神经系统危重症患者危重症营养风险评分及营养评估的临床研究

The clinical study of Nutric score system and nutritional assessment in neurological critical ill patients

目的针对神经系统危重症患者，探究危重症营养风险评分的价值，为临床营养支持奠定基础。方法选取安徽医科大学第一附属医院ICU病房2016年7月至2017年3月收治的神经系统危重症患者59例，进行危重症营养风险评分（Nutric评分），分为低分组（O～4分）31例及高分组（5～9分）28例，分别于入ICU后的第1天（次日）、第7天，测定其一般指标[体质量指数（BMI）、肱三头肌皮褶厚度（TSF）、上臂中段围（MAC）及上臂中段肌围（MAMC）]对所有患者的营养状况进行初步评估，清晨空腹抽取静脉血，测定血清白蛋白（ALB）、前蛋白（PA）、血红蛋白（Hb）及淋巴细胞绝对数（LY）水平作为营养指标，入ICU后第7天，对两组患者进行主观综合评价（SGA），同时记录两组患者28d内病死率。结果人住ICU后第1天，两组TSF、MAC、MAMC差异均无统计学意义（均P〉0．05）。入ICU后第7天，高分组TSF、MAC、MAMC分别为（0．943±0．484）cm、（24．143±3．203）cm、（21．187±2．625）cm，均显著低于低分组的（1．185±0．403）cm、（26．981±2．731）cm、（23．265±2．327）cm，差异均有统计学意义（t=2．090、3．672、3．223，均P〈0．05）。入住ICU后第1天，高分组血清ALB、Hb分别为（34．5±7．3）g／L、（103．68±13．5）g／L，低分组分别为（39．0±6．9）g/L、（122．29±20．4）g／L，两组差异均有统计学意义（t=2．466、4．168，均P〈0．05）；入ICU后第7天，高分组血清ALB、PA、Hb、LY分别为（30．6±5．1）g/L、（146．0±77．0）mg／L、（83．9±11．9）g/L、（1．123±0．535）×10^9／L，均显著低于低分组的（35．8±5．5）g/L、（209．9±105．1）mg／L、（105．8±19．2）g/L、（1．709±1．377）×10^9／L。与入ICU后第1d比较，高、低分组患者7d时的血清ALB、Hb显著下降，差异均有统计学意义（t=2．29、2．042、5．817、3．286，均P〈0．05）；与人ICU后第1天比较，低分组血清PA水平与入ICU后第7天差异无统计学意义，而高分组患者人ICU后第7天时血清PA水平呈显著下降趋势，差异有统计学意义（t=2．024，P〈0．05）。人院后第7天，高分组营养不良发生率（32．1％）高于低分组（9．7％），病死率（32．1％）明显高于低分组（6．5％），差异均有统计学意义（χ^2=4．583、6．402，均P〈0．05）。结论对神经系统危重症患者早期进行危重症营养风险评分，可帮助临床早期进行营养支持。

Objective To investigate the clinical utility of critical nutrients nutrition risk assessment（ Nutric score） in neurological critical ill patients, laying the foundation for clinical nutrition support. Methods From July 2016 to March 2017,59 ICU patients with neurological critical ill in the First Affiliated Hospital of Anhui Medical University were divided into low score group （ Nutric score 0 -4 ） and high score group （ Nutric score 5 -9 ） according to Nutric score system. On the first and seventh day after ICU admission,the body mass index（BMI） ,triceps skinfold thickness （TSF）, mid -upper arm circumference （MAC） and mid -upper arm muscle circumference （MAMC） were measured. The serum albumin （ ALB ）, prealbumin （ PA ）, hemoglobin （ Hb ） and lymphocyte （ LY ） were detected as nutritional indicators. And at the same time, recorded the 28 - day outcomes, and made the SGA evaluation. Results At the first day admission in ICU, there were no statistically significant differences between the two groups in TSF, MAC and MAMC （all P 〉 0.05 ）. But at the seventh day, the TSF, MAC, MAMC of the high score group were （0.943 ± 0. 484） em, （24. 143 ± 3. 203 ） cm, （ 21. 187 ± 2. 625 ） cm, respectively, which were significantly lower than those of the low score group [ （ 1. 185±0. 403 ） cm, （ 26. 981±2. 731 ） cm, （23. 265±2. 327 ） cm ], there were statistically significant differences between the two groups（t = 2.090,3. 672,3. 223 ,all P 〈 0.05 ）. At the first day after admission, the serum levels of ALB and Hb in the high score group were （34.5± 7.3 ）g/L, （103.68 ± 13.5）g/L, which of the low score group were （ 39.0 ± 6.9） g/L, （ 122.29 ± 20.4） g/L, respectively, and there were statistically significant differences between the two groups（ t = 2. 466,4. 168, all P 〈 0.05 ）. And at the seventh day after admission, the serum levels of ALB,PA,Hb and Ly in the high score group were （30.6 ＋5.1）g/L,（146.0±77.0） mg/L, （83.9± 11.9） g/L, （ 1. 123 ± 0. 535 ） × 10^9/L, respectively, which were significantly lower than those in the low score group [ （35.8 ± 5.5） g/L, （209.9 ±105.1 ） mg/L, （ 105.8 ± 19.2） g/L, （ 1. 709 ± 1. 377 ）×10^9/L ]. Compared with the first day after admission, the ALB, Hb levels in the two groups at the seventh day after admission were significantly decreased （t = 2.29,2. 042,5. 817,3. 286, all P 〈 0.05 ）;the PA level in the low score group had no statistically significant difference at the seventh day after admission, but the PA level in the high score group was decreased significantly （ t = 2. 024, P 〈 0.05 ）. The incidence rate of malnutrition, mortality of the high score group were 32. 1%, 32.1%, respectively,which were significantly higher than those in the low score group （9.7% ,6.5% ） （χ2 = 4. 583, 6. 402, all P 〈 0.05 ）. Conclusion The Nutric score system can be used in the purpose of early nutrition assessment in neurological critical ill oatients, and it is benefit for clinical early nutritional suDoort.