不同营养评估工具在重症肾脏病中的应用价值分析

重症肾脏病是20世纪90年代提出的新兴概念,重症肾脏病病人营养不良发生率高,与死亡风险升高显著相关,因此早期评估重症肾脏病病人的营养状态至关重要.目前国内外开发了多种营养评估工具,而鲜有研究将其应用于重症肾脏病领域.本文通过分析重症肾脏病病人营养不良风险的相关因素,比较了常见营养评估工具在重症肾脏病领域应用的优势和局限性,并为临床选择合适的营养评估工具给出建议.     

重症肾脏病医护人员对营养风险筛查工具的认识及体验

目的:了解重症肾脏病医护人员对营养风险筛查工具的认识及体验,帮助规范临床营养风险筛查,为后续构建针对性的营养风险筛查工具提供参考.方法:运用现象学研究方法,对17名医护人员进行半结构式深度访谈,采用Colaizzi 7步分析法整理访谈资料.结果:提炼出3个主题,医护人员对营养风险筛查工具的认知较为局限;现有工具不能真实...     

综合营养评估工具在心衰患者中的应用价值

目的 对心衰患者所采用的综合营养评估工具及应用价值进行综述,为我国心衰患者的营养相关研究提供理论基础。方法 以“营养”、“心力衰竭”、“nutrition”、“heart failure”等为关键词,查询PubMed、Web of Science、知网等数据库相关文献,综述材料。结果 对心衰患者运用的综合营养评估工具种类较多,各量表信效度较高,营养风险和营养不良检出率较好,但均为普适量表,测评内容不能与心衰患者的临床特征完全相符,开发针对心衰患者的营养评估工具处于起步阶段。结论 综合营养评估工具对心衰患者的营养评估效果较好,未来需要加强针对心衰患者营养量表的研究。     

肠内营养支持在急性重症胰腺炎中的应用

目的探讨肠内营养穴EN雪支持在急性重症胰腺炎穴ASP雪中应用的安全性和有效性。方法以急症手术后或入院后1周内开始实施EN的44例为研究组,行完全胃肠外营养的54例为对照组,观察两组并发症、住院天数和死亡率的差异。结果研究组和对照组总的并发症发生分别为14例和28例,两组比较有显著性差异(P<0.05),其中感染率分别为20.45%和40.74%,对照组明显高于研究组(P<0.05)。两组住院天数分别为39.5、47.8天,差异有显著性(P<0.05)。两组死亡率分别为13.64%、20.37%,对照组明显高于研究组,但无显著性差异(P>0.05)。结论在ASP患者中实施EN是安全有效的,能显著减少并发症的发生,降低感染率及死亡率,明显减少住院日。     

肠内营养支持在急性重症胰腺炎治疗中的应用

目的：探讨急性重症胰腺炎（SAP）时，肠内营养（EN）支持的应用原则、方法及疗效。方法：对27例SAP病人进行回顾性总结。结果：22例治愈，5例死亡。21例由肠外营养（PN）过渡到EN，19例应用EN时间超过3周。多数病人在应用EN达3周时，其血清蛋白、体重增加，呈正氮平衡。血清转氨酶、胆红素下降，肝功能改善。结论：（1）SAP初期应以PN支持为主。（2）SAP2－3周左右是应用EN的较好时机。（3）由PN过渡到EN的时间应不少于1周。（4）EN时，口服途径应视为禁忌，24h经空肠造口持续匀速滴入为首选方法。（5）以含食物纤维的能全力效果较好。总之，当病人出现严重的消化道症状时，PN＋EN是最理想的营养支持方法。     

肠内营养支持在急性重症胰腺炎中的应用

目的：探讨肠内营养（ＥＮ）在急性重症胰腺炎（ＡＳＰ）中应用和安全性有效性。方法：以近年来的ＡＳＰ作实验组,与既往的ＡＳＰ治疗结果作对比,观察住院天数,各种并发症,死亡率和费用的差异。结果：实验组平均住院天数,ＡＲＤＳ和其它感染性并发症均低于对照组,死亡率明显下降,治疗总费用显著减少。结论：ＥＮ在急性重症胰腺炎中的应用是安全有效的,值得提倡。     

