营养风险筛查2002在呼吸系统疾病患者中的应用效果

目的：用营养风险筛查2002（NRS 2002）对住院呼吸系统疾病患者进行营养风险筛查，了解住院患者营养风险发生率和营养支持状况，探讨有营养风险对临床结局的影响及NRS 2002结果与营养不良的相关性。方法：选取2015年7月至2016年12月在四川大学华西医院呼吸与危重症科住院的患者2 067例，采用NRS 2002在其入院24 h内进行营养风险筛查，按照是否存在营养风险分为营养风险组和无营养风险组。比较两组患者年龄、性别、体质量、实验室检查结果、营养治疗情况、住院天数、住院总费用、临床结局的差异，进一步分析NRS 2002营养风险筛查结果与营养不良的一致性。结果：入院时呼吸与危重症病房患者总体营养风险发生率为36.91%（男性36.44%、女性37.47%），总体营养不良发生率为65.56%（1 355/2 067）。营养风险组支持干预率8.12%，无营养风险组支持干预率1.22%。有营养风险患者年龄、身高、体质量、体质量指数（body mass index，BMI）与无营养风险患者差异有统计学意义（P<0.01）。营养风险组患者入院时的白蛋白、第7天总蛋白、第14天白蛋白，住院期间血红蛋白、第1天肌酐水平低于无营养风险组（P<0.01）。两组患者的住院时间差异无统计学意义。营养风险组患者住院总费用高于无营养风险组患者（P<0.05）。白蛋白与NRS 2002评分一致性较差，BMI与NRS 2002评分一致性一般，一致性系数Kappa值分别为0.207、0.468，且差异有统计学意义（P<0.001）。营养风险组患者的临床结局较无营养风险组患者更差（P<0.05）。结论：住院的呼吸系统疾病患者营养风险发生率较高，但营养支持干预率低，营养风险大小和营养不良严重程度影响患者临床结局。

Application of nutritional risk screening 2002 in patients with respiratory diseases

Objective: To screen nutritional risk of hospitalized patients with respiratory diseases by nutritional risk screening 2002 (NRS 2002), and to evaluate nutritional risk rate and nutritional support status, and to explore the effect on clinical outcomes of patients who had nutritional risk and the correlation of NRS 2002 results and malnutrition. Methods: A total of 2 067 patients were completed nutritional risk screening via NRS 2002 in the first 24 hours after their admission to the Department of Respiratory and Critical Care, West China Hospital of Sichuan University from July 2015 to December 2016. They were divided into nutritional risk group and non-nutritional risk group according to the nutritional risk results. The differences in age, gender, weight, laboratory tests, nutritional treatment, length of hospital stay, total hospitalization cost, and clinical outcomes were observed. The consistency between NRS 2002 nutrition risk screening results and malnutrition was further analyzed. Results: At the time of admission, the overall nutritional risk of patients in the Respiratory Department and Critical Care Unit was 36.91% (36.44% for men and 37.47% for women). The overall rate of malnutrition was 65.56%(1 355/2 067). The rate of nutrition support was 8.12% in the nutritional risk group and was 1.22% in the non-nutritional risk group. The age, height, weight, and body mass index (BMI) were significantly different between the two groups (P<0.05). The albumin on admission, total protein on day 7, albumin on day 14, hemoglobin during the hospitalization and creatinine on day 1 in the nutritional risks group were lower than those in the non-nutritional risk group (P<0.05). There was no significant difference in hospital stay between the two groups. The total hospitalization cost in the nutritional risk group was higher than that in non-nutritional risk group (P<0.05). The consistency of albumin and NRS 2002 score was poor, the consistency of BMI and NRS 2002 score was general, the Kappa values of the consistency were 0.207 and 0.468, respectively (P<0.001). The adverse clinical outcome rate in nutritional risk group was higher than that in non-nutritional risk group (P<0.05). Conclusions: The nutritional risk rate in patients with respiratory diseases is high, but the nutrition support rate is low. The level of nutritional risk and the severity of malnutrition may affect clinical outcomes of patients.