鼻咽癌患者放疗期间营养指数模型构建及营养状况下降影响因素分析

目的构建鼻咽癌患者放疗期间营养评价综合模型,探析营养状况下降的早期预测因素。方法调查104例鼻咽癌患者放疗前后的营养状况,定期评价放射毒性反应,采用主成分分析建立营养指数模型,采用多元线性回归分析患者放疗期间营养状况下降的影响因素。结果运用营养指数模型对患者的营养状况进行评价,放疗前后鼻咽癌患者营养不良率分别为6.73%和69.23%,放疗后患者的营养不良率高于放疗前(P0.001)。多因素分析显示:急性放射毒性反应、焦虑、诱导化疗周期数等是患者营养状况下降的影响因素。结论营养指数模型综合地反映了患者的营养状况,具有一定的临床应用价值。急性放射毒性反应、焦虑等因素可以对鼻咽癌患者放疗期间营养状况下降起到预测作用。     

胃及结直肠癌患者围术期营养状况调查分析

目的：调查围术期胃及结直肠癌患者的营养状况。方法：采用主观全面营养评价法（SGA）对165例胃癌及结直肠癌围术期患者的营养状况进行评价,观察不同营养状况术后并发症发生情况。结果：术前营养不良发生率为44．8％;术后营养不良发生率为49．1％;营养良好的患者并发症发生率为4．4％,而营养不良的患者并发症发生率为13．5％,差异有显著性意义（P〈0．05）。结论：胃及结直肠癌患者围术期营养不良发生率高,营养不良者易发生术后并发症。护理人员应及时对患者进行评估,并予合理的营养支持,以促进康复。     

微型营养评价法评价慢病住院老人的营养状况

[目的]用MNA法调查老年慢性住院患者的营养状况,并比较不同营养状况患者的传统营养评价指标的差异.[方法]随机抽取141例住院的慢性疾病的老年患者,用MNA对其进行营养状况评价,并收集和比较其常用的营养评价参数进行分析.[结果]慢性疾病的老年患者营养不良、营养不良危险的发生率分别为36.88%和26.95%,而营养状况良好的患者只占36.17%;对3种不同营养状况的患者常用营养指标分析后发现:3组患者BMI、ALB、HB、Na 、Ca2 、TLC和K 差异有统计学意义(P<0.01或P<0.05),营养状况好的患者,其BMI、ALB、HB和TLC较高,而TG和TC无明显统计学意义.[结论]慢性疾病老年住院患者营养不良和营养不良危险的发生率较高,营养不良和营养不良危险患者的常用营养评价指标也会下降.     

胃肠肿瘤术后化疗患者营养状况及对化疗不良反应的影响

目的：探讨胃肠肿瘤术后化疗患者的营养状况及对化疗不良反应的影响。方法：胃肠肿瘤术后化疗的患者51例在入院化疗前,使用人体测量法及血生化检查法和综合营养评价法调查患者的营养状况,同时使用问卷调查患者的生活质量。结果：营养良好的患者各项生化检查均较营养不良的患者要高,比较差异有统计学意义（P〈0．05）。营养良好的患者整体健康状况,生活质量得分为（67．1±18．6）分,营养不良的患者的整体健康状况／生活质量得分为（37．5±25．5）分,营养良好的患者症状子量表得分明显较营养不良的患者低。结论：SGA营养评估法可以准确地评定胃肠肿瘤术后患者化疗期的营养状况,便于及早发现并预防营养不良的发生。     

微型营养评定法在恶性肿瘤病人中的应用

为探讨微型营养评定法 (MNA)在恶性肿瘤病人的营养状况评价中的价值 ,测定 2 6 2例恶性肿瘤病人的MNA总分、身高、体重、年龄、体力状况、血液血红蛋白量 (Hb)、红细胞数 (RBC)、血清白蛋白浓度 (Alb)、血清前白蛋白浓度 (PA)。计算实际体重 健康时平时体重比 (UBW % )。根据MNA总分评价病人营养状况 :营养不良组 (MNA总分 <17) ;营养不良危险组 (MNA总分介于 17～ 2 3 5 ) ;营养良好组 (MNA总分≥ 2 4)。结果显示 :MNA总分与UBW %、Alb、PA、BMI值呈显著相关 (r=0 5 0 1～ 0 72 4,P =0 0 0 0 )。MNA与UBW %、BMI、PA、Alb方法评价病人的营养状况有良好的一致性 ,符合率分别为 82 %、76 %、71%、6 8%。根据MNA方法评价全组病人 ,营养不良者占 31 7% (83 2 6 2例 ) ,营养不良危险者占 2 5 9% (6 8 2 6 2例 ) ,营养良好者占 42 4%(111 2 6 2例 ) ;营养不良与营养不良危险的发生率无显著性差异 ;老年与非老年患者营养不良发生率无明显差异。胃癌、肝癌的营养不良发生率明显高于肺癌 (P =0 0 0 1)。体力状况越差 (ECOG分级越高 )、营养不良发生率越高。贫血患者营养不良发生率明显高于非贫血者。感染患者营养不良发生率明显高于非感染者。结果提示 ,MNA对于恶性肿瘤患者具有良好的营养评价作用。胃癌?     

