酒精依赖病人营养风险筛查及对医院感染的影响
|
摘要
目的:调查酒精依赖病人营养风险,分析营养风险对酒精依赖病人医院感染的影响。方法:选取住院戒酒的酒精依赖病人245例,使用营养风险筛查量表(NRS 2002),对病人进行营养评估,将病人分为研究组(NRS≥3,n=92)和对照组(NRS<3,n=153),观察两组病人医院感染率。结果:研究组发生医院感染34例,发生率36.96%;对照组发生医院感染28例,发生率18.30%。两组病人的医院感染率差异有统计学意义(P=0.01)。感染部位分布,两组病人均以胃肠道和上呼吸道感染为主,感染率分别为16.30%、13.04%和9.15%、6.54%。研究组病人红细胞(P=0.034)、血红蛋白(P<0.001)、白蛋白(P<0.001)和BMI水平(P<0.001)低于对照组病人,差异均有统计学意义;多因素Logistic回归分析显示,NRS 2002评分增加(OR=1.391,P=0.032)、白蛋白降低(OR=0.923,P=0.031)、血红蛋白降低(OR=0.979,P=0.018)和吸烟(OR=1.063,P=0.007)是酒精依赖病人发生医院感染的危险因素。结论:酒精依赖病人更易发生营养风险,且存在营养风险的酒精依赖病人医院感染发生率显著增高。医院感染部位分布显示,两组酒精依赖病人均以胃肠道和上呼吸道感染为主。NRS 2002评分增加、白蛋白降低、血红蛋白降低以及吸烟量增加是酒精依赖病人发生医院感染的危险因素,临床医师应加强对有营养风险的酒精依赖病人的关注,加强营养支持,预防医院感染。
Objective: To investigate the nutrition risk in patients with alcohol dependence and its effects on nosocomial infection. Methods: Two hundred and forty-five hospitalized patients with alcohol dependence at admission were included. Nutrition risk screening 2002(NRS 2002) was used to evaluate the nutrition risk of these patients. They were assigned to the study group(NRS≥3,n=92) and the control group(NRS<3,n=153) according to the NRS 2002 score, and the nosocomial infection rates were recorded and analyzed. Results: In the study group,nosocomial infection occurred in 34 cases,with an incidence rate of 36.96%. In comparison, 28 cases in the control group had nosocomial infection,with an incidence rate of 18.30%, which was significantly lower than that in the study group(P=0.01). Gastrointestinal tract and upper respiratory tract infections were the most common types both in the two groups,with incidence rates of 16.30%,9.15% in the study group and 13.04%, 6.54% in the control group, respectively.In addition,the red blood cells count(P=0.034),the serum levels of hemoglobin(P<0.001) and albumin(P<0.001),and body mass index(BMI)(P<0.001) in the study group were significantly lower than these in the control group.Multivariate Logistic regression analysis showed that increased NRS2002 score(OR=1.391,P=0.032),decreased albumin levels(OR=0.923,P=0.031),decreased hemoglobin levels(OR=0.979,P=0.018) and smoking(OR=1.063,P=0.007) were independent risk factors for nosocomial infection in patients with alcohol dependence. Conclusion:Patients with alcohol dependence are more likely to have nutrition risk, and the incidence of nosocomial infection in alcohol-dependent patients with high nutritional risk significantly increases. Gastrointestinal tract and upper respiratory tract were the most common infection sites in patients with alcohol dependence. Increased NRS 2002 score, decreased albumin levels, decreased hemoglobin levels, and smoking were risk factors for nosocomial infection in alcoholdependent patients. Hence, clinicians should pay more attention to the nutrition risk in alcohol-dependent patients and enhance their nutrition support to prevent infection.
Objective: To investigate the nutrition risk in patients with alcohol dependence and its effects on nosocomial infection. Methods: Two hundred and forty-five hospitalized patients with alcohol dependence at admission were included. Nutrition risk screening 2002(NRS 2002) was used to evaluate the nutrition risk of these patients. They were assigned to the study group(NRS≥3,n=92) and the control group(NRS<3,n=153) according to the NRS 2002 score, and the nosocomial infection rates were recorded and analyzed. Results: In the study group,nosocomial infection occurred in 34 cases,with an incidence rate of 36.96%. In comparison, 28 cases in the control group had nosocomial infection,with an incidence rate of 18.30%, which was significantly lower than that in the study group(P=0.01). Gastrointestinal tract and upper respiratory tract infections were the most common types both in the two groups,with incidence rates of 16.30%,9.15% in the study group and 13.04%, 6.54% in the control group, respectively.In addition,the red blood cells count(P=0.034),the serum levels of hemoglobin(P<0.001) and albumin(P<0.001),and body mass index(BMI)(P<0.001) in the study group were significantly lower than these in the control group.Multivariate Logistic regression analysis showed that increased NRS2002 score(OR=1.391,P=0.032),decreased albumin levels(OR=0.923,P=0.031),decreased hemoglobin levels(OR=0.979,P=0.018) and smoking(OR=1.063,P=0.007) were independent risk factors for nosocomial infection in patients with alcohol dependence. Conclusion:Patients with alcohol dependence are more likely to have nutrition risk, and the incidence of nosocomial infection in alcohol-dependent patients with high nutritional risk significantly increases. Gastrointestinal tract and upper respiratory tract were the most common infection sites in patients with alcohol dependence. Increased NRS 2002 score, decreased albumin levels, decreased hemoglobin levels, and smoking were risk factors for nosocomial infection in alcoholdependent patients. Hence, clinicians should pay more attention to the nutrition risk in alcohol-dependent patients and enhance their nutrition support to prevent infection.
引文
[1]沈渔邨.精神病学.第5版,北京:人民卫生出版社,2014.440-442.
