中国西南地区心脏外科患者术前营养状况横断面调查

Cross-sectional survey of preoperative nutritional status of cardiac surgery patients in southwest China

目的调查我国西南地区心脏外科患者术前营养状况,分析营养风险的发生率及特点,为建立规范的心脏外科患者术前个体化营养干预方案提供依据。方法采用横断面调查的研究方式,以发放电子问卷的形式,对我国云南、贵州、四川、重庆4个地区23家三甲综合医院心脏外科术前患者的营养及干预状况进行调查分析。调查对象为2022年7月7日00:00在上述医院心脏外科拟行心脏外科手术的年龄>18岁的住院患者。调查内容为2022年7月6日(即调查日)患者的营养现状,包括患者的基本信息(一般资料、营养指标等)、营养筛查与评定(营养风险筛查及器官支持等)、营养治疗(营养补充方式及处方等)和医护人员的营养认知度。结果最终共收集到126份问卷,其中有效问卷125份(占99.2%)。①基本信息:125例患者中,男性67例(占53.6%),女性58例(占46.4%);年龄19~86岁,平均(53.13±14.74)岁;体质量指数(BMI)为(22.21±3.78)kg/m^(2);其中男性患者年龄及BMI明显大于女性〔年龄(岁):56.63±13.34比49.09±15.35,BMI(kg/m^(2)):22.74±3.86比21.59±3.61,均P<0.05〕。125例患者中,瓣膜病75例;非瓣膜病50例,主要包括先天性心脏病〔19例(15.2%)〕、主动脉夹层〔13例(10.4%)〕、冠心病〔12例(9.6%)〕等。患者病程0.5 h~36年,其中>6个月93例(占74.4%),≤6个月32例(占25.6%);女性患者病程>6个月的比例明显高于男性〔87.9%(51/58)比62.7%(42/67),P<0.01〕。患者基础疾病主要包括高血压〔38例(30.4%)〕、冠心病〔12例(9.6%)〕、糖尿病〔7例(5.6%)〕、慢性阻塞性肺疾病〔COPD,6例(4.8%)〕等。125例患者中,总蛋白(TP)<60 g/L者24例(19.2%),白蛋白(Alb)<40 g/L者64例(51.2%),贫血〔男性血红蛋白(Hb)<120 g/L,女性Hb<110 g/L〕者33例(26.4%);共收集到前白蛋白数据60例,其中<200 mg/L者23例(38.3%)。②营养筛查与评定:125例患者中仍有33.6%的患者入院后未常规进行营养筛查,涉及省市级三甲医院;在进行营养筛查的83例患者中,存在营养风险者41例(49.4%)。对存在营养风险的患者进一步分析显示,41例患者中,男性20例(占48.8%),女性21例(占51.2%);瓣膜病27例(占65.9%),非瓣膜病14例(占34.1%);病程>6个月30例(占73.2%),≤6个月11例(占26.8%)。对上述83例患者进行比较发现,女性及术前存在基础疾病、病程较长的瓣膜病、贫血、低TP、低Alb患者相对更容易发生营养不良。③营养治疗:125例患者中,接受机械通气治疗者5例(4.0%),使用血管活性药物者2例(1.6%);胃肠功能障碍者5例(4.0%),主要表现为腹胀、腹痛、便秘、腹泻。1例患者经胃管肠内营养联合肠外营养支持治疗;124例患者经口进食,其中有2例存在通过外周静脉输注氨基酸脂肪乳的不规范现象。④医护人员营养认知度:125例患者中,有124例(99.2%)患者所在医院设立了营养科;有71例(56.8%)进行了营养宣教,其中请营养科会诊37例(52.1%);在所有病例中,请营养科会诊者仅38例(30.4%),其中1例(2.6%)在会诊后未进行营养宣教。结论目前我国西南地区心脏手术患者术前营养不良发生率高;术前存在基础疾病、病程较长的瓣膜病、低TP、低Alb和贫血的患者营养不良发生率较高,且女性发病隐匿,就诊时病程较男性更长,更容易发生营养不良,接诊医生对于上述人群应给予重视。有必要建立规范的个体化营养干预方案并应用到实际临床诊疗中,最终改善心脏手术患者的预后,增加患者在治疗中的获益。

