Nutritional Risk Screening with NRS2002 among Hospitalized Cancer Patients in China

Objective The Nutritional Risk Screening 2002(NRS 2002)was used to assess the nutritional risk of hospitalized oncology patients in China.This study explored the factors affecting the risk of nutrition to provide a scientific basis for the assessment and treatment of malnutrition in oncology patients.Methods We used the NRS 2002 to evaluate the nutritional risk in 48,831 hospitalized cancer patients.Descriptive statistical methods were used to describe the general patient information.A Chi-squared test was applied to analyze the relationship between NRS 2002 scores and different demographic characteristics,and the NRS 2002 scores of cancer patients with different characteristics were compared by one-way ANOVA.Results Among 48,831 patients,43.3%were women and 57.7%were men,and 36.5%(17,802)of patients were at risk of nutrition(score≥3).The NRS 2002 score was the highest in leukemia patients(2.93±1.28).A one-way ANOVA revealed that the differences in NRS 2002 scores among patients of different gender,ages,TNM stages,education levels,occupations and areas of residence were statistically significant(P<0.001).Male patients had slightly higher NRS 2002 scores than females(2.33 vs.2.17).The lowest NRS 2002 scores were in patients aged 45-59(2.00±1.26)years and the highest scores were in patients aged≥70(2.76±1.43)years.The NRS 2002 score of patients receiving surgery was the highest(2.45±1.41),and patients receiving surgery plus radiotherapy/chemotherapy was the lowest(2.00±1.26).The risk of nutrition was highest in patients who were farmers(2.34±1.37 scores)and lowest in office staff(2.15±1.32 scores).Patients living in rural areas had the highest risk of nutrition(2.32±1.37 scores).There were significant differences in the NRS 2002 scores for different cancer sub-types for different ethnic groups(P<0.05),except for Zhuang individuals(P=0.124).The risk of nutrition was highest in Uyghur patients(3.35±1.33 scores)and lowest in Mongolians(2.04±1.37 scores).Conclusion More attention should be paid to people at high risk of nutrition,such as elderly patients,patients with a high TNM stage,patients receiving surgical treatment,and patients living in rural areas.Active nutritional interventions should be carried out to improve the nutritional status of malnourished patients.

基于NRS2002 TEN和SJS患者的营养风险筛查

目的基于欧洲营养风险筛查工具(NRS2002)对中毒性表皮坏死松解症(TEN)和Stevens-Johnson综合征(SJS)患者进行营养风险筛查,研究TEN和SJS患者营养风险的发生率,探讨此类患者发生营养风险的危险因素。方法回顾性调查2011年1月至2021年3月在本院住院的临床资料完整的TEN和SJS患者215例,按受累皮肤的体表面积(BSA)予以区分TEN、SJS、SJS/TEN重叠综合征。同时基于NRS2002进行营养风险筛查评分,探讨TEN和SJS患者存在营养风险的危险因素。结果TEN和SJS患者入院时营养风险的发生率为64.19%(138/215)。其中,年龄(χ^(2)=7.198,P<0.01)、SCORTEN(χ^(2)=18.843,P<0.01)、致敏药物(χ^(2)=13.169,P<0.01)、皮损面积(χ^(2)=119.245,P<0.01)、黏膜受累部位(χ^(2)=8.241,P<0.01)对于TEN和SJS患者发生营养风险有统计学意义。多因素Logistic回归分析提示,年龄(OR=0.604,95%CI:0.472~0.973)、10%≤BSA≤30%(OR=4.638,95%CI:1.062-13.903)、BSA>30%(OR=6.128,95%CI:1.674~12.068)、黏膜受累部位为口腔黏膜(OR=5.978,95%CI:1.728~16.368)、血液净化治疗(OR=6.008,95%CI:1.316~22.175)是造成TEN和SJS患者营养风险的独立危险因素。结论大约2/3的TEN和SJS患者入院时即存在营养风险。而年龄、10%≤BSA≤30%、BSA>30%、黏膜受累部位为口腔黏膜、血液净化治疗则是造成TEN和SJS患者营养风险的独立危险因素。

mNUTRIC与NRS⁃2002评分对重症病人预后的评估价值比较

目的:采用改良危重症营养风险(mNUTRIC)评分和营养风险筛查(NRS⁃2002)评分评估急诊重症监护病房(EICU)病人的营养风险,并比较两种工具对EICU病人28 d死亡率的评估价值。方法:选取2023年2月-5月EICU由急诊入院的病人,从电子医疗记录文件中收集资料,并于病人入住EICU 24 h内采用NRS⁃2002和mNUTRIC评分进行营养评估。采用Cox回归分析探讨营养风险对病人28 d死亡率的影响;绘制受试者工作特征(ROC)曲线评价NRS⁃2002评分、mNUTRIC评分、急性生理与慢性健康状态评分系统Ⅱ(APACHE)Ⅱ评分和序贯器官衰竭(SOFA)评分对28 d死亡率的预测价值。结果:纳入152例病人,mNUTRIC评分筛查出高营养风险(>5分)病人102例,占67.1%;NRS⁃2002评分筛查出高营养风险(≥5分)病人67例,占44.1%;两种评分筛查结果存在不一致性(κ=-0.230)。Cox回归分析显示,mNUTRIC评分(HR=1.782)和SOFA评分(HR=1.186)是EICU危重症病人28 d死亡的危险因素。mNUTRIC评分预测病人28 d死亡率的受试者工作特征(ROC)曲线下面积为0.82[95%CI(0.73,0.90)],最佳临界值为6分,预测价值优于NRS⁃2002评分、APACHEⅡ评分和SOFA评分。结论:mNUTRIC评分可作为EICU重症病人营养风险评估的有效工具,且与病人28 d死亡率相关,但应考虑病人急性阶段和恢复阶段的特征,动态评估营养风险。

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

The Role of the PNI and NLR in Nutritional Risk Screening and Assessment of Gastric Cancer Patients

Background The use of nutritional risk screening and assessment is becoming increasingly common in cancer patients.The Nutritional Risk Screening 2002(NRS 2002)is a nutritional risk screening programe with good utility.The patient generated-subjective global assessment(PG-SGA)is a method used to assess the nutritional status of cancer patients.The prognostic nutritional index(PNI)and neutrophil to lymphocyte ratio(NLR)are considered to be predictors of the prognosis following treatment for patients with a variety of cancers.However,the relationship between the PNI and NLR in the nutritional screening and assessment in patients with gastric cancer is unknown.Methods A retrospective analysis was performed on 378 patients with gastric cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020.NRS 2002 and PG-SGA were performed within 24 hours of admission,and indicators such as the serum albumin level,body mass index(BMI),PNI and NLR were measured.Results In the grouping based on the NRS2002,patients in the positive group(NRS 2002≥3)had a higher platelet value,a higher median NLR,and a lower PNI than those in the negative group(NRS 2002<3)(295.50±118.49×10^(9)/L vs.269.36±93.52×10^(9)/L,2.38 vs.1.77,42.36±5.96 vs.46.64±4.29).Based on the PG-SGA grouping,the serum albumin level and lymphocyte count were highest in the mild group(PG-SGA:score 2-3),(36.94±3.51 g/L and 1.91±0.7610^(9)/L)and lowest within the severe group(PG SGA score≥9)(34.09±4.18 g/L and 1.51±0.6410^(9)/L).The BMI was highest in the mild group(23.35±3.00 kg/m^(2))and lowest in the severe group(20.63±2.97 kg/m^(2)),and the PNI was also highest in the mild group(46.50±5.17)and lowest in the severe group(41.64±5.53).However,the NLR was lowest in the mild group(median 1.91)and highest in the severe group(median 2.44).Conclusion The PNI and NLR in gastric cancer patients are closely related to the results of the nutritional risk screening and assessment,suggesting that they may be useful to guide the nutritional interventions for gastric cancer patients.

NRS-2002与PG-SGA在中晚期肿瘤患者营养筛查及评估中的应用

目的 研究欧洲营养风险筛查工具(NRS-2002)与主观整体评估量表(PG-SGA)在中晚期肿瘤患者营养筛查及评估中的应用效果。方法 回顾性分析2020年1月至2022年1月长安医院收治的116例中晚期肿瘤患者的临床资料,根据其在入院后接受的营养状况筛查和评估结果的不同分为营养正常组72例和营养不良组44例。比较两组患者的NRS-2002与PG-SGA评分情况、NRS-2002与PG-SGA不同分组患者的营养指标水平、应用NRS-2002与PG-SGA评分分组后两组患者近期的疗效及远期生存情况;采用Spearman秩相关分析法分析NRS-2002与PG-SGA评分与中晚期肿瘤患者营养指标的相关性。结果 营养正常组患者的NRS-2002与PG-SGA评分分别为(2.07±0.79)分、(3.52±1.01)分,明显低于营养不良组的(4.69±0.74)分、(5.22±1.14)分,差异均有统计学意义(P<0.05);NRS-2002评分中营养正常组患者的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平明显高于营养不良组,PG-SGA评分中营养正常组的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平也明显高于营养不良组,差异均有统计学意义(P<0.05);经Spearman秩相关分析法分析结果显示,NRS-2002和PG-SGA评分均与患者体质量指数、红细胞计数、血红蛋白、白蛋白、前白蛋白呈负相关(P<0.05);营养正常组患者的近期总有效率为94.44%,明显高于营养不良组的70.45%,差异有统计学意义(P<0.05);营养正常组患者的中位生存时间为(12.86±2.27)个月,明显长于营养不良组的(8.26±1.41)个月,生存率为93.06%,明显高于营养不良组的65.91%,而局部复发和远处转移率分别为16.67%、6.94%,明显低于营养不良组患者的34.09%、34.09%,差异均具有统计学意义(P<0.05)。结论 NRS-2002与PG-SGA均是筛查和评估中晚期肿瘤患者营养状态的有效方法,能及时发现患者的营养风险,以便及时对患者营养不良状况进行纠正,值得临床推广应用。

Clinical Significance of Preoperative Nutritional Risk Screening and Support in the Perioperative Period of Gastric Cancer Patients

Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020 treated in our hospital were grouped concerning the lottery method,and the reference group(n=35)used conventional nutritional support,while the experimental group(n=35)used preoperative dietary risk screening and support,comparing the clinical treatment differences between gastric cancer patients in the experimental group and the reference group.Results:After the intervention,IgA,IgM,IgG,serum albumin,complication rate,NRS score,hospitalization time and anal exhaust time of gastric cancer patients in the experimental group were compared with those in the reference group,P<0.05,and there was statistical validation analysis significance between the data indicators.P<0.05 for the comparison of IgA,IgM,IgG,serum albumin after the intervention and pre-intervention for gastric cancer patients in the experimental group and the reference group,with statistical validation analysis significance between the data indicators.Conclusion:Preoperative nutritional risk screening and support is of significant value in gastric cancer patients and can improve patients’nutritional status.

