摘要目的 前瞻性调查北京某二甲医院肿瘤内科非终末期晚期住院患者的营养风险、营养不足发生情况及营养支持应用现状,为今后营养支持改善临床结局研究奠定基础.方法 采用连续抽样方法对2011年10月至2013年4月北京某二甲医院肿瘤内科入院患者展开调查.对符合入选标准的患者,于入院次日采用营养风险筛查2002 (NRS2002)进行营养风险筛查和营养不足评估,并记录患者住院期间的营养支持情况.对没有营养风险患者每周重复筛查.出院后根据患者的临床及病理资料,将其分为早、中期(Ⅰ、Ⅱ、Ⅲa期)、非终末期晚期(Ⅲb、Ⅳ期)及终末期(预计生存期短于3个月)3组.本研究仅对非终末期晚期肿瘤患者的营养风险、营养不足发生率及营养支持应用情况进行统计学分析,所有数据进入EDC系统并经核查无误.结果 调查期间人院患者305例,排除不符合标准的患者后,共224例患者接受了营养风险筛查.其中,对非终末期晚期患者171例进行统计分析,结果营养风险发生率为67.8％ (116/171),不同肿瘤类型患者营养风险发生率依次为肺癌45.7％ (21/46),消化道肿瘤89.4％ (42/47),肝、胆、胰腺肿瘤81.3％ (26/32),头颈部肿瘤83.3％ (5/6).以体质量指数(BMI) ＜18.5 kg/m2计算营养不足发生率为12.3％ (21/171)；以NRS2002营养受损部分评分达到3分汁算营养不足的发生率为19.9％ (34/171).有营养风险的116例患者中,71例接受了营养支持,占61.2％；肠外与肠内营养的应用例数比为68∶3 (23∶1)；能量摄入为(56.78±8.20) kJ/(kg·d),氮摄入为(0.06±0.01) g/(kg·d).55例无营养风险患者中,5例接受了营养支持(9.1％).结论 非终末期晚期肿瘤患者营养风险、营养不足的发生率较高,且与肿瘤类型相关.非终末期晚期肿瘤患者的营养支持亦存在不合理之处,以有营养风险患者的营养支持率偏低为主.对于有营养风险的患者,营养支持能否改善其临床结局,是今后需要进行研究的课题.

abstractsObjective To investigate prospectively the nutritional risks,undernutrition,and nutritional support in hospitalized patients with later but non-end-stage malignancies in a second grade hospital in Beijing.Methods All patients who were admitted in the department of oncology in this hospital from October 2011 to April 2013 were consecutively recorded.Nutritional Risk Screening (NRS 2002) was used for screening nutrition risks,the undernutrition assessment was performed on the first morning for patients meet the inclusion criteria,and nutritional support was evaluated until the discharge.For patients with no nutritional risk,NRS 2002 was repeated weekly during the hospitalization.Results A total of 305 cases of inpatients admitted,and 224cases meeting the inclusion criteria were screened by NRS 2002,among whom only 171 patients with non-endstage later stage cancer entered the final analysis.Among these 171 patients,116 (67.8％) were at nutritional risks.Furthermore,for different types of tumor,the nutritional risk was 45.7％ for lung cancer,89.4％ for digestive-tract cancers,81.3％ for liver-biliary and pancreatic cancers,and 83.3％ for head-and-neck cancers.The undernutrition rate was 12.3％ (21/171) if based on body mass index ＜ 18.5 kg/m2 and 19.9％ (34/171) if evaluated from the score of nutritional defect part of NRS 2002.Only 71 patients (61.2％) at nutritional risk received nutritional support,while 5 of 55 patients (9.1％) without nutritional risk received nutritional support.The average ratio of parenteral nutrition to enteral nutrition was 23∶ 1.Intravenous calories intake was 56.78 ± 8.20 k J/ (kg · d) ; the intake of nitrogen was 0.06 ± 0.01 g/ (kg · d),and the ratio of calories to nitrogen was 204∶ 1.Conclusions A large proportion of inpatients with non-end-stage later cancer were at nutritional risk,which is associated with tumor types.The application of nutritional support should be further standardized,particularly for patients at nutritional risk but with low nutritional support.Furthermore,whether the clinical outcome of inpatients at nutritional risk may be improved by nutritional support still requires further investigation.