[2]时萍,时露,周建华.酒精依赖的研究进展.中国药物依赖性杂志,2015,24(4):254-256.
[3]张红梅.酒精依赖患者营养不良和肝功能异常的研究.中国药物与临床,2016,16(5):725-726.
[4]吕倩,王伟,姚颖,等.老年营养风险病人易发生医院感染.实用老年医学, 2017,31(1):33-35.
[5]郎华风,赵芳,胡金灵,等.结直肠癌患者营养风险筛查及对术后感染风险的影响.中华医院感染学杂志, 2017, 27(4):839-841.
[6]叶菊花,鲁燕飞,时红云,等.普通外科患者手术部位感染的危险因素分析.中华医院感染学杂志, 2016, 26(4):844-845.
[7]Faramarzi E, Mahdavi R, Mohammad-Zadeh M, et al. Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients. Chin J Cancer Res, 2013, 25(5):544-548.
[8]周锦,高聘,马宁,等.住院病人营养风险筛查及营养支持对临床结局影响的研究.肠外与肠内营养, 2017, 24(1):13-17.
[9]李金梅,李家斌,王进.综合医院医院感染横断面调查分析.中华医院感染学杂志, 2015, 25(1):102-104.
[10]盛永慧,李肖岩,高勇,等.精神科戒酒病房住院患者医院感染危险因素Logistic回归分析.中外医疗, 2017,(6):4-6, 10.
[11]郝伟,王学义,周小波,等.酒精相关障碍的临床表现.中国药物滥用防治杂志, 2017, 23(4):192-195.
[12]曲宝戈,潘锦敦,王中东,等.长期饮酒胃黏膜病理改变与PGE2和EGF的关系.胃肠病学和肝病学杂志, 2011, 20(9):801-803.
[13]李继荣.抗精神病药物致流浪救助病区医院感染分析与对策.中华医院感染学杂志, 2012, 22(21):4692.
[14]张鑫,李慧娟,周亮,等.人工关节置换术后感染的预防、诊断和治疗研究进展.实用药物与临床, 2016, 19(5):639-643.
[15]陈辉乐,徐昌隆,金领微,等.老年肾衰竭患者血液透析感染的危险因素分析.中华医院感染学杂志, 2014, 24(4):911-913.
[16]范世珍,林松青,莫莉,等.康复病房住院患者医院获得性肺炎病原学及危险因素分析.检验医学与临床, 2018, 15(8):1070-1073.
[17]Hu WH, Cajas-Monson LC, Eisenstein S, et al. Preoperative malnutriti-on assessments as predictors of postoperative mortality and morbidity in colorectal cancer:an analysis of ACSNSQIP.Nutr J, 2015, 14:91.
[18]孙庆山,王芳,石恩东,等.抗生素珠链植入联合VSD治疗对慢性骨髓炎患者红细胞免疫功能和生活质量的影响.山东医药, 2017, 57(37):76-78.
[2]时萍,时露,周建华.酒精依赖的研究进展.中国药物依赖性杂志,2015,24(4):254-256.
[3]张红梅.酒精依赖患者营养不良和肝功能异常的研究.中国药物与临床,2016,16(5):725-726.
[4]吕倩,王伟,姚颖,等.老年营养风险病人易发生医院感染.实用老年医学, 2017,31(1):33-35.
[5]郎华风,赵芳,胡金灵,等.结直肠癌患者营养风险筛查及对术后感染风险的影响.中华医院感染学杂志, 2017, 27(4):839-841.
[6]叶菊花,鲁燕飞,时红云,等.普通外科患者手术部位感染的危险因素分析.中华医院感染学杂志, 2016, 26(4):844-845.
[7]Faramarzi E, Mahdavi R, Mohammad-Zadeh M, et al. Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients. Chin J Cancer Res, 2013, 25(5):544-548.
[8]周锦,高聘,马宁,等.住院病人营养风险筛查及营养支持对临床结局影响的研究.肠外与肠内营养, 2017, 24(1):13-17.
[9]李金梅,李家斌,王进.综合医院医院感染横断面调查分析.中华医院感染学杂志, 2015, 25(1):102-104.
[10]盛永慧,李肖岩,高勇,等.精神科戒酒病房住院患者医院感染危险因素Logistic回归分析.中外医疗, 2017,(6):4-6, 10.
[11]郝伟,王学义,周小波,等.酒精相关障碍的临床表现.中国药物滥用防治杂志, 2017, 23(4):192-195.
[12]曲宝戈,潘锦敦,王中东,等.长期饮酒胃黏膜病理改变与PGE2和EGF的关系.胃肠病学和肝病学杂志, 2011, 20(9):801-803.
[13]李继荣.抗精神病药物致流浪救助病区医院感染分析与对策.中华医院感染学杂志, 2012, 22(21):4692.
[14]张鑫,李慧娟,周亮,等.人工关节置换术后感染的预防、诊断和治疗研究进展.实用药物与临床, 2016, 19(5):639-643.
[15]陈辉乐,徐昌隆,金领微,等.老年肾衰竭患者血液透析感染的危险因素分析.中华医院感染学杂志, 2014, 24(4):911-913.
[16]范世珍,林松青,莫莉,等.康复病房住院患者医院获得性肺炎病原学及危险因素分析.检验医学与临床, 2018, 15(8):1070-1073.
[17]Hu WH, Cajas-Monson LC, Eisenstein S, et al. Preoperative malnutriti-on assessments as predictors of postoperative mortality and morbidity in colorectal cancer:an analysis of ACSNSQIP.Nutr J, 2015, 14:91.
[18]孙庆山,王芳,石恩东,等.抗生素珠链植入联合VSD治疗对慢性骨髓炎患者红细胞免疫功能和生活质量的影响.山东医药, 2017, 57(37):76-78.