基于NRS-2002评估筛查下改良营养支持方案对老年脑梗死患者预后的临床价值

目的探讨基于营养风险筛查2002量表(NRS-2002)评估筛查下改良营养支持方案对老年脑梗死患者预后的临床价值。方法选取2020年3月—2022年3月新疆生产建设兵团第二师库尔勒医院收治的86例老年脑梗死患者作为研究对象,依据随机数表法分为常规治疗组、营养支持治疗组,各43例。常规治疗组接受常规治疗,营养支持治疗组接受基于NRS-2002评估筛查下改良营养支持方案治疗。比较两组患者营养状况指标、躯体功能指标、生活质量[日常生活能力评定量表(Barthel指数)、健康指数量表(EQ-5D指数)]及总住院时间。结果两组患者出院当天身体质量指数、上臂围及上臂皮褶厚度均较治疗前高,NRS-2002评分较治疗前低,且营养支持治疗组各指标较常规治疗组变化明显,差异有统计学意义(P<0.05);两组患者出院当天吞咽功能评分均较治疗前低,Barthel指数、EQ-5D指数均较治疗前高,且营养支持治疗组各评分较常规治疗组变化明显,差异有统计学意义(P<0.05);营养支持治疗组总住院时间较常规治疗组短,差异有统计学意义(P<0.05)。结论老年脑梗死病患者采用基于NRS-2002评估筛查下改良营养支持方案治疗具有较高临床价值,利于改善患者营养状况,提升生活质量。

NRS 2002和PG-SGA在胃肠道恶性肿瘤患者中的应用

背景:目前国内指南共识推荐对于围手术期胃肠道恶性肿瘤患者,需使用营养风险筛查2002(NRS 2002)和患者主观整体评估(PG-SGA)量表分别进行营养风险筛查和评估。但PG-SGA量表筛查专业要求更高,内容复杂,耗时长,在目前医务人员工作繁忙的情况下,仅使用NRS 2002量表进行筛查。目的:探索NRS 2002与PG-SGA对胃肠道恶性肿瘤患者营养状况和临床结局评估的相关性和一致性,探索仅使用NRS 2002进行筛查的准确性,为临床营养筛查与评估工作规范的建立提供指导。方法:回顾性分析2020年1月—2022年10月中南大学湘雅医院胃肠外科行胃肠道恶性肿瘤根治术的患者157例,采用NRS 2002和PG-SGA量表进行营养筛查与评估,收集人口学资料、营养相关实验室指标和术后短期临床结局资料。结果:存在营养风险或营养不良的患者的术前体质指数(BMI)、淋巴细胞、前白蛋白显著低于不存在营养风险或营养不良的患者(P<0.05);NRS 2002与PG-SGA的相关性(r=0.728)和一致性(κ=0.460)较好,预测术后并发症的曲线下面积(AUC)分别为0.691和0.702。此外,营养风险和营养不良患者术后并发症发生率明显增高(P<0.05)。结论:对于胃肠外科医师,在临床工作繁忙的情况下,可仅使用NRS 2002对患者进行营养筛查,并根据筛查结果进行相应的营养治疗。

PG-SGA量表与NRS 2002量表对肺癌病人营养风险预测效果的对比研究

目的:对比PG-SGA量表与NRS 2002量表在肺癌病人营养风险中的筛查效果,探讨适用于肺癌病人的营养风险筛查最佳工具。方法:采用便利抽样法,运用一般资料调查表、自评主观全面评定量表(PG-SGA)与营养风险筛查量表(NRS 2002)对符合纳入排除标准的120例肺癌住院病人营养状况进行筛查。结果:PG-SGA量表筛查出49例病人有营养风险,NRS 2002量表筛查出13例病人有营养风险,筛查结果差异无统计学意义(P>0.05);分别以BMI值、血清白蛋白值将病人分为营养正常和营养不良两组,两组病人NRS 2002量表筛查结果、筛查评分差异均有统计学意义(P<0.05),PG-SGA量表筛查结果、筛查评分差异均无统计学意义(P>0.05);NRS 2002量表筛查结果与BMI、血清白蛋白评定结果一致性检验具有统计学差异(P<0.05),一致性指数Kappa值分别为0.510,0.309,PG-SGA量表筛查结果与两项指标评定结果一致性检验差异均无统计学意义(P>0.05)。结论:NRS 2002量表与PG-SGA量表相比,准确度高,操作简单、快捷,推荐作为肺癌病人营养风险筛查的首选工具。此外,研究者可结合营养筛查目的,将PG-SGA量表作为补充筛查工具使用。

