上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 1: 16 - 20

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.01.003

临床护理专题

改良危重症营养风险评分在老年危重症患者中的应用

  • 陆雪梅 ,
  • 陈兰
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  • 1.上海交通大学护理学院，上海 200025
    2.上海交通大学附属第一人民医院护理部，上海 200080
陆雪梅（1996—），女，硕士生；电子信箱：lxm18681618623@sjtu.edu.cn。
陈兰，电子信箱：13636317690@126.com。

收稿日期: 2021-06-21

  网络出版日期: 2022-01-28

基金资助

上海市卫生健康委员会项目(201940074)

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Application of modified Nutrition Risk in the Critically Ill score to critically ill elderly patients

  • Xuemei LU ,
  • Lan CHEN
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  • 1.School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
    2.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
CHEN Lan, E-mail: 13636317690@126.com.

Received date: 2021-06-21

  Online published: 2022-01-28

Supported by

Program of Shanghai Municipal Health Commission(201940074)

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摘要

目的·验证改良危重症营养风险（modified Nutrition Risk in the Critically Ill，mNUTRIC）评分在老年危重症患者营养风险评估及预测其临床预后中的作用。方法·使用mNUTRIC评分评估2020年10月—2021年2月入住上海交通大学附属第一人民医院综合重症监护室（intensive care unit，ICU）的老年患者，根据评估结果将患者分为高营养风险组和低营养风险组。对2组患者进行观察记录至转科、出院或死亡，分析不同营养风险患者的营养支持情况（包括营养支持方式、支持开始时间及能量供给达标情况），比较不同营养风险患者的ICU停留时间、机械通气时间和28 d病死率。结果·老年危重症患者中，高营养风险者占51.8%。2组患者的营养支持方式差异无统计学意义。低营养风险组的能量达标率为73.3%，高营养风险组的能量达标率为58.8%，差异无统计学意义。低营养风险组能量达标所用时间为5.00（1.00，8.00）d，高营养风险组能量达标所用时间为9.00（3.00，12.50）d，差异无统计学意义。高营养风险组的机械通气时间为5.00（1.50，12.50）d，长于低营养风险组（P=0.018）；高营养风险组28 d病死率47.7%，高于低营养风险组（P=0.001）。2组患者的ICU停留时间差异无统计学意义。结论·在老年危重症患者中可以使用mNUTRIC评分来进行营养风险的评估，评估结果可用于预测老年危重症患者的临床预后。建议根据评估结果对于不同营养风险的老年危重症患者进行临床分层营养管理，通过个性化的营养支持方案等方式，使得老年危重症患者从营养支持中获益，并可能改善患者的临床预后。

关键词： 重症监护; 老年人; 营养评价; 预后; 营养支持

本文引用格式

陆雪梅 , 陈兰 . 改良危重症营养风险评分在老年危重症患者中的应用[J]. 上海交通大学学报（医学版）, 2022 , 42(1) : 16 -20 . DOI: 10.3969/j.issn.1674-8115.2022.01.003

Abstract

Objective

·To validate the role of the modified Nutrition Risk in the Critically Ill (mNUTRIC) score in the assessment of nutritional risk and clinical prognosis in critically ill elderly patients.

Methods

·A prospective observational study was carried out. The mNUTRIC score was employed to assess the nutritional risk of elderly patients who were admitted into the intensive care unit (ICU) of Shanghai General Hospital, Shanghai Jiao Tong University between October 2020 and February 2021. Patients were divided into high nutritional risk group and low nutritional risk group based on the mNUTRIC score results. The observational end-points were transferred, discharged or death. Different nutrition risk patients' nutritional support were analyzed, including nutritional support methods, the time period before nutritional support, and energy supply conditions. The length of ICU stay, days with mechanical ventilation, and 28-day mortality of different nutrition risk patients were compared.

Results

·Among critically ill elderly patients, 51.8% were at high nutritional risk. The energy compliance rate of the low nutritional risk group was 73.3%, and that of the high nutritional risk group was 58.8%. It took 5.00 (1.00, 8.00) d for the low nutritional risk group and 9.00 (3.00, 12.50) d for the high nutritional risk group to reach the energy standard. There was no statistical difference in the nutritional support methods, the time period before nutritional support, and energy supply conditions between the two groups. The mechanical ventilation time of the high nutritional risk group was 5.00 (1.50, 12.50) d, longer than that of the low nutritional risk group (P=0.018). The 28-day mortality rate of the high nutritional risk group was 47.7%, higher than that of the low nutritional risk group (P=0.001). There was no statistical difference in ICU stay between the two groups.

