Rocha Naruna Pereira, Fortes Renata Costa
Programa de Residência em Nutrição Clínica, Hospital Regional da Asa Norte, Secretaria de Estado de Saúde do Distrito Federal, Brasília, DC, Brazil.
Arq Bras Cir Dig. 2015 Jul-Sep;28(3):193-6. doi: 10.1590/S0102-67202015000300012.
Early detection of changes in nutritional status is important for a better approach to the surgical patient. There are several nutritional measures in clinical practice, but there is not a complete method for determining the nutritional status, so, health professionals should only choose the best method to use.
To evaluate the total lymphocyte count and albumin as predictors of identification of nutritional risk in surgical patients.
Prospective longitudinal study was conducted with 69 patients undergoing surgery of the gastrointestinal tract. The assessment of nutritional status was evaluated by objective methods (anthropometry and biochemical tests) and subjective methods (subjective global assessment).
All parameters used in the nutritional assessment detected a high prevalence of malnutrition, with the exception of BMI which detected only 7.2% (n=5). The albumin (p=0.01), the total lymphocytes count (p=0.02), the percentage of adequacy of skinfolds (p<0.002) and the subjective global assessment (p<0.001) proved to be useful as predictors of risk of postoperative complications, since the smaller the values of albumin and lymphocyte count and higher the score the subjective global assessment were higher risks of surgical complications.
A high prevalence of malnutrition was found, except for BMI. The use of albumin and total lymphocyte count were good predictor for the risk of postoperative complications and when used with other methods of assessing the nutritional status, such as the subjective global assessment and the percentage of adequacy of skinfolds, can be useful for identification of nutritional risk and postoperative complications.
早期发现营养状况变化对于更好地治疗外科患者很重要。临床实践中有多种营养评估方法，但尚无完整的营养状况评估方法，因此，医疗专业人员应仅选择最佳方法使用。
评估外周血淋巴细胞总数和白蛋白作为外科患者营养风险识别指标的价值。
对69例接受胃肠道手术的患者进行前瞻性纵向研究。通过客观方法（人体测量和生化检测）和主观方法（主观全面评定法）评估营养状况。
除BMI仅检测出7.2%（n = 5）的营养不良外，营养评估中使用的所有参数均检测出高比例的营养不良。白蛋白（p = 0.01）、外周血淋巴细胞总数（p = 0.02）、皮褶厚度充足率（p < 0.002）和主观全面评定法（p < 0.001）被证明可作为术后并发症风险的预测指标，因为白蛋白和淋巴细胞计数的值越小，主观全面评定法的评分越高，手术并发症风险就越高。
除BMI外，发现营养不良的比例较高。白蛋白和外周血淋巴细胞总数是术后并发症风险的良好预测指标，与其他营养状况评估方法（如主观全面评定法和皮褶厚度充足率）一起使用时，可用于识别营养风险和术后并发症。