Low Calf Circumference Predicts Nutritional Risks in Hospitalized Patients Aged More Than 80 Years

Objective The aim of this study was to determine whether low calf circumference(CC) could predict nutritional risk and the cutoff values of CC for predicting nutritional risk in hospitalized patients aged ≥ 80 years.Methods A total of 1,234 consecutive patients aged ≥ 80 years were enrolled in this study.On admission, demographic data, CC, and laboratory parameters were obtained.Patients with Nutritional Risk Screening 2002(NRS-2002) total score ≥ 3 were considered as having nutritional risk.Results CC values were significantly lower in patients with nutritional risk compared to those in patients without nutritional risk [27.00(24.50-31.00) vs.31.00(29.00-33.50], P < 0.001].CC was negatively correlated with age and nutritional risk scores.Logistic regression analysis of nutritional risk revealed that body mass index, albumin level, hemoglobin level, cerebral infarction, neoplasms, and CC(OR, 0.897;95% confidence interval, 0.856-0.941;P < 0.001) were independent impact factors of nutritional risk.Nutritional risk scores increased with a decrease in CC.In men, the best CC cutoff value for predicting nutritional risk according to the NRS-2002 was 29.75 cm.In women, the cutoff value was 28.25 cm.Conclusion CC is a simple, noninvasive, and valid anthropometric measure to predict nutritional risk for hospitalized patients aged ≥ 80 years.

NUTRIC评分与NRS 2002在ICU老年脑卒中病人营养风险评估中的效果比较

目的:比较危重症营养评分(NUTRIC)与营养风险筛查量表2002(NRS 2002)对神经内科重症监护室(ICU)老年脑卒中病人营养风险及并发症的预后效果。方法:选取2020年4月—2021年4月于河南省人民医院神经内科ICU住院的80例老年脑卒中病人为研究对象,评估病人入住ICU时的NRS 2002和NUTRIC评分,测量病人入住和转出ICU时的体质指数(BMI)、肱三头肌皮褶厚度(TSF)、上臂中段围(MAC)、血清清蛋白(ALB)、前清蛋白(PA)及血红蛋白(Hb)水平。根据病人ICU转出时的营养状况及并发症情况将病人分为营养不良组(n=31)与营养正常组(n=49)、并发症组(n=24)和无并发症组(n=56),比较两组NRS 2002和NUTRIC评分的差异,采用受试者工作特征(ROC)曲线分析NRS 2002和NUTRIC评分对病人营养风险的诊断价值。结果:营养不良组入院时NUTRIC与NRS 2002评分均低于营养正常组(P<0.05);NRS 2002评分与BMI、ALB、PA、TSF呈负相关,NUTRIC评分与BMI、ALB、PA、TSF、MAC及Hb呈负相关(P<0.05);NUTRIC评分定性预测营养不良的敏感度(96.77%)和特异度(73.47%)均高于NRS 2002评分(87.10%、36.73%);NUTRIC定量预测营养不良的ROC曲线下面积(0.894)高于NRS 2002评分(0.759)。并发症组NUTRIC评分高于无并发症组(P<0.05),两组NRS 2002评分差异无统计学意义(P>0.05)。结论:NUTRIC评分对神经内科ICU老年脑卒中病人营养风险及并发症风险的预测性能相对优于NRS 2002量表。

Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes.Despite its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled.Demographic information,laboratory parameters,nutritional support therapies,and 28-day mortality were recorded.Risk factors for mortality were examined using multi-variateadjusted logistic regression analysis.Receiver operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was compared.RESULTS:A total of 2,005 eligible patients were finally enrolled.At the 28-day follow-up,1,911 patients survived,and 94 died.The group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,respectively.Among the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day mortality.APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC.CONCLUSIONS:Nutritional risk is prevalent among older patients in EDOUs in China.APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU.Timely and appropriate nutritional screening and support measures are critical to reduce patients’length of hospital stay and mortality.