BISAP评分在重症急性胰腺炎预后评估中的应用价值

目的探究重症急性胰腺炎应用BISAP评分(Bedside Index for Severity in AP,BISAP)的预后价值。方法此次实验对象全部选自2016年7月—2018年10月期间接收的198例重症急性胰腺炎患者,用BISAP评分对其胸膜渗出、血尿素氮、全身炎症反应综合征、意识障碍以及年龄五项指标进行综合评估,并对比该评分和APACHE II评分对预测胰腺坏死、机体脏器功能衰竭、死亡的价值,以及对预后的影响。结果 198例患者中,34. 34%器官功能衰竭,胰腺坏死为48. 99%。对器官功能衰竭、胰腺坏死患者的BISAP评分、APACHE II评分进行AUC预测,以3分为最佳截点,BISAP评分的阴性预测值、阳性预测值、敏感性、特异性均优于APACHE II评分,差异有统计学意义(P <0. 05)。BISAP评分的预计死亡率为12. 12%,实际死亡率为11. 62%,差异无统计学意义(P> 0. 05); APACHE II评分的预计死亡率为9. 09%,实际死亡率为11. 62%,差异有统计学意义(P <0. 05); BISAP评分的预计死亡率和APACHE II评分差异有统计学意义(P <0. 05)。结论对重症急性胰腺炎患者应用BISAP评分进行评估的效果显著优于APACHE II评分,能够有效预测胰腺坏死和器官功能衰竭现象,可对患者预后进行有效评估,其临床应用价值较高。     

肠内营养在重症急性胰腺炎患者中的应用效果

目的探讨肠内营养应用于重症急性胰腺炎患者的疗效及改善营养状况的效果。方法采用随机平行对照法将2013年1月—2016年2月期间89例重症急性胰腺炎患者进行分组,对照组44例给予全胃肠外营养支持,观察组45例给予肠内营养支持,对比两组患者治疗后临床症状恢复时间、住院时间,与血清白蛋白、前白蛋白、血清淀粉酶、体质量改善效果,及并发症发生率。计数资料比较采用χ2检验,计量资料比较采用t检验,P0.05认为差异具有统计学意义。结果观察组腹胀缓解时间、体温恢复时间、血尿淀粉酶恢复时间及住院时间[(5.59±2.03)d、(11.33±2.46)d、(15.93±2.61)d、(36.92±12.66)d],均低于对照组[(1.98±1.39)d、(7.49±1.82)d、(9.98±2.33)d、(19.93±7.11)d](均P0.05);观察组治疗后血清白蛋白及前白蛋白高于对照组,血清淀粉酶低于对照组(均P0.05);观察组体质量略高于对照组(P0.05);观察组并发症发生率、死亡率(15.56%、0%)均低于对照组(59.09%、11.36%)(均P0.05)。结论肠内营养能够显著改善重症急性胰腺炎患者的营养状况,缓解临床症状,提高生存率,安全性高,值得临床的推广及应用。     

早期肠内营养在急性重症胰腺炎治疗中的临床应用价值和安全性

目的 探讨早期肠内营养在急性重症胰腺炎治疗中的临床应用价值和安全性.方法 选取我院2010年7月--2013年2月66例重症急性胰腺炎患者并随机分为两组,其中对照组采用常规治疗,观察组在常规治疗基础上加用肠内营养支持.结果 统计学结果显示,观察组的住院时间、尿淀粉酶及血淀粉酶恢复正常时间、并发症发生率较对照组都有明显缩短,差异有统计学意义(P<0.05);治疗后患者体重观察组较对照组明显提高,差异也具有统计学意义(P<0.05).结论 早期肠内营养可以为重症胰腺炎患者起到保护肠道屏障功能,减少肠道细菌易位,阻止SAP病情恶化等作用,值得临床上推广和应用.     

早期肠内营养在重症急性胰腺炎治疗中的疗效评价

目的：探讨肠内营养在治疗重症急性胰腺炎患者中的临床应用价值。方法：将急性重症胰腺炎患者60例随机分为肠内营养组（EN组,30例）和TPN组（30例）,观察两组治疗结果及临床指标的变化。结果：治疗后EN组的住院时间、尿淀粉酶及血淀粉酶恢复正常时间、并发症发生率较对照组都有明显缩短,差异有统计学意义（P〈0.05）;治疗后患者体重EN组较TPN组明显提高,差异也具有统计学意义（P〈0.05）。治疗后前清蛋白水平与TPN组相比,差异有统计学意义（P〈0.05）。结论：肠内营养是重症急性胰腺炎患者安全有效的一种治疗方式,此种治疗方式操作简单,方法安全有效,大大提高了患者的治愈率,同时还可以大大降低患者的病死率,也可减少并发症发生率,减少患者的住院时间,降低费用,减轻患者的经济负担和精神压力,有利于社会和家庭的和谐稳定。     

Validity of nutritional screening and assessment tools

OBJECTIVE: The aim of this paper is to address the design and analysis of validity studies for evaluating the performance of a nutritional screening or assessment tool. METHODS: Statistical aspects of validity are discussed with the non-statistician in mind. Particular emphasis is placed on construct and criterion validity. Design issues are considered in relation to numbers of subjects and assessments. Appropriate methods of analysis are considered, as is interpretation of results. Practical suggestions regarding the implementation of validity studies in the field of nutrition risk assessment are proposed. CONCLUSION: Guidelines for the standardization of the design, analysis, and publication of results are presented.     