潍坊市中小学生营养状况调查

为了解我市中小学生营养状况 ,探讨其影响因素 ,我们于1999年 5月对我市中小学生营养状况进行了抽样调查。1　调查对象及方法选择全市有代表性的 4所城乡中小学校 ,按照“全国学生健康监测方法”测量学生身高体重 ,采用“中国学生 7～ 2 2岁身高标准体重值”评价中小学生现时营养状况。2　调查结果2 .1　总体情况　共调查城乡男女中小学生 2 745人 ,营养良好16 92人 ,营养良好率 6 1.6 4% ;超重 15 3人 ,超重率 5 .5 7% ;肥胖10 3人 ,肥胖率 3 .75 % ;营养不良 797人 ,营养不良率 2 9.0 4%(其中轻度营养不良 6 92人 ,轻度营养不良率 2 5 .2 …     

老年慢性肾功能不全患者的营养状况评价

目的应用微型营养评定(MNA)方法来评价住院老年慢性肾功能不全病人的营养状况.方法110例住院老年慢性肾功能不全患者,采用微型营养评定(MNA)问卷调查法进行营养评定,同时结合人体测量、生化检查.结果[1]根据MNA评分营养不良者28例(25.5%);营养不良危险者56例(50.9%);营养良好者26例(23.6%).[2]轻度、中度、重度肾功能损害三组的营养不良及营养不良危险者发生率分别为70.9%、79.0%、100.0%.[3]MNA评价的营养状况结果有效的反映人体测量、生化检查.结论[1]住院老年慢性肾功能不全病人的营养不良发生率较高.[2]微型营养评定(MNA)方法应用在住院老年慢性肾功能不全病人的营养状况评价中是可行的.     

一种新营养状况评价方法在颌面外科的应用

目的　研究一种以体重、上臂围和握力建立的判别式所作新营养评价方法的可靠性及临床实用性。方法　用传统的营养状况综合评价法和新营养评价法对 1 2 7例口腔颌面恶性肿瘤患者进行营养评价 ,比较两种方法的一致程度及新评价法与临床常用营养指标的关系 ;同时还分析了新评价法对手术治疗病人临床结局的预示作用。结果　新评价法与传统的评价法有良好的一致性 ,总符合率为 88% ;在新评价法划定的两组病人间 ,营养不良组的绝大多数营养指标值低于正常组 ;手术病人中 ,不良组术后并发症发生率 1 4/30 ,47%高于正常组 ( 1 3/66,2 0 % ) ,住院时间也长于正常组。结论　新评价法是可靠的营养状况评价方法 ,可用于估计手术病人术后恢复情况 ,值得在临床上推广应用     

糖尿病患者的微型营养评价

目的用微型营养评价法（MNA）评价糖尿病（DM）患者的营养状况,了解营养不良的患病率,提出改善营养状况的措施。方法对重庆市新桥医院106例糖尿病患者进行MNA问卷调查,根据MNA评分标准评价糖尿病患者营养状况。结果 MNA问卷调查结果显示糖尿病患者8.5%营养不良,64.2%具有营养不良危险,27.3%营养良好。老年糖尿病患者（年龄≥60岁）有48例,其中有16.7%营养不良,62.5%具有营养不良危险,20.8%营养良好。结论糖尿病营养不良患病率与年龄正相关,心理指导对提高DM患者营养状况有益。     

集居儿童365例膳食评价分析

目的：为促进本地区集体膳食结构中6岁以下儿童饮食与健康状况，提高儿保工作效率和服务质量。方法：使用计算机集体营养分析软件系统，按WHO综合评价（W／H，H／A，W／A）标准，不同组合共15种进行分型评价。结果：29．8％为发育营养良好或较好，55．4％为发育营养正常，属中等水平，14．7％为发育营养有问题或营养不良，符合目前城市儿童发育营养状况。各年龄组儿童发育营养属中等水平约占50％，无明显年龄性别差异，1岁以内的婴儿营养良好者比例最高（占35．16％），1－2岁幼儿营养良好者较少（占23．9％），营养不良或发育欠佳者多见于3－6岁年龄组。结论：本文资料利用计算机综合评价，能快速准确地得出结果，在集体托幼机构，针对集体膳食，儿童营养状况定期检查，能起到快速督促，及时纠正问题，提高工作效率及服务质量的作用。     

