Porbén Sergio Santana
The Cuban Group for the Study of Hospital Malnutrition, Habana, Cuba.
Clin Nutr. 2006 Dec;25(6):1015-29. doi: 10.1016/j.clnu.2006.04.001. Epub 2006 Jun 9.
Current nutritional care provision to 1905 patients hospitalized in 12 Cuban hospitals is presented in this article, diagnosed after conducting the Hospital Nutrition Survey (HNS), as part of the activities comprising the Cuban Study of Hospital Malnutrition (Elan-Cuba). The obtained HNS results were contrasted with standards regarding the nutritional assessment of hospitalized patient, the diagnosis of nutritional disorders occurring in the patient, and the identification of patients in need of nutritional intervention. The Elan-Cuba Study returned a 41.2% malnutrition rate [Barreto Penié J, Cuban Group for the Study of Hospital Malnutrition. State of malnutrition in Cuban hospitals. Nutrition 2005;21:487-97]. However, malnutrition was recorded as an independent diagnosis in only 0.4% of the surveyed clinical charts. It could not be shown that medical care teams were systematically applying any of the techniques and procedures recommended for the assessment of the nutritional status of hospitalized patients. In the best of the cases, only 40.6% of the surveyed patients had their height and weight recorded in their clinical charts at admission, 9.0% of those with more than 15 days of hospitalization had a prospective value of weight, and less than 20.0% of them had their serum albumin levels and/or their counts of Lymphocytes annotated on their clinical charts. Although 10.9% of the surveyed patients (median of the subcategories values; range: 3.5-41.2%) fulfilled an indication for nutritional intervention, support (enteral and/or parenteral) was only provided to less than 15.0% of them, with the exception made of patients on NPO, of whom 32.3% received either of the two modes of artificial nutrition listed above. It is to be noticed that none of the patients with chronic organic failure were on nutritional support at the time of the survey. The current nutritional care provision to the hospitalized patient might explain the increased rates of hospital malnutrition documented in the Elan-Cuba Study, and should lead to the design and urgent implementation of nutritional and metabolic intervention programs in the surveyed hospitals, given the deleterious effects of nutritional disorders upon the ultimate results of the medical and surgical actions, and the quality and costs of medical care.
本文介绍了对古巴12家医院收治的1905例住院患者目前的营养护理情况。这些患者是在开展医院营养调查（HNS）后确诊的，该调查是古巴医院营养不良研究（Elan-Cuba）相关活动的一部分。将获得的HNS结果与住院患者营养评估、患者发生的营养障碍诊断以及需要营养干预患者识别的相关标准进行了对比。Elan-Cuba研究得出的营养不良率为41.2%[巴雷托·佩涅J，古巴医院营养不良研究小组。古巴医院的营养不良状况。《营养》2005年；21：487 - 97]。然而，在仅0.4%的被调查临床病历中，营养不良被记录为独立诊断。无法证明医疗团队系统地应用了任何推荐用于评估住院患者营养状况的技术和程序。在最佳情况下，仅40.6%的被调查患者在入院时其临床病历中有身高和体重记录，住院超过15天的患者中9.0%有体重的预期值，且其中不到20.0%的患者临床病历中标注了血清白蛋白水平和/或淋巴细胞计数。尽管10.9%的被调查患者（各亚类值的中位数；范围：3.5 - 41.2%）符合营养干预指征，但仅不到15.0%的患者得到了支持（肠内和/或肠外），禁食患者除外，其中32.3%接受了上述两种人工营养方式中的一种。需要注意的是，在调查时，没有一名慢性器官功能衰竭患者接受营养支持。目前对住院患者的营养护理情况可能解释了Elan-Cuba研究中记录的医院营养不良率上升的情况，鉴于营养障碍对医疗和外科手术最终结果以及医疗质量和成本的有害影响，应促使在所调查的医院设计并紧急实施营养和代谢干预计划。
