急诊留观老年患者营养状况分析

Analysis on the Nutritional Status of Elderly Patients in Emergency Observation Ward

目的对急诊留观老年患者进行营养筛查,了解患者营养状态,为进一步的营养支持及疾病治疗提供有效的参考。方法选取2017年2月1日-2017年8月31日间急诊留观患者147例,年龄≥65岁,同时≤90岁,采用营养风险筛查(NRS2002)和微型营养评定精法(MNA-SF)分别对患者营养风险和营养状况进行评价,同时记录患者入院时的年龄、性别、疾病、体质指数(BMI)等基本信息,并对患者血清白蛋白(ALB)、血红蛋白(HB)两个化验指标进行检测。结果用NRS2002方法筛查急诊留观老年患者有营养风险的发生率为66.67%,共98例;用MNA-SF方法筛查营养不良风险或营养不良的发生率为90.48%,共133例。用NRS2002和MNA-SF两种方法筛查中有营养风险的老年患者组入院时BMI、白蛋白、血红蛋白均明显低于无营养风险组。白蛋白和BMI与NRS 2002或MNA-SF具有良好的相关性。以BMI<18.5kg/m^2为营养不良标准,制作MNA-SF、NRS2002、HB及ALB的ROC曲线,曲线下面积(AUC)分别为0.889、0.795、0.524和0.633,灵敏度分别为0.95、0.70、0.30和0.70,特异性分别为0.693、0.803、0.874和0.591,Youden指数分别0.643、0.503、0.174和0.291。结论急诊留观老年患者营养不良的问题普遍存在;NRS2002和MNA-SF可用于评定急诊留观老年患者的营养状况,MNA-SF灵敏度及正确性更高,留观老年患者营养评定使用MNA-SF更合适;BMI、白蛋白可辅助评定急诊留观老年患者的营养状况。

Objectives To provide an effective reference for further nutritional support and diseases treatment through nutrition screening for elderly patients＇ nutrition status in emergency observation ward. Methods 147 patients were selected,aged from 65 to 90 years old. After admission,patients were assessed for the following items： NRS2002,MNA-SF,demographic information such as age,sex,diseases and body mass index,and laboratory tests including albumin and hemoglobin. Results There were 98 elderly patients evaluated as in need of nutritional support by NRS 2002,accounting for 66.67%.A total of 133 elderly patients were evaluated as risk of malnutrition or malnutrition by MNA-SF,accounting for 90.48%.The levels of BMI,albumin and hemoglobin of elderly patients with nutritional risks were significantly lower than those without nutritional risk.Albumin and BMI had a good correlation with NRS 2002 or MNA-SF.With BMI18.5 kg/m^2 as the standard. the AUCs of MNA-SF,NRS 2002,hemoglobin and albumin were 0.889,0.795,0.524 and 0.633,and the sensitivities were 0.95,0.70,0.30 and 0.70 and the specificities were 0.693,0.803,0.874 and 0.591,and the Youden indexes were 0.643,0.503,0.174 and 0.291,respectively.Conclusions The problem of malnutrition in elderly patients was widespread in emergency observation ward.Nutritional assessment tools such as NRS2002 and MNA-SF could be used to evaluate the nutritional status of elderly patients. MNA-SF had the highest sensitivity,AUC and Youden index,so it was recommended to perform MNA-SF at admission. Other commonly used indicators such as BMI and albumin can also be used.