老年肺部感染患者营养风险筛查及营养支持治疗状况分析

Nutritional risk screening and support therapy in elderly patients with pulmonary infection

目的调查老年肺部感染患者营养不足、营养风险的比例及营养支持治疗的发生率,为老年肺部感染患者的营养治疗提供依据。方法根据患者年龄分为3组：60-69岁组、70-79岁组及≥80岁组。根据急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分将患者分为2组：A组〈10分、B组≥10分。采用营养风险筛查表（NRS2002）对老年肺部感染患者进行营养风险筛查,体质量指数（BMI）〈18.5或血清白蛋白（sALB）〈30g/L评估为营养不足;NRS2002总分≥3分为存在营养风险。根据医嘱及护理措施调查入院时存在营养不足及营养风险患者给予肠外营养或肠内营养支持治疗的情况。结果 260例老年肺部感染患者营养不足及营养风险总发生比例为81.5%（212/260）,其中营养不足28.8%（75/260）、营养风险52.7%（137/260）;不同年龄组营养不足及营养风险的发生比例不同,≥80岁组与60-69岁组、70-79岁组比较,营养不足及营养风险的发生比例差异有统计学意义（P〈0.05）。不同APACHEⅡ评分患者营养不足及营养风险的发生比例也不同。212例患者存在营养不足及营养风险,接受营养支持治疗比例为86.8%（184/212）,给予肠外营养治疗的比例较肠内营养比例高。不同年龄给予的营养支持治疗的比例也不同,80岁以上老年人接受营养支持治疗比例明显升高（P〈0.05）。结论老年肺部感染患者发生营养不足及营养风险的比例较高,且随年龄的增加,发生比例增大;APACHEⅡ评分越高,营养不足及营养风险发生比例越高。

Objective To investigate the nutritional deficiency,the proportion of nutritional risk and the incidence of nutritional support treatment in elderly patients with pulmonary infection for the evidences in nutritional support therapy.Methods All patients were separated into three groups according to age,including 60-69 years old group,70-79 years old group and over 80 years old（≥80）group.All patients were separated into two groups based on APACHEⅡ score,including group A（〈10）and group B（≥10）.The international standard of Nutritional Risk Screening（NRS,2002）was applied to assess the nutritional risk in elderly patients with pulmonary infection.Body mass index（BMI）〈18.5or serum albumin（sALB）〈30g/L was considered as bad nourishment,and total score of NRS≥3was considered in nutritional risk.Enteral nutrition or parenteral nutrition treatment was given to patients in bad nourishment and nutritional risk when admitting into hospital.Results The incidence of nutrient deficiency and nutritional risk were 28.8%（75/260）and 52.7%（137/260）in 260 elderly patients with pulmonary infection,respectively;and the total incidence of nutritional deficiency and nutritional risk was 81.5%（212/260）.The proportion of nutritional deficiency and nutritional risk varied with age.Comparing ≥80years old group with 60-69 years old group and 70-79 years old group,there were significant difference in the proportion of nutritional deficiency and nutritional risk（P〈0.05）.The proportion of nutritional deficiency and nutritional risk varied with APACHEII score.The proportion receiving nutritional support therapy in all 212 patients with nutritional risk or nutritional deficiency was 86.8%（184/212）.The proportion of patients receiving parenteral nutrition support was higher than that of patients receiving enteral nutrition support.The proportion of nutritional support therapy varied with age,the proportion of≥80years old group receiving nutrition support was significantly higher（P〈0.05）.Conclusion The proportion of nutritional risk and nutritional deficiency are higher in elderly patients with pulmonary infection,and the higher the age and APACHEII score,the higher the proportion of nutritional risk and nutritional deficiency.