深圳某三甲医院神经内科脑梗死、脑出血患者营养风险、营养不足和营养支持情况调查

Nutritional risks, undernutrition, and nutrition support among inpatients with cerebral infarction or cerebral hemorrhage in Department of Neurology in a tertiary hospital in Shenzhen

目的通过调查深圳某三甲医院神经内科脑梗死和脑出血患者疾病组营养风险、营养不足及营养支持应用情况，了解该院营养风险和营养不足的发生率和规范营养支持情况，为该疾病组规范化营养支持提供理论依据。方法采用定点连续采样的方法，对2014年9月至2016年3月北京大学深圳医院神经内科住院患者2261例进行录入登记，排除人院不足24h、年龄〈18岁或〉90岁、神志不清、拒绝参加研究的患者164例，收录2097例。排除不符合预定诊断的病例后，筛出符合脑梗死和脑出血诊断的患者605例，在患者入院后24—48h内应用营养风险筛查2002（NRS2002）进行营养风险筛查，调查营养风险和营养不足发生率以及14d内（或至出院时）的营养支持应用状况。结果在符合脑梗死和脑出血预定诊断的605例脑梗死和脑出血患者中（脑梗死和脑出血分别有561例和44例），有营养风险的患者总计272例，总营养风险发生率44．96％（272／605），脑梗死和脑出血营养风险的发生率分别为45．63％（256／561）和36．36％（16／44）；脑梗死和脑出血患者总的营养不足发生率为1．82％（11／605），若从NRS2002营养状况受损评分=3分来评估营养不足，脑梗死和脑出血营养不足发生率分别为1．07％（6／561）和0，若从体质量指数≤18．5kg/m^2来评估营养不足，脑梗死和脑出血营养不足的发生率分别为0．7t％（4／561）和2．27％（1／44）。在有营养风险的272例患者中接受营养支持的仅有29例，营养支持率为10．7％，营养支持率较低，营养支持的能量摄入和氮量分别为（15．6±2．0）keal／（kg·d）（1kcal=4．184IO）和（0．10±0．02）g/（kg·d），而无营养风险的333例患者中有27例患者接受了营养支持，营养支持率为8．1％（27／333）。结论本院脑梗死和脑出血疾病组营养风险发生率较高，而营养不足的发生率极低，存在营养风险的患者营养支持应用率明显偏低，营养支持均为肠内营养为主，但能量和氮量明显偏低。同时，普遍存在营养支持应用不足与过度应用的现象。若以营养不足为营养支持的适应证，则仅有1．82％患者需要接受营养支持，若以营养风险为营养支持的适应证，则有44．96％的患者需要营养支持。而营养风险作为营养支持的适应证能不能改善患者的结局是我们下一步研究的起点。

Objective To investigate the prevalence of nutritional risk and undernutrition, and the ap-plication of nutrition support among inpatients with cerebral infarction or cerebral hemorrhage in Department of Neurology in a tertiary hospital in Shenzhen, Guangdong Province, to estimate the situation of the whole hospital, so as to provide guidance for standardizing nutrition support. Methods A total of 2 261 inpatients who were treated in Department of Neurology in Peking University Shenzhen Hospital were initially selected from September 2014 to March 2016 using consecutive sampling. After 164 patients were excluded for short hospi- tal stay （ 〈24 hours）, age 〈 18 years or 〉 90 years, obnubilation, and/or refusal to participate, 2 097 patients were sampled. After patients who did not meet the scheduled diagnosis were excluded, 605 patients with cerebral infarction or cerebral hemorrhage were enrolled. Nutritional Risk Screening 2002 （ NRS 2002） was applied within the first 24 - 48 hours after admission to estimate the prevalence of nutritional risk and un- dernutrition. Nutrition support within 14 days （or until discharge） was evaluated. Results Among the 605 patients （561 cases of cerebral infarction, 44 cases of cerebral hemorrhage）, 272 had nutritional risk （44. 96% ）, the prevalence of nutritional risk in inpatients with cerebral infarction or cerebral hemorrhage was 45.63% （256/605） and 36. 36% （ 16/44）, respectively. The total prevalence of undernutrition was 1.82% （11/605）. The prevalence of undemutrition in patients with cerebral infarction or cerebral hemor- rhage was 1.07% （6/561） and 0, respectively, if based on a score of 3 in impaired nutritional status of NRS 2002; 0.71% （4/561） and 2.27% （1/44） if based on body mass index≤18.5 kg/m2. Only 29 （10. 7% ） of the 272 patients with nutritional risk received nutrition support, with the energy and nitrogen in- take being （15.6±2.0） kcal/ （kg.d） （1 kcal=4.184 k J） and （0.10＋0.02） g/ （kg·d）, respectively. In the 333 patients without nutritional risk, 27 （ 8.1% ） received nutrition support. Conclusions The prevalence of nutritional risk is very high in the patients with cerebral infarction or cerebral hemorrhage in this hospital, while the prevalence of undernutrition is very low. The application of nutrition support in the patients with nutritional risk is very low, mainly in the form of enteral nutrition, but with insufficient energy and nitrogen intake. At the same time, overuse of nutrition support is also observed. Using undemutrition as the indication of nutrition support, only 1.82% patients need nutrition support; but if nutritional risk is considered the indication of nutrition support, 44. 96% patients need nutrition support. Whether nutrition support in patients with nutritional risk could improve patient outcome is the topic in our future research.