重庆某三甲医院不同分期肺癌住院患者营养风险与营养不良发生率横断面研究

Prevalence of nutritional risk and malnutrition in hospitalized patients with different stages of lung cancer in a tertiary hospital in Chongqing： a cross-sectional survey

目的调查重庆某三甲医院不同肿瘤分期肺癌住院患者营养风险与营养不良发生率。方法对陆军军医大学大坪医院2013年12月至2017年7月在呼吸科入院诊断为肺癌患者，采用营养风险筛查2002（NRS2002），在患者入院24h内进行营养风险筛查。在入院48h内为评定营养不良进行脏器功能有关血液检查、体格测量，完成患者主观整体营养评定量表（PG—SGA）。结果共有入院诊断为肺癌的患者2735例，除去重复入院、未能在规定时间完成营养风险筛查和营养评定的患者等，实际纳入肺癌患者548例。其中，NRS2002≥3分患者为162例，占29．56％。肿瘤不同病理分期患者营养风险的发生率依次为Ⅰ期17．39％、Ⅱ期15．00％、Ⅲ期22．00％、Ⅳ期36．86％。按不同病理分期，营养不良的发生率：按体质量指数（BMI）〈18．5kg／m^2及一般情况差，营养不良为53例（9．67％）；不同病理分期发生率为Ⅰ期6．52％、Ⅱ期5．00％、Ⅲ期8．67％、Ⅳ期11．22％。按NRS 2002的营养缺失评分为3分，识别有营养不良为107例（19．53％）；不同病理分期发生率为Ⅰ期10．87％、Ⅱ期5．00％、Ⅲ期14．67％、Ⅳ期25．00％。按PG—SGA评分≥9分，营养不良为125例（22．81％）；不同病理分期发生率为Ⅰ期2．19％、Ⅱ期2．50％、Ⅲ期12．67％、Ⅳ期33．33％。有营养风险和有营养不良患者的KPS评分均低于无营养风险及无营养不良患者。结论内科病房的肺癌患者营养风险和3种营养不良发生率属于中等。建议入院时进行营养风险筛查，以了解是否需要营养师咨询干预和肠外肠内营养支持，对有疑问的患者加营养评定。

Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing. Methods From December 2013 to July 2017, 2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment. Patients who did not complete a nutritional status assessment and who had repeated ad- mission were excluded from the study. The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study. The nutritional risk screening 2002 （ NRS 2002） was used to evaluate the nutritional risk. The individual nutritional status was also evaluated using the patient-generated sub- jeetive global assessment （PG-SGA） questionnaire, anthropometry measurements and hematological measure- ments. The physieal status was assessed by the Kamofsky performance status （KPS）. Results According to the NRS 2002 score, 29. 56% （162/548） of the eaneer patients had nutritional risk （ seore ≥3）. The preva- lence of nutritional risk was 17.39%, 15.00%, 22. 00% and 36. 86%, respectively, for patients with stage Ⅰ, Ⅱ , Ⅲ and IV lung eaneer. Forty-four patients （9.67%） had a body mass index〈18.5 kg/m^2 and poor general condition, and the prevalence was 6. 52%, 5.00%, 8.67% and 11.22%, respectively, for stages Ⅰ, Ⅱ , Ⅲ and Ⅳ. A total of 107 eases （ 19. 53% ） had impaired nutritional status （ indicated by a severity score of 3 in the NRS 2002）. The prevalence by different stages was 10. 87% （ stage Ⅰ）, 5.00% （ stageⅡ）, 14. 67% （stage Ⅲ） and 25.00% （stage Ⅳ）. One hundred and twenty-five patients （22. 81% ） had PG-SGA scores ≥ 9, with 2. 19%, 2. 50%, 12. 67%, and 33.33% of patients in stages Ⅰ, Ⅱ , Ⅲ and Ⅳ having these high scores. The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status. Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were medium. Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment.