住院天数≥14天患者营养风险筛查和营养支持现况调查

摘要

目的:调查住院天数≥14d的336例患者的营养风险发生率以及营养支持的应用情况,观察营养支持方式与住院天数之间的关系.方法:患者入院后第2d采用NRS2002进行营养风险筛查(除体重指数采用中国标准外,其余与NRS2002方法一致),并于出院时调查患者住院期间的营养支持应用情况.结果:336例住院天数≥14天的患者中完成NRS2002筛查的患者325例,NRS2002适用率为96.73％.存在营养风险(NRS ≥3分)患者117例,营养风险的发生率为36.00％.手术科室营养风险发生率为37.36％,非手术科室营养风险发生率为34.27％,不存在差异(x2 =0.333,P=0.564).其中70.94％的患者得到了营养支持,手术科室的营养支持率(79.41％)高于非手术科室(59.18％),支持率的差异有统计学意义(x2=5.653,P=0.017).营养支持多延后于营养风险筛查后3—4d.手术科室患者入院后7d内营养支持以全肠外营养为主,占62％,14d时肠外营养(全肠外、肠外肠内并用)仍占63％.非手术科室7d内的肠外营养(全肠外、肠外肠内并用)支持率79％,14d时以肠内营养为主,占71％.手术科室的平均住院天数多于非手术科室(F =3.991,p=0.001).结论:住院天数≥14d患者存在营养风险比例较高,肠外营养的过度使用情况比较严重,应推广和应用基于证据支持的营养指南来改善此情况.%[Objective] To investigate the incidence of nutritional risk and the application of nutritional support among 336 patients in China-Japan Friendship Hospital with 14d or more in hospital.[Method] NRS2002 was applied in the nutritional risks screening among patients 2 d after living in the hospital (except BMI by Chinese standards),and nutritional support of patients during hospitalization was observed.[Result] Totally 325 cases completed NRS2002 screening,and the applicable rate was 96.73％.117 Patients had nutritional risk (NRS≥3),and the incidence rate of nutritional risk was 36.00％.The nutritional risk rate of surgical departments was 37.36％,and incidence rate of non-surgical departments nutritional risk was 34.27％,and there was no difference (x2 =0.333,P =0.564).70.94％ of the patients received nutritional support.The rate of nutrition support in surgical departments (79.41％) was higher than that in non-surgical departments (59.18％),and the difference was statistically significant (x2 =5.653,P =0.017).Nutrition support delayed 3 or 4 d after nutritional risk screening.Nutritional support in surgical departments was given with total parenteral nutrition,which accounted for 62％ within 7 d after admission in hospital,63％ within 14 d parenteral nutrition (TPN,PN and EN).Non-surgical departments within 7 d of parenteral nutrition (TPN,PN and EN) accounted for 79％,14 d is given priority with enteral nutrition,accounted for 71％.The average hospital days for surgical departments were more than non-surgical departments (F =3.991,P =0.001).[Conclusion] Patients whose hospitalization was 14 d and more had high nutritional risk ratio,the overuse of parenteral nutrition was serious,and nutrition guidelines based on the evidence should be promoted and applied to improve the situation.