养评定表（MNA）、营养风险筛查2002评估表（NRS2002）进行营养风险筛查及营养指标检测，并与实验室检测指标及1年后的疾病转归进行关联性分析。结果（1）108例患者中，接受营养支持者95例（88．0％），其中仅接受肠外营养支持者占6．3％，肠内与肠外营养联合应用者占27．4％，仅接受肠内营养支持者占66．3％；完全经口进食者占总人数19．4％，经鼻管饲者占总人数69．4％。（2）根据MNA评定结果，正常营养状态者占2．8％，有营养不良风险者13．9％，营养不良者占83．3％；使用NRS2002筛查，有营养不良风险比例为91．7％。（3）以MNA评定结果将受试患者分为营养状态良好组、营养不良风险组和营养不良组，营养不良组上臂围、小腿围、血红蛋白明显低于营养状态良好组及营养不良风险组（P〈0．05）；血白细胞计数、淋巴细胞计数、血清总蛋白、白蛋白、三酰甘油、胆固醇和肌酐水平三组之间比较，差异无统计学意义（P〉0．05）。（4）MNA评分与体质量、体质指数、上臂围、小腿围、血红蛋白、血白蛋白呈负相关（P〈0．05）；NRS2002结果与血红蛋白、血总蛋白呈负相关，与尿酸呈正相关（P〈0．05）。（5）以血红蛋白男性〈120g／L、女性〈110g／L为标准判定营养不良的发生，与MNA及NRS2002评价结果相比较，与MNA评价营养不良发生率的一致性好于NRS2002评定结果，且与患者1年内的死亡率相关。结论高龄住院患者的营养不良及营养不良风险发生率较高。血红蛋白可以作为住院高龄老年患者营养不良及预后的适宜评价指标之一。

Objective To investigate the nutritional status and reasons for malnutrition in super elderly inpatients, and to propose the nutritional assessment index. Methods Totally 108 patients were enrolled from the elderly ward in Beijing Hospital. The Mini Nutritional Assessment （MNA） scale and Nutritional Risk Screening 2002 （NRS2002） were used to screen the nutritional risk and determine the nutritional index. Correlations of MNA and NRS2002 values with laboratory index and the prognosis of disease within 1 year were analyzed. Results （1） 95 patients （88.0%） administrated nutritional supports and the nutritional supports were classified into 3 types： the parenteral nutrition （6.3 %）, the enteral nutrition combined with parenteral nutrition （27.4 %）, the enteral nutrition （66.3%）. The rate of oral feeding was 19.4%, and the rate of tube feeding was 69.4%. （2） The incidences of normal nutrition, nutritional risk and malnutrition according to MNA were 2.8%, 13.9%, and 83.3%, respectively. The rate of malnutritional risk according to NRS2002 was 91.7%. （3） According to the screening of MNA, the patients were separated into 3 groups： well- nourished group, malnutrition risk group, and malnourished group. Biceps circumference, calf circumference, and hemoglobin （Hb） concentration were lower in malnourished group than in other groups （all P〈0.05）. There were no significant differences in white blood cell count, lymphocyte count, serum levels of total proteins, albumin, triglyceride, cholesterol and creatinine among the three groups （all P〉0.05）. （4） MNA scores showed negative correlations with body weight, body mass index （BMI）, biceps circumference, calf circumference, levels of hemoglobin and albumin （all P〈 0. 005）. NRS2002 scores showed negative correlations with levels of hemoglobin and total proteins, and had a positive correlation with uric acid （all P〈0.05）. （5） The sensitivity of the malnutrition evaluation was defined as Hb〈120 g/L in male and 〈 110g/L in female. Malnutrition evaluation by hemoglobin concentration had a better consistency with malnutrition evaluation by MNA than by NRS2002. The hemoglobin concentration in malnutrition evaluation was negatively related to the mortality within 1 year. Conclusions The incidences of nutritional risk and malnutrition are extremely high in super-elderly inpatients. Hemoglobin concentration can be used as one of eligible indexes of malnutrition in super-elderly inpatients.