评定外科病人蛋白质热量营养不良发病率

目的调查外科住院病人蛋白质-热量营养不良(PEM)发病率，评定并比较中青年及老年患者人体组成差异。方法随机抽取北京协和医院1998～1999年度外科择期手术病人378例(老年病例152例)术前进行(1)人体测量(体重、体重指数BMI、上臂围、上臂肌围、三头肌皮褶厚度、握力)；(2)人体组成分析(生物电阻抗法，测定瘦体组织LBM、总体脂肪TBF和总体TBW)；(3)血清前白蛋白测定(速率透射比浊法)及(4)膳食调查(24小时回顾法，测定5天)等。结果(1)术前PEM总发病率为33.4%，外科老年患者显著高于中青年患者(41.6%vs27.9%,P<0.05)；(2)营养正常与营养不良病人的人体测量及血清前白蛋白测定结果有显著性差异(P<0.05)；(3)与中青年相比，老年患者LBM显著降低(男性46.1±6.3kgvs51.3±6.1kg,P<0.05；女性34.2±4.5kgvs38.2±4.1kg,P<0.05)；老年女性LBM%显著降低(62.2±8.7%vs68.4±7.9%,P<0.05)，TBF%显著升高(38.0±5.8%vs31.2±7.5%,P<0.05)。结论应考虑对外科病人术前术后进行肠内与肠外营养支持；老年外科病人PEM发病率高，且易发生LBM丢失，故对其更应注意补充能量及氮源。

Assessment of protein energy malnutrition(PEM) mobidity in surgical patients

Objective To measure the protein-energy malnutrition(PEM)mobidity in surgical inpatients in Peking Union Medical College Hospital. Methods 387 surgical patients'(1)anthropometry (BWt,BMI,AC,AMC,TSF,GS),(2)body composition(LBM,TBF and TBW),(3)serum prealbumin and (4) diet intake (24 hour record)were measured within the first week of the hospitalized. Results (1)The PEM mobidity was 33.4% in surgical inpatients.The mobidity of elderly patients was significant higher than youngers'(41.6% vs 27.9%,P<0.05);(2)There were significant difference in anthropometry,serum prealbumin and body composition between well nourished or frank malnutrition patients judged by MNA;(3)Compare to youngers,LBM was decreased in elderly inpatients (male:46.1±6.3kg vs 51.3±6.1kg,P<0.05;female:34.2±4.5kg vs 38.2±.1kg,P<0.05);LBM % and TBF% were decreased (62.2±8.7% vs 68.4±7.9%,P<0.05)and increased (38.0±5.8% vs 31.2±7.5%,P<0.05) respectively in female elderly inpatients. Conclusions The nutritional status of surgical patients should be improved by enteral and parenteral nutritional support during pre-and postoperation periods.The supplements of energy and nitrogen to elderly inpatients should be plenty.