摘要目的 应用营养风险筛查2002(NRS 2002)和主观全面营养评定(SGA)等工具,对比观察三甲医院老年患者住院和出院时变化.方法 选择2014年6月至2014年9月9家三甲医院的消化内科、呼吸内科、普通外科、老年科、胸外科、神经内科、骨科和肿瘤内科等多个临床科室收治的住院时间在7～30 d、年龄≥65岁的住院患者,于入院和出院24 h内记录其临床资料、进行人体物理指标测量和实验室检查,应用NRS 2002和SGA;记录住院期间营养支持情况和临床结局指标,描述其与临床结局的相关性.结果 符合入选标准的2558例≥65岁老年患者进入本研究;与入院时的检查相比,患者在出院时的握力、上臂围和小腿围均显著降低(P＜0.05);总蛋白、白蛋白、血红蛋白均明显低于入院时水平(P＜0.05);入院时营养风险(NRS 2002≥3分)发生率为51.1％,营养不良(SGA B+C)的发生率32.6％,出院前的营养风险发生率53.0％和营养不良发生率35.6％,高于入院时;入院时合并营养不良者的住院时间和医疗花费高于营养支持者,出院时营养状态与住院时间和医疗花费成负相关;住院期间61.3％存在营养风险患者未接受营养支持,接受营养支持的患者患者中,肠外营养使用率(19.6％)高于肠内营养(11.9％).结论 老年患者入院时营养风险或营养不良发生率较高,出院时上述指标没有显著改善,应重视住院期间老年患者的营养风险筛查和评价,规范营养干预,改善临床结局.

abstractsObjective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization.Methods A prospective,multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology,respiratory medicine,general surgery,geriatrics,thoracic surgery,neurology,orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014.On admission and within 24 hours after discharge,the clinical data were recorded,physical indices were measured,and laboratory examination were conducted.NRS 2002 and SGA were used to make an evaluation.The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed.Results A total of 2558 patients above 65 years old were included into the study.Compared with their status on admission,their grip strength,upper arm circumference and crural circumference were reduced significantly at discharge (P＜0.05).The total protein,albumin and hemoglobin levels were significantly lower than those on admission (P＜0.05).The incidence of nutritional risk (NRS 2002 score ≥ 3) and malnutrition (SGA B + C) on admission were lower than those at discharge (51.1％ vs 53.0％,32.6％ vs 35.6％).The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes.The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses.61.3％ patients having nutritional risk did not take nutritional support during the hospital stay,while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6％ vs 11.9％).Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission,these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge.Therefore,the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes.