普通外科住院患者营养风险筛查及营养支持应用情况

Nutritional risk screening and application of nutritional support for hospitalized patients in general surgical wards

目的调查普通外科住院患者营养风险、营养不良发生率及营养支持应用情况,评价营养支持的合理性。方法普通外科住院患者1 236例,采用营养风险评估法(NRS 2002)进行营养风险筛查,对存在营养风险患者进行营养不良评估,并分析患者营养风险发生率及营养支持比例。结果共1 156名患者完成NRS 2002筛查,完成率93.5%,其中肝胆胰疾病患者521例,胃肠疾病患者635例。营养风险总发生率为39.1%,营养不良发生率为52.7%;胃肠疾病患者的营养风险及营养不良发生率(43.0%、26.5%)均高于肝胆胰疾病患者(34.4%、13.4%)(P<0.05);有营养风险且营养不良患者、有营养风险但无营养不良患者以及无营养风险且无营养不良患者行营养支持者分别占64.7%、66.8%、16.9%,所有患者肠外和肠内营养的应用比例为3.1∶1。结论普通外科住院患者存在明显的营养风险或营养不足,不同疾病的营养风险及营养不良发生率不同,应注意分病种筛查和评估;有营养风险患者给予营养支持率不足,肠内肠外营养应用存在明显不合理性。

Objective To investigate the incidences of nutritional risk and malnutrition,and the application of nutrition support among hospitalized patients in general surgical wards, and to evaluate the rationality of nutrition support.Methods A nutritional risk screening was performed in 1 236 hospitalized patients in the general surgery ward with nutritional risk screening 2002 （ NRS2002 ） .The assessment on the condition of malnutrition was conducted in the patients with nutritional risk.The incidence of nutritional risk and the proportion of the patients accepting nutrition support were analyzed.Results A total of 1 156 patients were involved in the NRS2002 screening,with the response rate of 93.5%.There were 521 patients with liver,gallbladder and pancreas diseases,and 635 patients with gastrointestinal diseases.The overall incidence of nutritional risk was 39.1%,and the incidence of malnutrition in the patients with nutrition risk was 52.7%.The incidences of nutritional risk（43.0%） and malnutrition（26.5%） in patients with gastrointestinal diseases were higher than those in patients with liver, gallbladder and pancreas diseases （ 34.4% and 13.4%, respectively ） （ P 〈0.05 ） .The proportions of nutrition support application in patients with nutritional risk and malnutrition,in patients with nutritional risk but without malnutrition and in the patients without nutritional risk and malnutrition were 64.7%,66.8%and 16.9%,respectively.The application proportion of parenteral and enteral nutrition in all the patients was 3.1：1.Conclusion For the hospitalized patients in general surgery wards,nutritional risk and malnutrition are common.Patients with different diseases show different incidences of nutritional risk and malnutrition, screening and assessment therefore should be conducted depending on the type of disease.The nutritional support is deficient for the patients with nutritional risk,and the application of combined parenteral and enteral nutrition is obviously inappropriate.