【摘要】 目的通过对比微型营养评估表(MNA)、住院患者营养风险筛查表(NRS2002)及实验室营养评分对于老年心血管内科住院患者营养状况评估,研究营养不良影响因素,观察其对临床预后的影响。方法选取2016年1月至2018年1月住院的老年患者485例。对入选患者于入院72 h内完成NRS2002营养风险筛查、MNA问卷、患者基本资料及临床检查资料的调查。结果对患者均进行实验室检查、MNA、NRS 2002量表评分方法,营养异常检出率分别为(48.7%vs 44.3%vs 34.0%)。MNA量表检查与实验室指标检查一致率为81.2%,Kappa值为0.62;NRS 2002量表检查与实验室指标检查一致率为62.3%,Kappa值为0.25。应用MNA量表比较:60～69岁组、70～79岁组及≥80岁组患者发生营养异常比例分别27.5%、35.6%和56.6%(P<0.001);不同性别之间以及是否吸烟之间营养异常发生率差异无统计学意义(P>0.05)。BMI越小、饮酒者以及有相关个人疾病史者营养异常发生率明显升高(P<0.001)。使用MNA量表评分将入选的患者分为营养正常、潜在营养不良和营养不良3组。3组患者的白蛋白水平和血红蛋白水平差异均有统计学意义(P<0.05),3组患者的上臂中点周径、非利手握力和小腿最大周径差异均有统计学意义(P<0.05)。3组患者的肱三头肌皮摺厚度以及上臂肌肉周径之间差异无统计学意义(P=0.073)。结论 MNA量表与实验室指标判定营养不良的发生率相似,且一致性较好,优于NRS2002量表。老年心血管内科住院患者的营养异常发生率受到年龄、BMI、饮酒史和个人疾病史的影响。上臂中点周径、非利手握力和小腿最大周径可以用来评判不同营养状态。更多还原

【Abstract】 Objective To evaluate the nutriture status of elderly inpatients with cardiovascular diseases by means of mini nutritional assessment(MNA),inpatients nutritional risk screening scale(NRS2002) and the laboratory nutrition scores, and to investigate the influence factors of malnutrition, and to observe its effects on the prognosis of patients.Methods A total of 485 elderly patients who were admitted and treated in our hospital from January 2016 to January 2018 were enrolled in the study. The nutritional risk screening(NRS2002),MNA questionnaire, the survey of basic data and clinical examination data in these patients were completed within 72 hours after admission.Results All the patients underwent laboratory examination, MNA,NRS2002 scale evaluation. The results showed that the heterotrophia detction rates among the three methods were 48.7%,44.3%,34.0%,respectively. Moreover the examination concordance rate between the MNA scale and the laboratory index was 81.2%,with the kappa value being 0.62. The examination concordance rate between the NRS 2002 scale and the laboratory index was 62.3%,with the kappa value being 0.25. The propotion of patients heterotrophia among the 60～69 years old group, the 70～79 years old group and more than 80 years old group was 27.5%,35.6%,56.6%,respectively by comparing them with MNA rating scales(P<0.01). However there were no significantly statistical differences in the occurrence rate of heterotrophia between male and female patients or the patients with and without smoking(P>0.05). The smaller BMI of patients, alcohol user and the patients with basic diseases had higher incidence rate of heterotrophia(P<0.01). All the patients were divided into the normal nutrition group, potential malnutrition group and malnutrition group according to the MNA scale evaluation. There were significant differences in the levels of albumin and hemoglobin among the three groups(P<0.05). In addition there were significant differences in the cross-section diameter of the midpoint of the upper arm, the power of gripping of no handedness and the maximum circumference of calf(P<0.05). However there were no significant differences in the skinfold thickness of triceps muscle of arm and the upper arm muscle circumference among the three groups(P>0.05).Conclusion The incidence rate of malnutrition evaluated by MNA scale is similar to that by laboratory indexes, with better consistency, which are superior to the NRS2002 scale.And the incidence rate of nutritional abnormalities in elderly hospitalized patients with cardiovascular disease is influenced by age, BMI,drinking history, and individual diseases history. The midpoint cross-section diameter of the upper arm, non dominant hand grip strength and the maximum circumference of the lower leg can be used to the evaluate different nutritional status.更多还原