改良版NRS2002在急性创伤骨折患者营养风险筛查中的效果评价

目的将营养风险筛查表(nutritional risk screening,NRS2002)与改良版营养风险筛查表(改良版NRS2002)应用于创伤性骨折患者的营养评估中,评估2种筛查表达的检验效能,以便合理选择筛查工具,及时发现创伤性骨折患者营养不足并给予支持。方法选取因急性创伤收治的骨折患者271例,采用NRS2002及改良版NRS2002对患者进行营养风险筛查,分析2种筛查工具的敏感度、特异度,再通过计算Kappa值判断2种筛查工具的一致性,并验证体格检查指标及实验室指标与营养风险的相关性。结果271例患者中,NRS2002筛查出有营养风险的患者68例(25.1%),改良版NRS2002筛查出有营养风险的患者103例(38.0%)。传统NRS2002筛查和改良版NRS2002筛查得出的存在营养风险的患者(≥3分)上臂围(arm muscle circumference,AMC)、肱三头肌皮褶厚度(triceps skinfold,TSF)、握力(grip strength,GS)、总蛋白(total protein,TP)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,pALB)、钙、磷、镁、红细胞(red blood cell,RBC)和血红蛋白(hemoglobin,HGB)均低于不存在营养风险者,小腿围(calf circumference,CC)、氯、白细胞(white blood cell,WBC)和C反应蛋白(C-reactive protein,CRP)均高于不存在营养风险者(P<0.05)。采用改良版NRS2002及NRS2002筛查出的存在营养风险患者(≥3分)的体格检查指标及化验指标差异无统计学意义。改良版NRS2002及NRS2002筛查结果一致性检验良好(Kappa=0.673,P<0.05),改良版NRS2002营养风险筛查表ROC曲线下面积为0.894。1周后,对不存在营养风险(<3分)的患者进行复筛时发现NRS2002复筛的阳性率明显高于改良版NRS2002(P<0.05)。AMC、TSF、GS、ALB、pALB、HGB与NRS2002、改良版NRS2002均呈负相关(P<0.05);CC与NRS2002、改良版NRS2002呈正相关(P<0.05)。结论改良版NRS2002及NRS2002的筛查结果一致性一般,在营养风险筛查方面改良版NRS2002敏感度较高,且1周后复筛阳性率较低,说明其发现患者存在营养风险的能力优于NRS2002。BMI、AMC、TSF、GS、ALB、pALB、HGB等与营养风险发生相关的因素,可与改良版NRS2002联合应用评估患者营养风险。

Prevalence of Nutritional Risk, Undernutrition, Overweight/Obesity and Application of Nutritional Support Among Geriatric Patients at Peking University People’s Hospital

Objective To investigate the prevalence of nutritional risk, undernutrition, overweight/obesity, and the application of nutritional support among geriatrics so as to provide evidence for whether elderly inpatients with undernutrition and nutritional risk should receive timely nutritional support. Methods A total of 445 elderly inpatients in the Department of Geriatrics of Peking University People’s Hospital were consecutively enrolled from July 2010 to June 2011. The Nutritional Risk Screening 2002 (NRS 2002) questionnaire was used on the second day after admission. The application of nutritional support was investigated on the 14th day or the discharge day. The relationship between the nutritional risk and nutritional support was analyzed. A NRS 2002 score ≥ 3 was defined as nutritional risk. A body mass index (BMI)< 18.5 kg/m2 was defined as malnutrition, 24.0 kg/m2 ≤ BMI < 28.0 kg/m2 as overweight, and a BMI ≥ 28.0 kg/m2 as obese. Results A total of 445 patients were enrolled and 423 patients (95.1%) completed the NRS 2002. The prevalence of undernutrition and nutritional risk was 4.7% and 13.2%, respectively. Among 230 patients who were overweight/obese, the prevalence of nutritional risk was 6.1%. In total, 15 of the 56 patients (26.8%) with NRS 2002 scores ≥ 3 received nutritional support, and 14 patients (3.8%) with NRS 2002 scores < 3 also received nutritional support. The average PN: EN ratio was 1.6:1. Conclusion A certain proportion of elderly inpatients in the department of geriatrics were experiencing undernutrition or were at nutritional risk. The prevalence of nutritional risk did not increase significantly with age. The current application of nutritional therapy is inappropriate. Evidence-based guidelines are required to improve this situation. The NRS 2002 may not applicable for overweight/obese elderly inpatients.

