营养不良筛选评分在机械通气的慢性阻塞性肺疾病急性加重患者中的应用价值

The value of malnutrition screening tool in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨营养不良筛选评分(MST)在有创机械通气(IMV)的慢性阻塞性肺疾病(简称慢阻肺)急性加重患者中的应用价值。方法采用单中心回顾性观察研究。纳入广州医科大学附属第一医院重症医学科自2015年1月1日到2016年6月30日收治的主要诊断为慢阻肺急性加重的患者,根据入ICU时MST评分分为营养不良高风险组(≥2分)和营养不良低风险组(<2分)。主要比较两组患者的ICU病死率、住院病死率、有创通气时间、ICU停留时间、48 h ICU重返率,并同时比较两组一般资料以及入ICU时的生化指标。结果共纳入符合标准的患者101例,其中营养不良高风险组77例,营养不良低风险组24例。两组间患者性别(χ~2=1.882,P=0.172)、年龄(t=1.091,P=0.33)、急性生理学和慢性健康状况评分系统Ⅱ评分(t=1.475,P=0.16)比较,差异无统计学意义;营养不良高风险组患者体重指数(t=2.887,P=0.004)以及血淋巴细胞计数水平(t=3.402,P<0.001)均显著低于营养不良低风险组;而血红蛋白(t=0.817,P=0.36)、白蛋白(t=0.706,P=0.44)、前白蛋白(t=1.782,P=0.08)以及降钙素原(t=1.296,P=0.17)等生化指标在两组间比较,差异无统计学意义;营养不良高风险组患者IMV时间(χ~2=2.181,P=0.035)和ICU停留时间(χ~2=2.364,P=0.02)显著高于营养不良低风险组患者;两组间ICU病死率(χ~2=0.212,P=0.645),住院病死率(χ~2=0.212,P=0.645)以及48 h ICU重返率(χ~2=1.656,P=1.0)比较,差异无统计学意义。结论 MST评分是在ICU内评价需要IMV的慢阻肺急性加重患者营养不良风险的一个简便有效工具,MST评分≥2分提示患者需要更长的通气时间和ICU停留时间。

Objective To investigate the value of Malnutrition Screening Tool （MST） in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A single center retrospective observational study was conducted. The AECOPD patients who needed mechanical ventilation, admitted to ICU from January 2015 to June 2016 were enrolled in the study. They were divided into two groups according to the MST score, ie. a high risk malnutrition group （MST score/〉 2） and a low risk malnutrition group （MST score〈2）. The principle factors were analyzed including ICU mortality, in-hospital mortality, duration of invasive mechanical ventilation （IMV）, length of ICU stay, and ICU readmission rate within 48 hours. Meanwhile the patients＇ demographic and laboratory data were analyzed. Results A total of 101 patients were enrolled with 77 cases in the high risk malnutrition group and 24 cases in the low risk malnutrition group. The gender （X2=1.882, P=0.172）, age （t=1.091, P=0.33） and APACHE Ⅱ score （t=1.475,P=0.16） were similar in two groups. The high risk malnutrition group had significantly lower BMI （t=2.887, P=0.004） and lymphocyte count （t=3.402, P〈0.001） than the low risk malnutrition group. Hemoglobin （t=0.817, P=0.36）, albumin （t=0.706, P=0.44）, pre-albumin （t=1.782, P=0.08） and procalcitonin （t=1.296, P=0.17） were similar in two groups. The high risk malnutritiongroup had significantly longer IMV duration （X2=2.181, P=0.035） and length of ICU stay （X2=2.364,P=0.02） than the low risk malnutrition group. While the ICU mortality （X2=0.212, P=0.645）, in-hospital mortality （X2=0.212, P=0.645） and ICU readmission rate within 48 hours （X2=1.656, P=1.0） were similar in two groups. Conclusion MST is a valuable tool in ICU to evaluated the nutrition status of ventilated AECOPD patients, and MST~〉 2 indicates longer IMV duration and length of ICU stay.