营养筛查与营养评估工具在围手术期老年患者中应用的研究进展

Proqress in the application of nutritional screening and nutritional assessment tools in perioperative elderly patients

老年人群随增龄身体和器官功能会逐渐下降,而在下降的同时,体内营养物质也会大量的流失,再加上患病,造成营养不良发生率攀升。营养筛查和营养评估在临床尚未很好普及和规范化执行,其中适合围手术期老年患者营养筛查和评估的工具也未统一,在一定程度上阻碍了老年患者的康复治疗进程,成为医患关注的热点问题。本研究对常见的7种营养筛查工具(NRS2002、MUST、MST、NRI、GNRI、MEONF-Ⅱ、PONS)和5种营养评估工具(MNA、MNA-SF、SGA、PG-SGA、NUFFE)的产生、内容、适用对象、应用的优缺点进行了梳理汇总。本研究发现,在筛查工具中NRS2002在临床最普遍适用且信度和效度得到了验证,GNRI为老年人专项营养筛查工具,PONS为专门围手术患者营养筛查工具,但在临床的应用都较少,效能需要进一步检验。营养评估工具中MNA更适合65岁以上社区人群,SGA适用于普通成人患者,PG-SGA更适合肿瘤患者,且都在临床应用较为广泛。其余量表在临床使用较少,适用性和效能也没有明确证实。本研究的目的是为围手术期老年患者选择合适的营养筛查和评估工具提供参考,同时也为后续临床开展相关共识与标准的研究提供参考。

The elderly population with aging body and organ function will gradually decline,and in the decline at the same time,the body will also lose a large amount of nutrients,coupled with the disease,resulting in the incidence of malnutrition climbed.Nutritional screening and nutritional assessment have not been well popularized and standardized in clinical practice,and the tools suitable for nutritional screening and assessment of perioperative elderly patients have not been standardized,which to a certain extent hinders the rehabilitation process of elderly patients and has become a hot issue of concern for doctors and patients.In this study,the advantages and disadvantages of seven common nutritional screening tools(NRS2002,MUST,MST,NRI,GNRI,MEONF-Ⅱ,and PONS)and five nutritional assessment tools(MNA,MNA-SF,SGA,PG-SGA and NUFFE)in terms of their generation,content,applicability,and application were sorted out and summarized.Among the screening tools,NRS2002 was found to be the most commonly used in the clinic,and its reliability and validity had been verified;GNRI was a special nutritional screening tool for the elderly,and PONS was a special nutritional screening tool for perioperative patients,but their applications in the clinic were relatively small,and their efficacy needed to be further examined.Among the nutritional assessment tools,MNA is more suitable for community people over 65 years old,SGA is suitable for general adult patients,and PG-SGA is more suitable for oncology patients,and all of them are more widely used in clinical practice.The remaining scales are less used in clinical practice and their applicability and efficacy have not been clearly confirmed.This study aims to provide a reference for choosing appropriate nutritional screening and assessment tools for elderly patients in the perioperative period,as well as a reference for subsequent research on relevant consensus and standards in clinical.