NRS 2002在老年COPD合并吞咽障碍患者中的应用价值

目的应用营养风险筛查2002(nutritional risk screening 2002,NRS 2002)量表评估老年慢性阻塞性肺疾病(Chronic obstructive lung disease,COPD)合并吞咽障碍患者住院时的营养风险发生率,并探究NRS 2002在临床中的应用价值。方法选取2021年11月至2022年10月在云南省第三人民医院全科医学科收治的老年COPD合并吞咽障碍患者124例,根据评分结果将患者分为NRS≥3组(n=69例)和NRS<3组(n=55例)。比较2组的一般资料及营养相关生化指标(总蛋白、白蛋白和前白蛋白),并进行相关性分析。结果老年COPD合并吞咽障碍患者营养风险发生率为55.6%,存在营养风险的患者中80岁以上占84.0%(P<0.05),营养风险评分≥3分组的总蛋白、白蛋白、前白蛋白水平和BMI值均低于<3分组(P<0.05)。采用Spearman相关分析显示,营养风险评分与年龄、住院时间、住院费用呈正相关(P<0.05),与营养学相关指标(总蛋白、白蛋白、前白蛋白、BMI)水平呈负相关(P<0.05)。单因素方差分析结果显示,NRS 2002评分、总蛋白、白蛋白、BMI的均值在不同吞咽障碍等级的患者中,总体分布差异具有统计学意义(P<0.05),各组间前白蛋白水平差异均无统计学意义(P﹥0.05)。结论老年COPD合并吞咽障碍患者营养风险发生率高(55.6%),NRS 2002可作为老年COPD合并吞咽障碍患者的早期营养风险筛查,早期识别患者的营养风险,采取积极干预措施,预防老年COPD患者吞咽障碍的发生。

围手术期营养风险与髋部骨折患者静脉血栓栓塞症的关系

目的探讨围手术期营养风险与髋部骨折患者静脉血栓栓塞症(VTE)的关系。方法选取因摔伤或扭伤导致单侧髋部骨折择期行外科手术患者379例,根据围手术期是否发生VTE分为非VTE组(246例)和VTE组(133例),收集2组患者的基本信息、手术和麻醉记录、营养风险相关指标和炎症指标;采用多因素Logistic回归分析围手术期VTE的独立影响因素;受试者工作特征(ROC)曲线评估独立因素的鉴别能力,并用DeLong检验比较曲线下面积(AUC)。结果与非VTE组比较,VTE组年龄偏大,合并高血压、就诊时间>2 d、接受(空心/髓内钉)内固定手术、围手术期输血和美国麻醉医师协会(ASA)Ⅲ—Ⅳ级患者比例,入院时NRS(营养风险筛查表)-2002评分和术后中性粒细胞/淋巴细胞比值(NLR)更高;入院时和术后预后营养指数(PNI)、血红蛋白(Hb),入院时前白蛋白(PA)均低于非VTE组(P<0.01);多因素Logistic回归分析显示,患者行内固定术,入院时PNI降低,NRS-2002评分和PA升高,就诊时间>2 d,ASAⅢ—Ⅳ级是髋部骨折围手术期发生VTE的独立危险因素(P<0.05)。ROC曲线分析显示,入院时NRS-2002的AUC(95%CI)为0.739(0.692~0.783),入院时PNI的AUC(95%CI)为0.720(0.672~0.765),两者的预测价值优于其他影响因素(P<0.01)。结论髋部骨折患者入院时NRS-2002和PNI对围手术期VTE具有一定的预测价值。