采用主成分分析法对糖尿病住院患者营养状况综合评价

目的采用主成分分析法综合评价糖尿病住院患者营养状况,探讨科学的综合评价方法.方法选取95例肝肾功能正常无发热的糖尿病住院患者,测量其身高、体重、上臂围、三头肌皮褶厚度以及血红蛋白、淋巴细胞计数、血清总蛋白、白蛋白、前白蛋白、视黄醇结合蛋白等指标,采用主成分分析法综合评价.结果前4个主成分累积贡献率达到81%,被确定为重要主成分,建立主成分函数表达式,分析主成分与原始变量之间的关系.这4个主成分分别反映内脏蛋白消耗型营养不良(慢性蛋白质营养不良)、蛋白质-能量营养不良、急性蛋白质营养不良以及免疫功能低下型营养不良,同时采用主成分评分法对营养状况进行综合评价,结果内脏蛋白消耗型营养不良占25.26%,蛋白质-能量营养不良型占30.53%,急性蛋白质营养不良占25.26%,免疫功能低下型营养不良占18.95%.结论运用主成分分析法可以消除原始变量间的信息重叠,合理、综合地评价糖尿病住院患者的营养状况.     

Effects of an appropriate oral diet on the nutritional status of patients with HCV-related liver cirrhosis: a prospective study

BACKGROUND AND AIMS: In patients with liver cirrhosis, protein-energy malnutrition is a frequent finding and a risk factor influencing survival. The aim was to estimate the effects of an adequate diet on malnutrition and clinical outcome in patients with Child A or B HCV-related liver cirrhosis. METHODS: We enrolled 90 consecutive outpatients (M/F=52/38) with liver cirrhosis, 30 in Child class A and 60 in class B. Patients were evaluated by anamnesis, clinical examination, estimation of daily caloric intake and measurement of anthropometrical and biochemical indexes. Patients were randomized into two groups: group 1 with a 3-month oral controlled diet started one week after the first examination and this was followed by a 3-month of spontaneous dietary intake, and group 2 which started a 3-month spontaneous dietary intake followed by a 3-month of controlled diet. The follow-up was performed every month. RESULTS: During the period of controlled diet in patients of both groups, protein malnutrition assessed by midarm muscle circumference, creatinine-height index and serum albumin significantly improved independently of the Child class. Lipid malnutrition, assessed by triceps skin fold thickness values, did not improve during the course of the study. The compliance to the prescribed diet was very high in both groups, and no carry over effect of the previous dietary intake was observed during the follow-up period. CONCLUSIONS: The results emphasize the importance of both nutritional status evaluation and improvement in the Child A and B cirrhotic patients with HCV-related disease. The proposed nutritional approach was able to influence their protein malnutrition positively.     

营养支持治疗在慢性肝功能衰竭病中效果观察

目的探究营养支持治疗在慢性肝衰竭上在治疗上的效果。方法对住入我院的40例慢性肝衰竭患者的营养状况进行综合的分析评价,对这些患者进行治疗时,以现代的内科综合治疗为主,再辅助以相对专业的营养支持治疗,结合患者自身情况选用肠内或肠外或者是两者相结合的方法进行具体的治疗。以生化指标的具体变化以及营养状况作为对比条件,对患者的情况进行治疗前后的比较,进而来判断其临床疗效到底如何。结果在未进行治疗的时候,40例患者中有38例都存在着营养不良的状况,但是这些患者营养不良的程度各自之间都有所差别,经过一段时间的治疗,其营养不良的现象均有所好转,只是好转的程度各有差异。结论在进行对慢性肝病患者的治疗时,要结合患者自身的不同差异,根据患者具体的病情以及病情的发展情况,采取适合于患者的营养支持方案,如果患者能够很好地再配合内科医生进行综合地治疗,就一定会取得相当好的疗效。     

Prise en charge nutritionnelle en oncogériatrie

Determination of the nutritional status of elderly patients with cancer is essential before to make any decision of therapeutic strategy. It is part of a comprehensive geriatric assessment of the patient whose purpose is to identify frailty that may interfere with the development of the disease and tolerance of treatments. This initial assessment allows for a personalized healthcare for the elderly patient with cancer. Determination of nutritional status combines anthropometric indexes, evaluation of biological data and measure of food intake. The diagnosis of malnutrition or risk of malnutrition is crucial because this is a risk factor for toxicity of the treatment and impaired quality of life. Refeeding has a beneficial impact on the efficiency of the treatment and quality of life of patients with cancer.     

