老年冠心病住院患者营养状态评估及对住院日影响的研究

Effect of nutrition assessment on hospital stay time of elderly coronary heart disease patients

目的探讨老年冠心病患者,应用简易营养评价精简法(MNA-SF)进行营养评估的可行性和价值,并评价营养状态对住院日等治疗相关指标的影响。方法采用前瞻性研究,随机入选住院的老年冠心病患者86例,根据MNA-SF评分分为营养正常组45例及营养不良组41例。研究对象又根据是否合并糖尿病分为糖尿病组38例,非糖尿病组48例。同时获取血脂、尿酸、蛋白等实验室检查结果,比较MNA-SF评分对营养评估的一致性。并以MNA-SF评分作为营养状态的量化指标,观察其与住院日的相关性。结果与营养正常组比较,营养不良组跌倒风险、住院天数明显升高[(11.14±6.31)分vs(7.91±4.68)分,P<0.05;(17.49±7.01)d vs(12.93±4.37)d,P<0.05],白蛋白和MNA-SF评分明显降低[(37.57±5.11)g/L vs(40.01±3.79)g/L,P<0.05;(9.07±2.05)分vs(12.87±1.04)分,P<0.01]。糖尿病组与非糖尿病组跌倒风险和住院日比较,差异无统计学意义(P>0.05)。多重线性回归分析显示,MNA-SF评分与住院日呈负相关(r=-0.614,P=0.000),回归方程为:住院日=36.459-0.614×MNA-SF评分。结论老年冠心病患者中,白蛋白水平降低是营养不良的表现之一。营养不良会增加跌倒的风险,并且导致住院日明显延长。

Objective To study the feasibility and value of mini-nutritional assessment short-form version（MNA-SF）in assessing the nutrition of elderly coronary heart disease（CHD）patients and its effect on their hospital stay time.Methods Eighty-six CHD patients were divided into normal nutrition group（n=45）and malnutrition group（n=41）according to their MNA-SF score and into diabetes mellitus（DM）group（n=38）and non-DM group（n=48）according to their blood glucose.Their serum levels of blood-lipid,uric acid and albumin were measured.The effects of MNASF score on hospital stay time of the patients were compared.Results The falling risk was significantly higher and the hospital stay time（days）was significantly longer whereas the serum albumin level and MNA-SF scores were significantly lower in normal nutrition group than in malnutrition group（11.14±6.31 vs 7.91±4.68,P〈0.05;17.49±7.01 vs 12.93±4.37,P〈0.01;37.57±5.11g/L vs 40.01±3.79g/L,P〈0.05;9.07±2.05 vs 12.87±1.04,P〈0.01）.No significant difference was found in falling risk and hospital stay time between DM group and non-DM group（P〉0.05）.Multivariate logistic regression analysis showed that MNA-SF score was negatively related with hospital stay time（r=-0.614,P=0.000）.Conclusion Low serum albumin level is one of the manifestations of malnutrition in elderly CHD patients.Malnutrition is a falling risk factor and prolongs hospital stay time.