普通外科病人住院期间营养风险和营养不良动态变化的多中心横断面调查

Dynamic change in nutritional risk and malnutrition of general surgical patients during hospitalization:a multicenter cross-sectional survey

目的:调查普通外科病人入院时及出院时营养风险和营养不良的动态变化。方法:在2014年6月至2015年5月期间,对5家三甲医院普通外科住院病人进行前瞻性调查;在入院和出院时分别应用营养风险筛查(NRS 2002)和主观全面营养评定(SGA)对病人进行一次营养状态评估,并收集体质量、BMI、握力、臂围、血清蛋白、血脂等营养相关指标,分析病人营养状态在住院期间的变化情况。结果:共纳入普通外科住院病人1818例,其中良性疾病病人806例,恶性肿瘤病人1012例;出院时NRS 2002筛查营养风险的发生率为56.71%,显著高于入院时的52.48%(χ^2=6.578,P=0.010);出院时SGA评定轻度以上营养不良发生率为42.01%,也显著高于入院时的31.02%(χ^2=47.256,P<0.001);分层分析发现恶性疾病营养风险和营养不良比例的差异更显著(P<0.001),而良性疾病出院时和入院时的营养状态没有显著改变(P>0.05)。出院时病人体质量、握力、臂围、总蛋白、白蛋白、前白蛋白和血红蛋白均较入院时均显著降低(P<0.05)。结论:普通外科住院病人出院时营养状态劣于入院时,尤其在恶性肿瘤病人中;营养不良是导致不良临床结局的重要因素。

Objective:To investigate dynamic change in nutritional risk and malnutrition of general surgical patients during hospitalization.Methods:A prospective,multi-center survey was conducted in department of general surgery from 5 hospital,during June 2014 to May 2015.Anthropometric measuring and laboratory examination were recorded after admission and before discharge respectively.NRS 2002 and SGA were used to assess patients’nutritional status.Results:A total of 1835 patients included into the study,806 patients with benign diseasesand 1012 patients with malignant tumor.Compared with admission,patients’weight,BMI,grip,upper circumference and some main proteins were reduced significantly at discharge(P<0.05).The incidence of nutritional risk at discharge was 56.71%,higher than 52.48%on admission(χ2=6.578,P=0.010).The incidence of malnutrition(SGA B+C)at discharge was 42.01%,higher than 31.02%on admission(χ2=47.256,P<0.011).The incidence of nutritional risk and malnutrition during hospitalization had a significant change in patients with malignant tumor(P<0.0001)and no change in patients with benign diseases(P>0.05).Conclusion:Nutritional status of general surgery patients at discharge was worse than that on admission,particularly on patients with malignant tumor.Malnutrition was an important factor leading to adverse clinical outcomes.