NRS2002评分预测ICU成人重症患者预后的临床研究
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摘要
目的应用营养风险筛查2002(NRS2002)预测ICU成人重症患者的预后。方法选择2017年1—5月滨州市人民医院重症医学科收治的成人重症患者201例,进行调查性研究。24 h内完成NRS2002评分、急性生理学及慢性健康状况评分(APACHEⅡ),入选患者均经过肠内和/或肠外营养支持。根据患者预后分为死亡组和存活组,比较2组NRS2002评分和APACHEⅡ评分;观察不同营养风险组APACHEⅡ评分和病死率差异;分析NRS2002评分和APACHEⅡ评分对预后的预测价值。应用SPSS 16.0统计软件进行统计分析。结果危重患者中度以上营养风险高达88.6%;死亡组和存活组NRS2002评分和APACHEⅡ评分比较差异有统计学意义(P<0.05);不同营养风险组APACHEⅡ评分和病死率比较差异有统计学意义(P<0.05),中度和重度营养风险组病死率比较差异无统计学意义(P>0.05);NRS2002评分和APACHEⅡ评分与预后呈正相关,相关系数r分别为0.269和0.329;两种评分ROC曲线下面积分别为0.644和0.682,两者比较差异无统计学意义(P>0.05)。结论 ICU成人重症患者存在较高的营养风险,NRS2002评分可反映患者病情危重程度,可对重症患者预后进行预测,尽早营养支持可改善重症患者预后。
Objective To predict the prognosis in ICU adult critically ill patients by application of Nutritional Risk Screening( NRS2002). Methods The 201 adult critically ill patients at Binzhou City People's Hospital of intensive care unit from January,2017 to May,2017,were used investigative research. The patients were scored NRS2002 and APACHEⅡ in 24 hours to complete the score. To give Enteral and/or Parenteral nutrition support. According to the prognosis of patients were divided into death and survival groups,to compare two groups NRS2002 score and APACHEⅡ;Observe there groups APACHE Ⅱ and case fatality rate difference; Analysis the predictive value of NRS2002 and APACHEⅡ on prognosis. Use SPSS 16. 0 statistical software for statistical analysis. Results The risk of moderate nutritional risk was 88. 6% in critical patients. Death and survival groups NRS2002 and APACHEⅡ comparison difference was statistically significant( P < 0. 05). Different nutritional risk group APACHE Ⅱ and case fatality rate comparison difference was statistically significant( P < 0. 05). There was no statistical significance in the moderate and severe nutritional risk group( P > 0. 05). NRS2002 with and APACHEⅡ prognosis presented positive correlation,the correlation coefficient r of 0. 269 and 0. 329,respectively. The two rated ROC curves were 0. 644 and 0. 682 respectively,and the difference was not statistically significant( P > 0. 05). Conclusion There are high nutritional risks in adult critical patients. The NRS2002 reflects the severity of the patient's condition,which can predict the prognosis of a critical patient.Early nutritional support can improve patient outcomes.
Objective To predict the prognosis in ICU adult critically ill patients by application of Nutritional Risk Screening( NRS2002). Methods The 201 adult critically ill patients at Binzhou City People's Hospital of intensive care unit from January,2017 to May,2017,were used investigative research. The patients were scored NRS2002 and APACHEⅡ in 24 hours to complete the score. To give Enteral and/or Parenteral nutrition support. According to the prognosis of patients were divided into death and survival groups,to compare two groups NRS2002 score and APACHEⅡ;Observe there groups APACHE Ⅱ and case fatality rate difference; Analysis the predictive value of NRS2002 and APACHEⅡ on prognosis. Use SPSS 16. 0 statistical software for statistical analysis. Results The risk of moderate nutritional risk was 88. 6% in critical patients. Death and survival groups NRS2002 and APACHEⅡ comparison difference was statistically significant( P < 0. 05). Different nutritional risk group APACHE Ⅱ and case fatality rate comparison difference was statistically significant( P < 0. 05). There was no statistical significance in the moderate and severe nutritional risk group( P > 0. 05). NRS2002 with and APACHEⅡ prognosis presented positive correlation,the correlation coefficient r of 0. 269 and 0. 329,respectively. The two rated ROC curves were 0. 644 and 0. 682 respectively,and the difference was not statistically significant( P > 0. 05). Conclusion There are high nutritional risks in adult critical patients. The NRS2002 reflects the severity of the patient's condition,which can predict the prognosis of a critical patient.Early nutritional support can improve patient outcomes.
引文
[1]范锐心,黄娟,陆鹏,等.住院恶性肿瘤患者营养状况及影响因素调查[J].广东医学,2015,36(24):3846-3848.
[2]王中平,王健,王帅,等.危重症患者的营养支持评定[J].临床误诊误治,2014,27(1):112-114.
[3]程伟鹤,刘华平.营养风险筛查工具在危重症患者中的应用现状[J].中国护理管理,2016,16(8):1140-1143.
[4]Kyle UG,Kossovsky MP,Karsegard VL,et al.Comparison of tools for nutritional assessment and screening at hospital admission:A population study[J].Clin Nutr,2006,25(3):409-417.
[5]米国莲,王翠坤,王春艳.健康体检人群体重指数与脂肪肝关系的调查分析[J].河北医药,2013,35(17):2671-2672.
[6]习秀霞,李景荣,程景林.APACHEⅡ评分在预测百草枯中毒预后中的应用[J].安徽医药,2014,18(9):1699-1701.
