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营养不良评定(诊断)标准沿革及目前存在问题的思考

The development of malnutrition assessment criteria and the analysis of current problems

摘要:

营养支持治疗有助于改善存在营养不良或营养风险的患者的临床结局,并已在外科临床实践中获得广泛应用,但临床工作者对营养不良的认知仍然不足.2015版欧洲肠外肠内营养学会营养不良评定(诊断)标准共识和2017版欧洲肠外肠内营养学会临床营养相关定义和术语指南发布后,许多临床营养专家提出了不同意见.营养不良评定(诊断)标准全球领导人(GLIM)共识于2018年颁布,虽然尚未获得临床有效性验证,但已较之前有较大进步.分析和对比近年来营养不良评定(诊断)的核心内容,可以看到GLIM评定(诊断)标准并非替代“营养筛查—营养评定—营养干预”三步骤,而是希望借此更为合理地在临床工作中对营养不良进行更好的诊断和干预.

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abstracts:

It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk,and surgical nutrition has been used in China for 40 years.However,there is still insufficient awareness of malnutrition among clinical workers.There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017.Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018.Though it is lack of clinical validation,it is a big step forward.In order to achieve better prevention and treatment of malnutrition in clinical work,this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years,proposes current practical strategy for Chinese clinical workers,emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention".

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