Results of nutritional status surveillance in El Salvador, 1975 - 77

Nutritional status surveillance data based on the clinical diagnosis of malnutrition and on weight-for-age, as well as diarrhoeal disease data for preschool age children attending government health clinics in El Salvador are presented for a 3-year period (1975 - 77). Surveillance results indicated consistently higher rates of clinical malnutrition and weight-for-age deficit in rural children as compared with urban children, and higher malnutrition rates in children 1 - 4 years of age as compared with infants less than 1 year old. Consistent seasonal increases in malnutrition were observed that were most pronounced in older preschool children (1 - 4 years) in rural areas. Seasonal peaks in malnutrition consistently followed 1 - 2 months after the major seasonal peak in diarrhoea at the onset of the rainy season, suggesting that diarrhoea may play a role in the etiology of malnutrition. A secondary seasonal peak in diarrhoea in the cooler, dry season was most prominent in infants but was not related to increased malnutrition. These results indicate that nutritional and health status indicators formed from data collected regularly at health centres can demonstrate consistent age group, urban/rural, and seasonal differences in nutritional status that may be useful in identifying risk groups and in monitoring nutritional changes for planning and evaluation purposes.     

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

BACKGROUND AND GOAL: Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. METHODS: Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: 'Anthropometric assessment' based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 相似文献   

Comprehensive Care Improves Physical Recovery of Hip-Fractured Elderly Taiwanese Patients With Poor Nutritional Status

ObjectivesThe effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge.DesignA secondary analysis of data from a randomized controlled trial with 24-month follow-up.SettingA 3000-bed medical center in northern Taiwan.ParticipantsSubjects were included only if they had “poor nutritional status” at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group.InterventionsThe 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation.MeasurementsData were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression.ResultsPatients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06–2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered.ConclusionsAn in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.     

Simple pediatric nutritional risk score to identify children at risk of malnutrition

BACKGROUND: Although hospitalized children are at risk of malnutrition, routine screening of nutritional status has been hindered by lack of a validated nutritional assessment tool. OBJECTIVE: Our aim was to develop a simple pediatric nutritional risk score that could be used at hospital admission to identify patients at risk of acute malnutrition during hospitalization. DESIGN: Nutritional risk was assessed prospectively in 296 children. Anthropometric measurements, food intake, ability to eat and retain food, medical condition, and symptoms interfering with feeding (pain, dyspnea, and depression) were evaluated within 48 h of admission. Pathology was classified as mild (grade 1), moderate (grade 2), or severe (grade 3). The risk of weight loss was investigated with stepwise logistic regression. RESULTS: Weight loss during hospitalization occurred in 65% of the children and was >2% of admission weight in 45% of patients. Multivariate analysis indicated that food intake <50%, pain, and grade 2 and 3 pathologic conditions (P = 0.0001 for all) were associated with weight losses of >2%. The nutritional risk score ranged from 0 to 5 and was calculated by adding the values for the significant risk factors as follows: 1 for food intake <50%, 1 for pain, 1 for grade 2 pathologic condition, and 3 for grade 3 pathologic condition. A score of 1 or 2 indicated moderate risk and a score >/=3 indicated high risk of malnutrition. CONCLUSIONS: This simple score is suitable for routine use to identify patients at risk of malnutrition during hospitalization. Implementation may prevent hospital-acquired malnutrition.     

术前体成分及营养状况对消化道肿瘤病人临床结局的影响

营养不良是消化道肿瘤病人术前常见并发症,对其临床结局可产生不良影响。为保证病人围术期安全性,术前需对病人进行综合评估。针对肿瘤病人营养状况评估指标较多,然而目前针对消化道肿瘤病人营养状况有效评估方法尚不明确且缺乏肿瘤相关营养不良的评估路径。因此,本文通过综述形式探讨不同营养相关指标对消化道肿瘤病人临床结局的预测作用,以期为临床医生对消化道肿瘤病人行术前营养状况评估提供参考。     

Nutritional status at submission for dietetic services and screening for malnutrition at admission to hospital.

This paper presents two studies in a quality management project that aims to diminish malnutrition among hospitalized patients. The objective of study 1 was to investigate what information was available on the nutritional status of patients submitted for dietetic services for reasons other than obesity (n= 167) and of study 2 to evaluate a nine-question screening sheet for malnutrition in patients (n= 115) within 48 h of admission to the hospital. In study 1 sufficient data to evaluate nutritional status was found for 17% of the patients submitted for dietetic services. In study 2 the screening sheet identified 21% of the patients as malnourished and a full nutritional assessment of seven anthropometrical and biochemical measurements 20%. The screening sheet could be simplified to six questions and then had a sensitivity of 0.69, a specificity of 0.91 and a positive predictive value of 0.65. It is concluded that evaluation of nutritional status in hospitalized patients has been disregarded and a simple screening sheet can be used to identify patients in need of further nutritional assessment and treatment.