吉林省五家中小医院胃肠病住院患者营养风险和营养不足发生率及营养支持状况

目的调查吉林省3个地区5家中小医院胃癌、结直肠癌（病组I）及胃肠溃疡、肠梗阻、克罗恩病（病组1／）两病组住院患者营养风险和营养不足发生率及营养支持状况。方法采用连续抽样方法选取吉林省长春地区、松原地区、白城地区等5家中小医院2010年5月至2013年3月普外科住院患者4330例，排除年龄〈18岁或〉80岁、住院时间不足24h或次日8时前手术、神志不清、拒绝参加本研究、不符合预定诊断的、符合预定诊断且未手术的病例后，筛选出诊断为胃结直肠癌、胃溃疡、肠梗阻、克罗恩病等患者687例，其中病组Ⅰ140例、病组Ⅱ547例，被纳入的患者入院后24h内利用营养风险筛查2002进行营养风险筛查，调查营养不足发生率并记录住院期间营养支持应用情况。结果两病组存在营养风险的患者为167例，营养风险发生率为24．3％；两病组存在营养风险的患者接受营养支持的占73．7％，未接受营养支持的占26．3％；无营养风险的患者为520例，接受营养支持的占8．8％，未接受营养支持的占91．2％。病组Ⅰ患者营养风险发生率占64．3％，病组Ⅱ营养风险发生率占14．1％，两组比较差异具有统计学意义（P=0．000）。687例患者中以体重指数〈18．5kg／m^2计算营养不足发生率为3．2％，而以营养状况评分≥3分计算营养不足发生率为8．3％，两组比较差异具有统计学意义（P=0．000）。结论5家中小医院符合纳人标准的患者营养风险总发生率为24．3％，营养不足的发生率为3．2％-8．3％，低于大医院的营养不足发生率。5家中小医院均应用肠外营养支持，尚未应用肠内营养和肠内肠外联合营养支持。

Nutritional risk and undernutrition and the status of nutritional support on inpatients with gastrointestinal disease in 5 middle and small hospitals in Jilin province

Objective To survey the incidence of nutritional risk and undernutrition and the status of nutritional support on surgical inpatieuts in general surgery departments of 5 middle and small hospitals in Jilin province. Methods A total of 4 330 hospitalized patients from the surgical departments of 5 hospitals in Changchun, Songyu, and Baicheng of Jilin province were recruited from May 2010 to March 2013. Among them 687 cases entered the final analysis based on the exclusion criteria. They were further divided as group Ⅰ （ n = 140, including patients with gastric cancer or colorectal cancer） and group Ⅱ （ n = 547, including patients with gastric ulcer, intestinal obstruction, or Crohn＇s disease）. Nutritional Risk Screening 2002 was performed within 24 hours after admission. The incidence of undernutrition and nutrition risk was calculated, and the nutritional support was evaluated until the discharge. Results In these two groups, 167 patients （24. 3% ） were at nutritional risk, among whom 73.7% received nutritional support and 26. 3% received non-nutritional support. Also, 520 cases were not at nutritional risk, among whom 8.8% received nutritional support and 91.2% received non-nutritional support. In addition, 64. 3% of patients were at nutritional risk in group Ⅰ and 14. 1% in group Ⅱ （P =0. 000）. Among these 687 cases, body mass index was 〈 18.5 kg/m^2 in 3.2% of patients and nutritional status ≥3 scores in 8. 3% （P = 0. 000）. Conclusions Patients with different gastrointestinal diseases may have different nutritional risks and undernutrition status. Parenteral nutrition support has been applied in 5 middle and small hospitals in Jilin provinicne, while enteral nutrition and combination of parenteral nutrition and enteral nutrition has not been introduced.