Conclusion

·mNUTRIC score can be used to evaluate nutritional risk and predict the clinical prognosis of critically ill elderly patients. It is suggested that stratified clinical nutrition management should be carried out for the critically ill elderly patients with different nutritional risks. Critically ill elderly patients can benefit from personalized nutritional support programs, and the clinical prognosis of patients may be improved.

Key words： critical care; aged; nutrition assessment; prognosis; nutritional support

参考文献

1 VRANE?I? B D, KRZNARI? ?. Nutritional issues and considerations in the elderly: an update[J]. Croat Med J, 2020, 61(2): 180-183.
2 CHEN S, CUI Y, DING Y P, et al. Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study[J]. BMC Geriatr, 2020, 20(1): 352.
3 KIMURA A, SUGIMOTO T, KITAMORI K, et al. Malnutrition is associated with behavioral and psychiatric symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease[J]. Nutrients, 2019, 11(8): 1951.
4 SHPATA V, OHRI I, NURKA T, et al. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients[J]. Clin Interv Aging, 2015, 10: 481-486.
5 TRIPATHY S, MISHRA J C. Assessing nutrition in the critically ill elderly patient: a comparison of two screening tools[J]. Indian J Crit Care Med, 2015, 19(9): 518-522.
6 ZHU M, WEI J, CHEN W, et al. Nutritional risk and nutritional status at admission and discharge among Chinese hospitalized patients: a prospective, nationwide, multicenter study[J]. J Am Coll Nutr, 2017, 36(5): 357-363.
7 HEYLAND D K, DHALIWAL R, JIANG X, et al. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool[J]. Crit Care, 2011, 15(6): R268.
8 RAHMAN A, HASAN R M, AGARWALA R, et al. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool[J]. Clin Nutr, 2016, 35(1): 158-162.
9 JEONG D, HONG S B, LIM C M, et al. Comparison of accuracy of NUTRIC and modified NUTRIC scores in predicting 28-day mortality in patients with sepsis: a single center retrospective study[J]. Nutrients, 2018, 10(7): 911.
10 林靖, 阿斯楞, 王婧超, 等. Nutric评分与改良nutric评分在成人重症患者营养评估中的应用进展[J]. 临床和实验医学杂志, 2020, 19(15): 1674-1676.
11 SINGER P, BLASER A R, BERGER M M, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1): 48-79.
12 LEE Z Y, HEYLAND D K. Determination of nutrition risk and status in critically ill patients: what are our considerations? [J]. Nutr Clin Pract, 2019, 34(1): 96-111.
13 FELDBLUM I, GERMAN L, CASTEL H, et al. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status[J]. Nutr J, 2007, 6: 37.
14 VOLKERT D, BECK A M, CEDERHOLM T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics[J]. Clin Nutr, 2019, 38(1): 10-47.
15 REIS A M D, FRUCTHENICHT A V G, MOREIRA L F. NUTRIC score use around the world: a systematic review[J]. Rev Bras Ter Intensiva, 2019, 31(3): 379-385.
16 何多奇, 张西强, 云慧斌, 等. 谷氨酰胺强化鼻空肠管营养对老年重症颅脑损伤患者肠黏膜屏障及免疫功能的影响[J]. 上海交通大学学报(医学版), 2015, 35(5): 785-788.
17 刘骅, 凌伟, 曹晖. 免疫强化肠内与肠外营养对老年胃癌患者全胃切除术后营养和免疫功能的影响[J]. 上海交通大学学报(医学版), 2011, 31(7): 1000-1004.
18 刘彩云, 杜红娣, 李薇, 等. 基于临床护理路径的营养支持对阿尔茨海默病老年住院患者营养状况和生活质量的影响[J]. 中华临床营养杂志, 2019, 27(5): 287-292.
19 卢少萍, 徐永能, 任晓晓, 等. 延续性营养护理服务对改善老年卧床患者营养状况的效果[J]. 中国护理管理, 2018, 18(12): 1678-1681.
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