老年创伤患者营养状况及其影响因素

Nutritional status in elderly trauma patients and its influencing factors

目的分析围术期老年创伤患者营养状况及其影响因素,为早期营养干预和临床诊疗提供科学依据,改善其临床结局及预后,提高生活质量。方法选择四川大学华西医院2021年1月至12月收治的103例老年创伤患者为研究对象,基于患者实验室检查、体成分数据等多维度描述老年创伤患者的营养状况。依据微型营养评定法(MNA-SF)的结果将患者进行营养风险分组,其中营养风险组46例,营养正常组57例,分析老年创伤患者营养状况及其影响因素。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ2检验进行组间比较。采用二分类变量的多元逐步logistic回归分析老年创伤患者营养状况的影响因素。结果MNA-SF筛出营养状况良好者57例,潜在营养不良者39例,营养不良者7例,合计营养风险发生率为44.66%(46/103)。老年创伤患者还存在能量摄入不足、血糖较高、体脂偏高、骨骼肌质量减少、体蛋白质水平偏低等营养问题。logistic回归分析结果显示,高体脂(OR=0.126,95%CI 0.022~0.707;P=0.019)、低血清白蛋白(OR=3.579,95%CI 1.365~9.388;P=0.010)及低骨骼肌质量指数(OR=4.757,95%CI 1.854~12.209;P=0.001)与老年创伤患者的营养风险具有较高的相关性。存在营养风险(Z=-2.908,P=0.004)和低血清白蛋白(Z=-3.511,P<0.001)的老年创伤患者住院时间更长。结论老年创伤患者存在诸多营养问题,营养风险发生率较高,且与患者住院时间相关,需及时监测营养状况,重点关注低体脂、低血清白蛋白、低骨骼肌质量指数的老年患者,及时给予营养支持,以改善其营养状况及预后。

Objective To analyze the nutritional status and its influencing factors of elderly trauma patients in perioperative period so as to provide scientific basis for early nutritional intervention and clinical diagnosis and treatment,promote clinical outcomes and prognosis,and improve their quality of life.Methods A total of 103 elderly trauma patients admitted in West China Hospital of Sichuan University from January 2021 to December 2021 were included in the study.The results of laboratory examinations and body composition data were recorded to describe the nutritional status of elderly trauma patients in multiple dimensions.According to the evaluation results of mini nutritional assessment-short form(MNA-SF),they were divided into nutritional risk group(n=46)and normal nutrition group(n=57).The nutritional status and the influencing factors were studied in the elderly trauma patients.SPSS statistics 19.0 was used to perform the statistical analysis.Student′s t test,rank sum test or Chi-square test was employed for intergroup comparison.Multivariate stepwise logistic regression for binary variables was performed to analyze influencing factors of nutritional status in elderly trauma patients.Results The results of MNA-SF showed there were 57 patients with good nutritional status,39 with potential malnutrition,and 7 with malnutrition,with an incidence of nutritional risk of 44.66%(46/103).Elderly trauma patients also had nutritional problems such as insufficient energy intake,high blood glucose,high body fat,reduced skeletal muscle mass and low body protein level.Logistic regression analysis indicated that high body fat(OR=0.126,95%CI 0.022-0.707;P=0.019),low serum albumin level(OR=3.579,95%CI 1.365-9.388;P=0.010)and low skeletal muscle mass index(OR=4.757,95%CI 1.854-12.209;P=0.001)were significantly associated with nutritional risk in elderly trauma patients.The length of hospital stay was prolonged in the patients with nutritional risk(Z=-2.908,P=0.004)and those with low serum albumin level(Z=-3.511,P<0.001).Conclusion Elderly trauma patients had many nutritional problems and are at high nutritional risk,which is associated with the length of hospital stay.Monitoring of nutritional status should be carried out,especially in those with low body fat,serum albumin and skeletal muscle mass index.Timely nutritional support should be given to improve their nutritional status and prognosis.