脊柱外科住院病人营养现状调查及其危险因素分析——基于501名病人的横断面研究

Survey and analysis of nutritional status in the patients hospitalized in the Department of Spine Surgery——a cross-sectional study

目的:明确现阶段脊柱外科住院病人的营养状况,分析营养风险和营养不良的危险因素,提出综合评价营养状况的敏感指标,为尽早筛查高危人群和制定营养支持方案提供依据。方法:对南方医院脊柱骨科2019年6月至2019年12月收治住院拟行手术病人进行营养筛查及危险因素分析。在病人入院24 h内完成营养筛查、基础疾病史、医疗保险情况、现居住区域等情况,测量身高和体质量,计算体质指数(BMI),行营养三项(白蛋白、前白蛋白、转铁蛋白)及血常规化验;根据NRS 2002营养筛查量表,进行营养情况调查及营养风险评判。分析营养风险及营养不良的总体发生率,对比不同年龄段、不同脊柱疾病之间营养风险及营养不良发生率的差异,采用Logistic回归分析不同营养指标对营养风险和营养不良的预测意义。结果:共有501名病人纳入本研究,其中男性249例(49.70%),女性252例(50.30%),病人年龄18~89岁,平均(55.2±14.5)岁。营养风险(114例)发生率为22.75%。营养不良(126例)发生率为25.15%。不同类型脊柱疾病和不同年龄段间营养风险和营养不良发生率均存在统计学差异(P<0.05),其中老年组、脊柱感染疾病的发生率较其他组高;伴有合并症组较无合并症组高,有统计学差异(P<0.05)。Logistic回归分析提示,年龄、白蛋白、转铁蛋白、前白蛋白、血红蛋白均对营养风险或营养不良的预测有指导意义。结论:脊柱疾病病人营养风险和营养不良的发生率较高,临床中医务人员应重视营养对疾病预后的影响,及时进行筛查,发现高危人群,积极采取营养支持措施,维持机体内稳态,促进早日康复,提高生活质量。

Objective:To investigate the nutritional status of hospitalized patients in the Department of Spine Surgery and find out the potential indicators for predicting nutritional risk and malnutrition.Methods:The patients undergoing surgical treatments in the Department of Spine Surgery between June 2019 and December 2019 were enrolled in this study.Nutritional screening and assessment were performed using the NRS 2002 within 24 hours after admission.The patients’body mass indices(BMI)were calculated,and the serum levels of albumin,pre-albumin and transferrin and complete blood counts were determined.The prevalence of nutritional risk and malnutrition were analyzed,and the differences in the malnutrition incidences between different groups were compared.The potential values of different indicators for predicting nutritional risk and malnutrition was evaluated by the Logistic regression analysis.Results:A total of 501 patients were included in this study,including 249 males(49.70%)and 252 females(50.30%).The age of the patients ranged from 18 to 89 years old,with an average age of(55.2±14.5)years.The prevalence of nutritional risk(114 cases)in the patients was 22.75%,and the prevalence of malnutrition(126 cases)was 25.15%.Significant differences in the prevalence of nutritional risk and malnutrition were observed between groups with different types of spinal diseases or different ages(P<0.05).The highest prevalence of nutritional risk and malnutrition was seen in the elderly patients with spinal infection.The patients with comorbidities showed much higher prevalence of nutritional risk and malnutrition compared to those without comorbidities(P<0.05).Logistic regression analysis indicated that age,albumin,transferrin,pre-albumin and hemoglobin were independent factors for predicting nutritional risk or malnutrition.Conclusion:There are considerable prevalence of nutritional risk and malnutrition in patients with spinal diseases,among which the prevalence of nutritional risk and malnutrition is higher in patients with older age,comorbidities and spinal infections.Albumin,transferrin,pre-albumin and hemoglobin could be considered as sensitive indicators for predicting nutrition risk and malnutrition.In clinical practice,nutritional status of the patients should be paid much attention by the medical staff and timely nutritional intervention should be given,which would contribute to early recovery of the patients and improvement of the life quality.