[7]詹斯·康卓普,雷米·梅耶,顾良军,等.营养风险筛查2002改善临床结局[J].中华临床营养杂志,2013,21(3):133-139.
[8]蒋朱明,陈伟,朱赛楠,等.中国东、中、西部大城市三甲医院营养不良(不足)营养风险发生率及营养支持应用状况调查[J].中华临床营养杂志,2008,16(6):335-337.
[9]周锦,高娉,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[J].肠外与肠内营养,2017,24(1):13-17.
[10]Eide HK,Saltyte Benth,Sortland K,et al.Prevalence of nutritional risk in the non-demented hospitalised elderly:a cross-sectional study from Norway using stratifled sampling[J].J Nutr Sci,2015,4:e18.
[11]凌燕.神经外科危重患者营养风险及其影响因素研究[J].实用临床医药杂志,2017,21(10):43-46.
[12]Kondrup J,Rasmussen HH,Hamberg O,et al.Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J].Clin Nutr,2003,22(3):321-336.
[13]侯永超,王建芬,宁亮亮.ICU危重病人营养风险筛查与营养支持效果[J].护理研究,2015,29(3):361-362.
[14]毕红英,唐艳,王迪芬.重症患者的营养风险评估及其预后分析[J].中华危重病急救医学,2016,28(6):557-562.
[15]Taylor BE,Mc Clave SA,Martindale RG,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N)[J].Crit Care Med,2016,44(2):390-438.
[16]李广罡,张美燕,孙玥,等.危重症营养风险评分在神经系统危重症病人中的应用[J].肠外与肠内营养,2015,22(5):261-263.
[17]王润辉,苑玉存,王芳,等.早期肠内营养应用于神经外科重症患者临床观察[J].陕西医学杂志,2017,46(7):919-922.
[18]安志红,王殿华,张静,等.营养风险筛查2002和APACHEⅡ评分与老年危重患者预后的关系[J].内科急危重症杂志,2014,20(4):235-236,243.
[19]丁雪,冯秋斌,赵苏丹.肺癌脑转移患者放化疗前后营养风险筛查比较[J].河北医药,2017,39(14):2161-2163.
[20]戴莉敏,贡浩凌,高燕,等.JCI标准下住院患者营养管理的实践与效果[J].中华护理杂志,2014,49(3):316-321.
[2]王中平,王健,王帅,等.危重症患者的营养支持评定[J].临床误诊误治,2014,27(1):112-114.
[3]程伟鹤,刘华平.营养风险筛查工具在危重症患者中的应用现状[J].中国护理管理,2016,16(8):1140-1143.
[4]Kyle UG,Kossovsky MP,Karsegard VL,et al.Comparison of tools for nutritional assessment and screening at hospital admission:A population study[J].Clin Nutr,2006,25(3):409-417.
[5]米国莲,王翠坤,王春艳.健康体检人群体重指数与脂肪肝关系的调查分析[J].河北医药,2013,35(17):2671-2672.
[6]习秀霞,李景荣,程景林.APACHEⅡ评分在预测百草枯中毒预后中的应用[J].安徽医药,2014,18(9):1699-1701.
[7]詹斯·康卓普,雷米·梅耶,顾良军,等.营养风险筛查2002改善临床结局[J].中华临床营养杂志,2013,21(3):133-139.
[8]蒋朱明,陈伟,朱赛楠,等.中国东、中、西部大城市三甲医院营养不良(不足)营养风险发生率及营养支持应用状况调查[J].中华临床营养杂志,2008,16(6):335-337.
[9]周锦,高娉,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[J].肠外与肠内营养,2017,24(1):13-17.
[10]Eide HK,Saltyte Benth,Sortland K,et al.Prevalence of nutritional risk in the non-demented hospitalised elderly:a cross-sectional study from Norway using stratifled sampling[J].J Nutr Sci,2015,4:e18.
[11]凌燕.神经外科危重患者营养风险及其影响因素研究[J].实用临床医药杂志,2017,21(10):43-46.
[12]Kondrup J,Rasmussen HH,Hamberg O,et al.Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J].Clin Nutr,2003,22(3):321-336.
[13]侯永超,王建芬,宁亮亮.ICU危重病人营养风险筛查与营养支持效果[J].护理研究,2015,29(3):361-362.
[14]毕红英,唐艳,王迪芬.重症患者的营养风险评估及其预后分析[J].中华危重病急救医学,2016,28(6):557-562.
[15]Taylor BE,Mc Clave SA,Martindale RG,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N)[J].Crit Care Med,2016,44(2):390-438.
[16]李广罡,张美燕,孙玥,等.危重症营养风险评分在神经系统危重症病人中的应用[J].肠外与肠内营养,2015,22(5):261-263.
[17]王润辉,苑玉存,王芳,等.早期肠内营养应用于神经外科重症患者临床观察[J].陕西医学杂志,2017,46(7):919-922.
[18]安志红,王殿华,张静,等.营养风险筛查2002和APACHEⅡ评分与老年危重患者预后的关系[J].内科急危重症杂志,2014,20(4):235-236,243.
[19]丁雪,冯秋斌,赵苏丹.肺癌脑转移患者放化疗前后营养风险筛查比较[J].河北医药,2017,39(14):2161-2163.
[20]戴莉敏,贡浩凌,高燕,等.JCI标准下住院患者营养管理的实践与效果[J].中华护理杂志,2014,49(3):316-321.