危重症营养风险评估在COPD合并机械通气病人中的应用价值

The clinical utility of critical nutrients nutrition risk assessment in COPD patients with mechanical ventilation

目的:探讨危重症营养风险评估(Nutric评分)在慢性阻塞性肺疾病(COPD)合并机械通气病人中的应用价值。方法:将入选的189例病人于住院当天分别测量并记录体重和身高,以计算病人的体重指数。次日清晨空腹抽取静脉血,测定血清清蛋白(ALB)和前清蛋白(PA)等营养指标。记录病人住院时间以及28 d内病人好转出院或死亡等病情转归情况。分析比较营养评分与营养指标(ALB和PA)、病人病情转归(4周后死亡/生存率、脱机率)以及与营养支持方式的关系。结果:入院时,Nutric评分低分与高分的病人入院时血清ALB、PA、Hb和转铁蛋白(TF)值均无显著性差异(P>0.05)。营养支持1周后,营养评分低分组与高分组病人间血清ALB、PA、Hb、TF值均有显著性差异(P<0.05)。与高分组病人比,低分组病人的病死率明显较低,脱机成功率明显较高(P<0.05)。结论:营养风险评估可对COPD合并机械通气病人营养支持的热量供给起临床指导作用。

Objective： To investigate the clinical utility of critical nutrients nutrition risk assessment （Nutric score） in COPD patients with mechanical ventilation. Methods： On the day of hospital admission, BMI of each patient was measured according to the weight and height, which wasaccurate to 0.5 kg and O. 5 cm, respectively. Serum albumin and prealbumin （PA） on the day after admission, length of hospital stay, and 28-day outcomes were also collected. The potential association between Nutric scores and nutrition status （albumin and PA）, outcomes （mortality, rate of survival and offline）, and the type of nutrition support were analysed. Results ： At the time of admission, the level of ALB, PA, Hb and TF were similar in patients with low and high Nutric score （P 〉 0.05 ）. However, after 7 days of admission, a significant difference was found between the two groups in terms of the level of ALB, PA, Hb and TF（P 〈 0. 05）. Compared to those with high Nutric score, patients with low score had decreased mortality, and increased rate of offline （P 〈 0. 05 ）. Conclusion ： Nutric score is valuable for clinical nutrition support in COPD patients receivingmechanical ventilation.