老年肝硬化住院患者的营养风险以及对策

目的 应用营养风险筛查-2002（nutritional risk screening 2002，NRS-2002）量表评估老年肝硬化住院患者的营养风险．制定相应干预策略。方法 选取北京佑安医院人工肝中心2012年4～12月住院的肝硬化患者216例，其中观察组为老年人（A组），年龄≥65岁37例，对照组（B组）年龄≤64岁179例。采用上臂肌围（AMC）、肱三头肌皮褶厚度（TSF）评价患者营养状况。NRS-2002评估患者营养风险。记录患者的体质指数（BMI）、握力、白蛋白、前白蛋白、淋巴细胞计数、人院时肝功能Child—Pugh分级和出院转归。结果 入院时A组有营养风险患者的比例明显高于B组（51．4％VS．33．0％．P=0．034）。以TSF及AMC评价患者营养状况．A组和B组营养不良发生率的差异无统计学意义。入院时有营养风险的患者中Child—Pugh分级C级的比例高于无营养风险的患者（29．5％VS．19．6％，P〈0．001），而A组和B组Child—Pugh分级的构成比无明显差异。有营养风险者的BMI及握力、入院时的白蛋白及前白蛋白均低于无营养风险者，死亡比例高于无营养风险者（11．5％VS．2．9％。P=0．016）。结论 肝硬化住院患者营养不良风险较高。有营养风险的老年肝硬化患者临床转归较差．生活质量下降，需要积极进行营养干预。

A study on nutrition risk and the strategy to elderly hospitalized cirrhotic patients

Objective To assess the nutritional risks in elderly hospitalized patients with cirrhosis by nutritional risk screening 2002 （NRS-2002）, and to explore the clinical significance and develop appropriate nursing strategies to against it. Methods The data of 216 hospitalized patients in artificial liver center, Beijing You＇an Hospital from April 2012 to December 2012 were analyzed, including 37 cases of elderly group （≥ 65 years old, group A） and 179 cases of young group （≤ 64 years old, group B ） .The nutritional status, arm muscle circumference （AMC） and triceps skin-fold thickness （TSF） were evaluated; and NRS-2002 was used to assess nutritional risks. Patient＇s body mass index （BMI）, grip strength, albumin, pre-albumin, lymphocyte count, liver function at admission and discharge, Child-Pugh classification and outcome were recorded. Results The proportion of nutritional risk in group A was higher than in group B （51.4% vs. 33.0%, P = 0.034）. There were no statistically significant differences of malnutrition rates between group A and B by using TSF and MAMC. The proportion of nutritional risk in the patients with Child-Pugh grade C on admission was higher than in non- nutritional risk patients （29.5% vs. 19.6% ,P〈 0.001 ）, whereas no significant difference in the distribution of Child-Pugh classification could be found between group A and B. The BMI, grip strength, albumin and pre-albumin of patients with nutritional risk on admission were lower than those who had non-nutritional risk. And the patients with nutritional risk had higher proportion of deaths than those who had non-nutritional risks （11.5% vs. 2.9%, P= 0.016）. Conclusion Hospitalized cirrhotic patients have high proportion of nutritional risk and malnutrition. Elderly patients with nutritional risks have poor outcomes and low quality of life, so nutritional nursing and nutrition interventions are needed.