Objective To investigate the preoperative nutritional status of cardiac surgery patients in southwest China,analyze the incidence and characteristics of nutritional risk,and provide basis for establishing a standardized individualized nutritional intervention program for cardiac surgery patients.Methods A cross-sectional survey was conducted on the nutritional status and intervention status of preoperative patients in cardiac surgery department of 23 general hospitals in Yunnan,Guizhou,Sichuan and Chongqing districts.At 00:00 on July 7,2022,the patients aged>18 years old in cardiac surgery departments of the above hospitals who planned to undergo surgical treatment were enrolled as the survey objects to investigate the nutritional status on July 6,2022(the survey date),including basic information(general information,nutrition indicators,etc.),nutrition screening and evaluation(nutrition risk screening and organ support,etc.),nutrition treatment(nutrition supplement methods and prescriptions,etc.)and nutrition awareness of medical staff.Results The 126 questionnaires were collected,of which 125 were valid(99.2%).①Basic information:of the 125 patients,67 patients were male(53.6%)and 58 patients were female(46.4%).The age ranged from 19 years old to 86 years old,with an average of(53.13±14.74)years old.Body mass index(BMI)was(22.21±3.78)kg/m^(2).The age and BMI of men were significantly higher than those of women[age(years old):56.63±13.34 vs.49.09±15.35,BMI(kg/m^(2)):22.74±3.86 vs.21.59±3.61,both P<0.05].Of the 125 patients,75 had valvular disease and 50 were with non-valvular diseases,which mainly included congenital heart disease[19 cases(15.2%)],aortic dissection[13 cases(10.4%)],coronary heart disease[12 cases(9.6%)],etc.The course of disease was 0.5 hour to 36 years,of which 93 patients(74.4%)were more than 6 months and 32 patients(25.6%)were equal to or less than 6 months.The proportion of female patients with disease duration>6 months was significantly higher than that of male patients[87.9%(51/58)vs.62.7%(42/67),P<0.01].The basic diseases mainly included hypertension[38 cases(30.4%)],coronary heart disease[12 cases(9.6%)],diabetes[7 cases(5.6%)],chronic obstructive pulmonary disease[COPD,6 cases(4.8%)],etc.Among 125 patients,total protein(TP)<60 g/L in 24 cases(19.2%),albumin(Alb)<40 g/L in 64 cases(51.2%),anemia[male hemoglobin(Hb)<120 g/L,female Hb<110 g/L]in 33 cases(26.4%).A total of 60 cases of prealbumin data were collected,of which 23 cases(38.3%)were less than 200 mg/L.②Nutrition screening and assessment:33.6%of the 125 patients did not undergo routine nutrition screening after admission,including the provincial and municipal tertiary hospitals.Among the 83 patients undergoing nutritional screening,41(32.8%)were at nutritional risk.Further analysis of patients with nutritional risk showed that of the 41 patients,20 were male(48.8%)and 21 were female(51.2%);27 cases(65.9%)was with valvular diseases and 14 cases(34.1%)was with non-valvular diseases;the course of disease was more than 6 months in 30 cases(73.2%),and≤6 months in 11 cases(26.7%).Statistical comparison of the above 83 patients showed that women,basic disease,long term-valvular disease,anemia,low TP,and low Alb before operation were more prone to innutrition.③Nutritional therapy:of the 125 patients,5 were receiving mechanical ventilation(4.0%)and 2 were using vasoactive drugs(1.6%);there were 5 cases with gastrointestinal dysfunction(4.0%),mainly manifested as abdominal distension,abdominal pain,constipation and diarrhea.One patient was treated with enteral nutrition through gastric tube combined with parenteral nutrition support,124 patients were fed orally,and an irregular phenomenon of injecting amino acid fat emulsion through peripheral vein in 2 patients.④Nutrition awareness of medical staff:124(99.2%)of the 125 patients had a nutrition department in their hospital;71 cases(56.8%)received nutrition education,of which 37 cases(52.1%)were consulted by the nutrition department.Of all the cases,only 38(30.4%)were consulted by the nutrition department,of which 1(2.6%)did not receive nutrition education after consultation.Conclusions At present,the incidence of preoperative malnutrition in patients undergoing cardiac surgery is high in southwest China.The incidence of malnutrition in patients with basic diseases,long term-valvular disease,low TP,low Alb and anemia before operation is higher,and the incidence of malnutrition is hidden in women.The course of disease of women is longer than that of men at the time of treatment,and malnutrition is more likely to occur.The attending physicians should pay attention to the above groups.It is necessary to establish a standardized individualized nutritional intervention program and apply it to actual clinical diagnosis and treatment,so as to ultimately improve the prognosis of patients undergoing cardiac surgery and increase the benefits of patients in treatment.