中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2014年
1期
28-33
,共6页
张晓芹%王杨%王红%李佳艺%于康%张小田%蒋朱明
張曉芹%王楊%王紅%李佳藝%于康%張小田%蔣硃明
장효근%왕양%왕홍%리가예%우강%장소전%장주명
非终末期晚期肿瘤%营养风险筛查2002%营养风险%营养不足%营养支持%电子数据采集系统
非終末期晚期腫瘤%營養風險篩查2002%營養風險%營養不足%營養支持%電子數據採集繫統
비종말기만기종류%영양풍험사사2002%영양풍험%영양불족%영양지지%전자수거채집계통
Later but non-end stage cancer patients%Nutritional Risk Screening 2002%Nutritional risk%Undernntrition%Nutritional support%Electronic data collection system
目的 前瞻性调查北京某二甲医院肿瘤内科非终末期晚期住院患者的营养风险、营养不足发生情况及营养支持应用现状,为今后营养支持改善临床结局研究奠定基础.方法 采用连续抽样方法对2011年10月至2013年4月北京某二甲医院肿瘤内科入院患者展开调查.对符合入选标准的患者,于入院次日采用营养风险筛查2002 (NRS2002)进行营养风险筛查和营养不足评估,并记录患者住院期间的营养支持情况.对没有营养风险患者每周重复筛查.出院后根据患者的临床及病理资料,将其分为早、中期(Ⅰ、Ⅱ、Ⅲa期)、非终末期晚期(Ⅲb、Ⅳ期)及终末期(预计生存期短于3个月)3组.本研究仅对非终末期晚期肿瘤患者的营养风险、营养不足发生率及营养支持应用情况进行统计学分析,所有数据进入EDC系统并经核查无误.结果 调查期间人院患者305例,排除不符合标准的患者后,共224例患者接受了营养风险筛查.其中,对非终末期晚期患者171例进行统计分析,结果营养风险发生率为67.8％ (116/171),不同肿瘤类型患者营养风险发生率依次为肺癌45.7％ (21/46),消化道肿瘤89.4％ (42/47),肝、胆、胰腺肿瘤81.3％ (26/32),头颈部肿瘤83.3％ (5/6).以体质量指数(BMI) ＜18.5 kg/m2计算营养不足发生率为12.3％ (21/171)；以NRS2002营养受损部分评分达到3分汁算营养不足的发生率为19.9％ (34/171).有营养风险的116例患者中,71例接受了营养支持,占61.2％；肠外与肠内营养的应用例数比为68∶3 (23∶1)；能量摄入为(56.78±8.20) kJ/(kg·d),氮摄入为(0.06±0.01) g/(kg·d).55例无营养风险患者中,5例接受了营养支持(9.1％).结论 非终末期晚期肿瘤患者营养风险、营养不足的发生率较高,且与肿瘤类型相关.非终末期晚期肿瘤患者的营养支持亦存在不合理之处,以有营养风险患者的营养支持率偏低为主.对于有营养风险的患者,营养支持能否改善其临床结局,是今后需要进行研究的课题.
目的 前瞻性調查北京某二甲醫院腫瘤內科非終末期晚期住院患者的營養風險、營養不足髮生情況及營養支持應用現狀,為今後營養支持改善臨床結跼研究奠定基礎.方法 採用連續抽樣方法對2011年10月至2013年4月北京某二甲醫院腫瘤內科入院患者展開調查.對符閤入選標準的患者,于入院次日採用營養風險篩查2002 (NRS2002)進行營養風險篩查和營養不足評估,併記錄患者住院期間的營養支持情況.對沒有營養風險患者每週重複篩查.齣院後根據患者的臨床及病理資料,將其分為早、中期(Ⅰ、Ⅱ、Ⅲa期)、非終末期晚期(Ⅲb、Ⅳ期)及終末期(預計生存期短于3箇月)3組.本研究僅對非終末期晚期腫瘤患者的營養風險、營養不足髮生率及營養支持應用情況進行統計學分析,所有數據進入EDC繫統併經覈查無誤.結果 調查期間人院患者305例,排除不符閤標準的患者後,共224例患者接受瞭營養風險篩查.其中,對非終末期晚期患者171例進行統計分析,結果營養風險髮生率為67.8％ (116/171),不同腫瘤類型患者營養風險髮生率依次為肺癌45.7％ (21/46),消化道腫瘤89.4％ (42/47),肝、膽、胰腺腫瘤81.3％ (26/32),頭頸部腫瘤83.3％ (5/6).以體質量指數(BMI) ＜18.5 kg/m2計算營養不足髮生率為12.3％ (21/171)；以NRS2002營養受損部分評分達到3分汁算營養不足的髮生率為19.9％ (34/171).有營養風險的116例患者中,71例接受瞭營養支持,佔61.2％；腸外與腸內營養的應用例數比為68∶3 (23∶1)；能量攝入為(56.78±8.20) kJ/(kg·d),氮攝入為(0.06±0.01) g/(kg·d).55例無營養風險患者中,5例接受瞭營養支持(9.1％).結論 非終末期晚期腫瘤患者營養風險、營養不足的髮生率較高,且與腫瘤類型相關.非終末期晚期腫瘤患者的營養支持亦存在不閤理之處,以有營養風險患者的營養支持率偏低為主.對于有營養風險的患者,營養支持能否改善其臨床結跼,是今後需要進行研究的課題.
목적 전첨성조사북경모이갑의원종류내과비종말기만기주원환자적영양풍험、영양불족발생정황급영양지지응용현상,위금후영양지지개선림상결국연구전정기출.방법 채용련속추양방법대2011년10월지2013년4월북경모이갑의원종류내과입원환자전개조사.대부합입선표준적환자,우입원차일채용영양풍험사사2002 (NRS2002)진행영양풍험사사화영양불족평고,병기록환자주원기간적영양지지정황.대몰유영양풍험환자매주중복사사.출원후근거환자적림상급병리자료,장기분위조、중기(Ⅰ、Ⅱ、Ⅲa기)、비종말기만기(Ⅲb、Ⅳ기)급종말기(예계생존기단우3개월)3조.본연구부대비종말기만기종류환자적영양풍험、영양불족발생솔급영양지지응용정황진행통계학분석,소유수거진입EDC계통병경핵사무오.결과 조사기간인원환자305례,배제불부합표준적환자후,공224례환자접수료영양풍험사사.기중,대비종말기만기환자171례진행통계분석,결과영양풍험발생솔위67.8％ (116/171),불동종류류형환자영양풍험발생솔의차위폐암45.7％ (21/46),소화도종류89.4％ (42/47),간、담、이선종류81.3％ (26/32),두경부종류83.3％ (5/6).이체질량지수(BMI) ＜18.5 kg/m2계산영양불족발생솔위12.3％ (21/171)；이NRS2002영양수손부분평분체도3분즙산영양불족적발생솔위19.9％ (34/171).유영양풍험적116례환자중,71례접수료영양지지,점61.2％；장외여장내영양적응용례수비위68∶3 (23∶1)；능량섭입위(56.78±8.20) kJ/(kg·d),담섭입위(0.06±0.01) g/(kg·d).55례무영양풍험환자중,5례접수료영양지지(9.1％).결론 비종말기만기종류환자영양풍험、영양불족적발생솔교고,차여종류류형상관.비종말기만기종류환자적영양지지역존재불합리지처,이유영양풍험환자적영양지지솔편저위주.대우유영양풍험적환자,영양지지능부개선기림상결국,시금후수요진행연구적과제.
Objective To investigate prospectively the nutritional risks,undernutrition,and nutritional support in hospitalized patients with later but non-end-stage malignancies in a second grade hospital in Beijing.Methods All patients who were admitted in the department of oncology in this hospital from October 2011 to April 2013 were consecutively recorded.Nutritional Risk Screening (NRS 2002) was used for screening nutrition risks,the undernutrition assessment was performed on the first morning for patients meet the inclusion criteria,and nutritional support was evaluated until the discharge.For patients with no nutritional risk,NRS 2002 was repeated weekly during the hospitalization.Results A total of 305 cases of inpatients admitted,and 224cases meeting the inclusion criteria were screened by NRS 2002,among whom only 171 patients with non-endstage later stage cancer entered the final analysis.Among these 171 patients,116 (67.8％) were at nutritional risks.Furthermore,for different types of tumor,the nutritional risk was 45.7％ for lung cancer,89.4％ for digestive-tract cancers,81.3％ for liver-biliary and pancreatic cancers,and 83.3％ for head-and-neck cancers.The undernutrition rate was 12.3％ (21/171) if based on body mass index ＜ 18.5 kg/m2 and 19.9％ (34/171) if evaluated from the score of nutritional defect part of NRS 2002.Only 71 patients (61.2％) at nutritional risk received nutritional support,while 5 of 55 patients (9.1％) without nutritional risk received nutritional support.The average ratio of parenteral nutrition to enteral nutrition was 23∶ 1.Intravenous calories intake was 56.78 ± 8.20 k J/ (kg · d) ; the intake of nitrogen was 0.06 ± 0.01 g/ (kg · d),and the ratio of calories to nitrogen was 204∶ 1.Conclusions A large proportion of inpatients with non-end-stage later cancer were at nutritional risk,which is associated with tumor types.The application of nutritional support should be further standardized,particularly for patients at nutritional risk but with low nutritional support.Furthermore,whether the clinical outcome of inpatients at nutritional risk may be improved by nutritional support still requires further investigation.
