CAJ | 학술논문

目的了解普外择期手术住院病人是否存在营养不良,判断营养不良的类型和程度,制定治疗方案,监测治疗效果,对病人预后进行判定.方法普外科15个月内收治1002例择期手术住院病人.男430例,女572例,最大年龄89岁,最小年龄15岁.消化道内疾病411例(良性疾病181例,恶性疾病230例),消化道外疾病591例(良性疾病506例,恶性疾病85例).入院后三天内对有所有患者多项营养指标进行检测.1.人体测量:WT/HT(与理想体重比)、TSF(上臂皮褶厚度)、MAC(上臂周径)、AMC(上臂肌围)、GS(握力).2.实验室检查:Hb(血红蛋白),Alb(血浆白蛋白),Tf(转铁蛋白),CHI(尿肌酐身高指数),Tlc(淋巴细胞总数).3.生物电阻抗测体脂.人体测量及24小时尿标本收集均由专人负责,实验室检查由本院检验科承担.评定营养不良程度采用多数学者应用的标准.体脂测定用北京军区军事医学研究所研制的"人体脂肪分析仪",并按国人不同年龄体脂(%)建议值进行评定.结果各营养指标异常的发生率为:WT/HT18.1%(181/1002)、TSF25.8%(259/1002)、AMC22.2%(222/1002)、GS65.5%(674/989),Hb51.2%(410/801)、Alb6.1(51/837)、Tf24.9%(87/349)、CHI47.6%(255/536)、TIC23.7%(203/855),Fat63.6%(269/455).其中1～2项指标异常者占42.3%,3～5项异常者占41.3%,6～8项异常者占11.4%.凡有Alb低下者87%合并其他3～7项指标异常.结论外科住院病人中营养不良发生率很高,因而对外科医生来说术前病人营养不良状况是一个不可忽视的问题.从目前研究看尚无一个或一组检查能较敏感且特异地诊断营养不良,多数学者强调多指标联合应用,综合评价.用生物电阻抗法测定人体组成是近年来应用于临床的一种新方法,其原理是利用脂肪组织和非脂肪组织对电流导电性的差异而推测体脂含量,是一种简单、快捷、安全、经济和无创伤的测量方法.
목적료해보외택기수술주원병인시부존재영양불량,판단영양불량적류형화정도,제정치료방안,감측치료효과,대병인예후진행판정.방법보외과15개월내수치1002례택기수술주원병인.남430례,녀572례,최대년령89세,최소년령15세.소화도내질병411례(량성질병181례,악성질병230례),소화도외질병591례(량성질병506례,악성질병85례).입원후삼천내대유소유환자다항영양지표진행검측.1.인체측량:WT/HT(여이상체중비)、TSF(상비피습후도)、MAC(상비주경)、AMC(상비기위)、GS(악력).2.실험실검사:Hb(혈홍단백),Alb(혈장백단백),Tf(전철단백),CHI(뇨기항신고지수),Tlc(림파세포총수).3.생물전조항측체지.인체측량급24소시뇨표본수집균유전인부책,실험실검사유본원검험과승담.평정영양불량정도채용다수학자응용적표준.체지측정용북경군구군사의학연구소연제적"인체지방분석의",병안국인불동년령체지(%)건의치진행평정.결과각영양지표이상적발생솔위:WT/HT18.1%(181/1002)、TSF25.8%(259/1002)、AMC22.2%(222/1002)、GS65.5%(674/989),Hb51.2%(410/801)、Alb6.1(51/837)、Tf24.9%(87/349)、CHI47.6%(255/536)、TIC23.7%(203/855),Fat63.6%(269/455).기중1～2항지표이상자점42.3%,3～5항이상자점41.3%,6～8항이상자점11.4%.범유Alb저하자87%합병기타3～7항지표이상.결론외과주원병인중영양불량발생솔흔고,인이대외과의생래설술전병인영양불량상황시일개불가홀시적문제.종목전연구간상무일개혹일조검사능교민감차특이지진단영양불량,다수학자강조다지표연합응용,종합평개.용생물전조항법측정인체조성시근년래응용우림상적일충신방법,기원리시이용지방조직화비지방조직대전류도전성적차이이추측체지함량,시일충간단、쾌첩、안전、경제화무창상적측량방법.
Objective Appraisal of nutrition status of patients has been recognized to be important. The objective of nutrition assessment is to understand whether the patients are malnutritioned and to evaluate the type and degree of malnutrition for therapy plan, evalnating therapy effects and the prognosis. Methods We treated 1 002 (430 M, 572 F) selected operative cases (aged 15 to 89) within 15 months in general surgical dept of our hospital. Of 1002 eases, 411 have digestive tract disease (benign 181, malignant 230) and 591 have nondigestive tract disease (benign 506, malignant 85). Several nutrition indexes are examined in all patients in three days after hospitalization. Above mentioned indexes included: 1, Anthropometry: WT/HT, TSF, MAC, AMC and GS. 2. laboratory examnation: Hb, Alb, Tf, CHI and TLC. 3. Body fat measurement with bioetectricity impedance method. A special person was responsible for the anthropometry and the collection of 24 hours urine samples. Clinical laboratory of our hospital undertaked the laboratory examination. In assessing the degree of malnutrition, we adopted the criteria that the majority of scholars applied. Measuring body fat was performed using "Body Fat Analysis Appliance" made by Institution of Military Medicine of BeiJing Military Area and its nutrition effect was appraised according to suggested criterion for body fat ( % ) of different aged chinese. Results The incidence of abnormal nutrition indexes: WT/HT ( 18.1% ), TSF ( 25.8% ), AMC ( 22.2 %), GS ( 65.5% ), Hb (51.2), Alb (6.1% ) TG (24.9% ), CHI (47.6% ), TLC (23.7% ), Fat (63.6% ). Among these patients, 42.3 % had 1～2 abnormal parameters, 41.3% and 3～5 abnormal and 11.4 %, 6～8 abnormal. Of all patients with lower Alb, 44 cases ( 81% ) were accompanied with other 3～7 abnormal parameters. Both these results demonstrated that the incidence of malnutrition of surgery inpatients is very high. It' s very important for surgeons to evaluate nutrition status of paitnets before surgery. From present research, no one or a group of examination can diagnose malnutrition perceptively and distinctively. Most of scholars emphasized multiple parameters combination and synthetic assessment. Component of human body is measured by biolelectricity impedance technique, which is a new method applied to clinic in recent years. It's mechanism is to utilize the difference of conductibility between fat tissue and nonfat tissue for evaluating body fat content. Conclusions It's a noninvasive detecting method, simple, quick, safe and economical. It is also favourable for scholars and has widely applied prospect.