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术后护理单元中营养评估工具的发病率和死亡率预测性

Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

作者信息

Özbilgin Şule, Hancı Volkan, Ömür Dilek, Özbilgin Mücahit, Tosun Mine, Yurtlu Serhan, Küçükgüçlü Semih, Arkan Atalay

机构信息

Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation Dokuz Eylul University, School of Medicine, Department of General Surgery Dokuz Eylül University, Faculty of Medicine, Postoperatif Care Unit, Izmir, Turkey.

出版信息

Medicine (Baltimore). 2016 Oct;95(40):e5038. doi: 10.1097/MD.0000000000005038.

Abstract

The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

摘要

本研究旨在采用经典的客观人体测量方法、系统评估方法以及危重症患者营养风险(NUTRIC)评分,评估入住术后急性护理病房患者的营养状况,并将这些方法作为发病率和死亡率的预测指标进行比较。在术后护理病房入院时,对接受各种手术的患者进行以下项目评估:主观全面评定法(SGA)、营养风险指数(NRI)、营养风险筛查(NRS)-2002、微型营养评定法(MNA)、查尔森合并症指数(CCI)和NUTRIC评分,并进行人体测量、检测血清总蛋白、血清白蛋白和淋巴细胞计数。对患者进行术后并发症监测直至死亡或出院。同时分析并发症与这些参数之间的相关性。

本研究共纳入152例患者。在本研究中,确定死亡率与NRS-2002、SGA、CCI、急性生理与慢性健康状况评价系统、脓毒症相关器官功能衰竭评估以及NUTRIC评分呈正相关,而死亡率与NRI呈负相关。NUTRIC评分与肺炎、房颤发生、谵妄、肾衰竭、血管活性药物使用以及机械通气时间存在相关性。在我们的术后患者研究组中,MNA对任何并发症均无预测价值,而SGA除对住院时间和死亡率外,对任何并发症均无预测价值。

NUTRIC评分是术后外科患者死亡率和发病率的重要指标。NRI与许多术后并发症相关,虽然SGA和NRS与死亡率相关,但它们与大多数并发症无关。在我们的患者组中,确定MNA与任何并发症、死亡率和住院时间均无相关性。

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