Reliability of nutritional screening and assessment tools

OBJECTIVE: The aim of this paper is to address the design and analysis of studies for evaluating the reliability of a nutritional screening or assessment tool. METHODS: Statistical aspects of reliability are discussed with the non-statistician in mind. Design issues are considered in relation to numbers of raters and subjects and to the appropriateness of raters. The analysis of data to obtain a measure of reliability and its confidence interval is illustrated with examples. Practical suggestions regarding the implementation of reliability studies in the field of nutritional risk assessment are proposed. CONCLUSION: Guidelines for the standardization of the design, analysis, and publication of results are presented.     

Determination of nutritional status in critical care

The application of the standard battery of nutritional assessment tests, measurements, and calculations is of limited value in the immediate nutritional diagnosis of the critically ill patient. Many of these tests are affected by stress, making it impossible to distinguish the etiology of abnormalities during the early postinjury period. Altered test results because of stress or injury include: increased excretion of creatinine; increased white blood cell (WBC) counts; increased anergy to skin tests; and decreased serum albumin, transferrin, thyroxin-binding prealbumin, and retinol-binding protein concentrations. Therefore, in assessing the nutritional status of the critically ill patient, it is important to focus on indexes that are realistic relative to the patient's metabolic status. Timing of data collection is of keen importance; data collected after fluid resuscitation and the peak metabolic response to injury on postinjury days 5 through 10 are usually more meaningful than those collected immediately after hospital admission. Admission assessment is necessary only to identify the high-risk patient in need of immediate nutrition intervention, to estimate energy/nutrition and fluid requirements, and to provide guidelines for planning nutrition care. This article presents recommendations for initial assessment, postcatabolism assessment, and serial assessment of the critically ill patient. Guidelines for estimating energy/nutrient requirements and timing data collection are also presented.     

The value of nutritional assessment in the surgical patient

The prevalence of malnutrition in Veterans Administration Hospitals has been well documented. Several methods have been proposed to assess nutritional status including prognostic nutritional index (PNI) and instant nutritional assessment (INA). A prospective study was done to evaluate the currently used nutritional assessments and determine their efficacy based on sensitivity and specificity in predicting surgical morbidity and mortality. Data on 46 patients were evaluated for the multiparameter index of PNI, total lymphocyte count and serum albumin for INA, and weight loss alone. In this analysis, intermediate and high risk PNI were combined as positive predictor of complications. Any abnormal value in INA was considered positive as was weight loss of greater than 6% of usual body weight. Sensitivity and specificity of each assessment method were determined by 2 X 2 contingency table, and significance of observed differences between methods was determined by chi 2 analysis. There were no complications or deaths in patients with less than 6% weight loss. All three patients with abnormal albumin and total lymphocyte count had complications as compared to only three of 32 patients when both of these parameters were normal. The PNI was also able to predict complications with an increasing incidence as the PNI increased. Only the difference between specificity of weight loss alone vs INA was statistically significant, p less than 0.05. Thus, weight loss alone can be used as a rapid, inexpensive assessment of nutritional status for predicting postoperative complications.     

A critical approach to nutritional assessment in critically ill patients

BACKGROUND AND AIMS: Nutritional assessment enhances quality of nutritional care, however, its practice bemuses professionals. This prospective study aimed to identify a feasible/informative nutritional parameter in intensive care. METHODS: 44 patients (APACHE II: 23.8+/-10.1), age 58.4+/-18.6 years, were evaluated at admission: clinical data, height, weight, body mass index (BMI), tricep skinfold thickness, mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), albumin, total protein and lymphocyte count. Anthropometric parameters' performance was evaluated isolated or assembled according to Blackburn and McWhirter criteria. RESULTS: Oedema increased %IW and BMI (P<0.01); muscle depletion was frequent and agreed with MAC or MAMC ranked by both criteria, P=0.02. %IW and BMI overestimated well-nourished/overweight patients, whilst arm anthropometry, mostly MAC/MAMC, shifted towards +/-50% malnutrition. Patients were not equally ranked by both criteria; McWhirter's by using percentiles clarified the distribution and showed agreement between MAC and MAMC, P=0.007, unlike Blackburn's. Mortality was higher in patients with MAC<5th percentile, P=0.003; MAC;<15th percentile was able to predict mortality and major complications. In invasive ventilated patients, severe muscle depletion was associated with mortality, P=0.05. CONCLUSION: In intensive care most nutritional assessment methods are useless; MAC is simple, feasible and if classified by percentiles may prove functional with prognostic value.     

危重病人营养与代谢支持的新策略

现代营养支持概念的提出距今已近40年,以完全胃肠外营养(TPN)为支柱的现代营养支持方法已有了长足的进步,但近年来随着对危重病营养与代谢研究的深入,TPN的不足(主要是感染和肝功能障碍)日益突出.为达到给予危重病人合理的营养支持、维持与改善机体器官及细胞的代谢与功能、促进病人康复的目的,国内外有关专家提出了危重病人营养与代谢支持的新策略.