营养管理在伴有营养不良的结核病住院患者中的使用效果观察

Observation on the effect of nutrition management in hospitalized tuberculosis patients with malnutrition

目的:观察规范化营养管理在伴有营养不良的住院肺结核患者中的使用效果,为临床推广提供依据。方法:选择2021年9月至2022年9月在我院住院的存在营养风险(营养风险筛查NRS2002评分≥3分)的肺结核患者,所有患者入院后在给予正规抗结核治疗的基础上,接受规范化营养管理两周。使用主观全面评定(SGA)营养评估表对患者进行营养评定,根据SGA评分情况将患者分为无营养不良组(SGA评定A级,40例)和营养不良组(SGA评定B或C级,40例),观察不同营养评定患者在入院时和住院2周后的NRS2002评分、体重、SGA评定的变化,以及4项营养监测指标(总蛋白TP、白蛋白ALB、前白蛋白PAB和转铁蛋白TRF)的变化情况。结果:营养管理有助于改善肺结核患者的营养状况,且对肺结核伴有营养不良的患者营养状况改善作用更明显,营养不良组患者NRS2002评分住院两周后改善(评分降低)率52.5%,高于未伴有营养不良组的35%,且住院两周后营养不良组的SGA改善(评定降级)率高达37.5%。在营养指标方面,营养干预可提高患者PAB水平,且在肺结核伴有营养不良的患者中PAB水平显著提高,P<0.05。结论:营养管理可有效改善存在营养风险并伴有营养不良的肺结核住院患者的营养状况,值得临床重视并推广普及。

Objective:To observe the effectiveness of standardized nutrition management in hospitalized pulmonary tuberculosis(PTB)patients with nutrition risk and provide a basis for clinical promotion.Method:PTB patients with nutritional risk(NRS2002 score≥3)who were hospitalized in our hospital from September 2021 to September 2022 were selected.All patients received standardized nutritional management for two weeks on the basis of regular anti-tuberculosis treatment.The patients were assessed with SGA(subjective global assessment)method.According to the SGA score,the patients were divided into two groups:no malnutrition group(SGA rating A,40 cases)and malnutrition group(SGA rating B or C,40 cases).The changes of NRS2002 score,body weight,SGA score and four nutritional evaluation indicators(total protein(TP),albumin(ALB),prealbumin(PAB)and transferrin(TFR))were observed at the time at admission and 2 weeks after admission.Results:Nutrition management was helpful to improve the nutritional status of the combined patients,especially for patients with malnutrition.The improvement(reduction)rate of NRS 2002 score in malnutrition group was 52.5%after two weeks in hospital,which was higher than that in non-malnutrition group(35%),and the improvement(degradation)rate of SGA in malnutrition group was as high as 37.5%after two weeks in hospital.In terms of nutritional indicators,nutritional intervention can improve the level of PAB in patients with PTB and malnutrition,and the level of PAB is significantly increased,P<0.05.Conclusion:Nutrition management can effectively improve the nutritional status of hospitalized tuberculosis patients with malnutrition,which deserves clinical attention and popularization.