基于营养风险筛查2002的全程营养管理方案对胃肠道恶性肿瘤患者营养状况及生活质量的影响

目的 探讨基于营养风险筛查2002(NRS2002)的全程营养管理方案对胃肠道恶性肿瘤患者营养状况及生活质量的影响。方法 2020年3月至2021年2月上海市第六人民医院临港院区收治的65例胃肠道恶性肿瘤患者为对照组,2021年6月至2022年5月上海市第六人民医院临港院区收治的65例胃肠道恶性肿瘤患者为干预组。对照组给予常规营养管理方案,干预组给予基于NRS2002的全程营养管理方案。采用NRS2002量表比较两组干预前后营养状况,比较两组血红蛋白(Hb)、白蛋白(ALB)水平及生活质量[生命质量测定量表(QLQ-C30)]。结果 干预后,两组NRS2002评分均低于干预前,且干预组低于对照组(P<0.05);两组Hb、ALB均高于干预前,且干预组高于对照组(P<0.05);两组QLQ-C30评分均高于干预前,且干预组高于对照组(P<0.05)。结论 基于NRS2002的全程营养管理方案可改善胃肠道恶性肿瘤患者营养状况,提高生活质量。

3种营养筛查工具在骨与软组织肿瘤患者营养不良风险评估中的临床价值

目的:调查骨与软组织肿瘤患者营养不良风险的发生情况,探索营养风险筛查2002(NRS2002)、通用筛查工具(MUST)、患者主观整体评估简表(PG-SGASF)等3种营养筛查工具在骨与软组织肿瘤患者营养不良风险评估中的临床价值。方法:对山西省肿瘤医院骨与软组织科2023年8月—2024年5月的所有入院成年患者进行问卷调查,调查内容包括:患者一般情况(年龄、性别、身高、体重);患者体重在近2周、1个月、2个月、3个月、6个月的变化情况;饮食改变情况以及影响饮食的原因等。整理完成NRS2002、MUST、PG-SGASF得分。结合患者临床资料疾病诊断、治疗情况进行统计分析。率的比较采用卡方检验,定量资料两组比较采用Mann-Whitney检验,多组比较采用Kruskal-WallisH检验,绘制韦恩图、ROC曲线。结果:合格问卷633份,男性327例、女性306例,平均年龄(54.41±14.35)岁。骨与软组织肿瘤患者营养不良风险在14%~22%之间,恶性肿瘤患者营养不良风险发生率更高。3种筛查结果绘制韦恩图显示,NRS2002与MUST一致性更高。以NRS2002为基础绘制ROC曲线(曲线下面积:MUST:0.9287,PG-SGASF:0.596)。结论:骨与软组织肿瘤患者营养不良风险发生率较其他类型肿瘤患者偏低,但恶性度越高营养不良风险越大。NRS2002有一定的漏诊情况,MUST简易且全面,PG-SGASF更适合用于评估。

579名医护人员对住院患者营养风险筛查认知的现况调查

目的调查并了解云南省医护人员对住院患者营养风险筛查的认知水平及培训需求,为探索适合本省的临床营养管理培训方案提供参考依据。方法采用方便抽样法,于2023年11月至12月使用自制问卷对云南省相关医护人员进行线上调查。结果共579名医护人员参与调查,其中医生267名(46.11%),护士291名(50.26%),其他医技人员21名(3.63%)。调查对象对住院患者营养风险筛查的关注度较高,但营养风险筛查2002(NRS 2002)量表的知晓率只有32.15%,并且49.07%的参与者仅对部分患者实施营养风险筛查。对于营养相关培训需求,369名(63.73%)医务人员表示“非常需要”,且更愿意接受持续性网络培训的方式。结论云南省医护人员营养风险筛查知识储备不足,培训需求迫切,下一步将基于临床需求,科学构建培训方案,以期促进临床营养风险筛查工作常规化、规范化。