广东梅州消化内科住院患者营养风险率调查
|
摘要
目的：
使用营养风险筛查2002工具(Nutritional Risk Screening 2002,NRS2002)筛查消化内科住院患者营养风险率及临床营养支持使用率。
方法：
定点连续调查广东省梅州市两家医院消化内科住院患者共1190例。患者入院后应用NRS2002方法调查。根据患者疾病严重程度,营养状况受损以及年龄三方面,评定营养风险。营养风险总评分大于或等于3分者评定为有营养风险,总评分小于3分者评定为无营养风险。通过病历了解患者的营养支持情况。
结果：
1、在1190名患者中营养风险总评分大于或等于3分者共460例,占38.7%,营养风险总评分小于3分者共730例,占61.3%。
2、640例男性住院患者中有营养风险254例,占39.7%；550例女性患者中有营养风险的206例,占37.5%；不同性别间未见显著性差异(χ2=0.674,P=0.407)。
3、调查对象中大于或等于65岁的患者共434例,有营养风险214例,占49.3%；小于65岁的患者756例,有营养风险246例,占32.5%；大于等于65岁组患者营养风险发生率明显高于65岁以下组患者的营养风险发生率(χ2=26.345,P=0.000)。
4、1190例患者中,实施了营养支持的共435例,占36.6%。
5、在460例有营养风险的患者中实施了营养支持的共270例,占有营养风险患者总人数的58.7%；730例无营养风险的患者中实施了营养支持的中共有165例,占无营养风险患者总人数的22.6%。
6、在1047例可测体质指数(body mass index,BMI)的患者中,经BMI评定处于低体重者共316例,占30.2%；理想体重患者共545例,占52.1%；肥胖及超重患者共186例,占17.7%。
7、316例经BMI评定处于低体重者中共有168例患者实施了营养支持,占53.2%。
8、1190例患者中可计算BMI的患者共1047例；其中有营养风险者423例,占可测BMI患者总例数的40.4%；423例可测量BMI并有营养风险的患者中,营养支持率为53.0%；1047例可测量体质指数的患者中,共有624例患者无营养风险。在此624例可测量BMI、无营养风险的患者中,营养支持率为26.3%。
结论：
1、梅州市医院消化内科住院患者存在较高的营养风险率与营养不良的发生率,营养支持率低,临床营养支持远远没有满足目前住院患者的需要,既存在营养支持使用不足,同时也存在着滥用。
2、在已实施营养支持的患者中肠外营养应用率要高于肠内营养。
3、NRS2002是一个简便、快速、经济的营养风险筛查工具,该工具结合我国BMI的评定标准可用于筛查我国住院患者的营养风险。
Objective:
To assess the nutritional risk and the nutritional support rate in hospitalized patients of gastroenterology by Nutritional Risk Screening 2002(NRS2002).
Methods:
Nutritional risk screen and the status of nutrition support were evaluated in hospitalized patients in gastroenterology department of two hospitals in Meizhou city, Guangdong province. The NRS2002 includes three parts:①the severity of disease;②the nutrition status including BMI (or sALB);③the ages of patients. The total score greater than 3 was justified as at nutritional risk.
Results:
1. Totally 1190 patients were evaluated with NRS2002. Among them 460 patients which account for 38.7% were considered at nutritional risk, and 730 patients which account for 61.3% were not considered at nutritional risk.
2. There were 254 male patients that account for 39.7% of all male patients at nutrition risk, and 206 female patients that account for 37.5% of all female patients were at nutritional risk. There was no significant difference between male patients and female patients(x2=0.622, P =0.430).
3. There were 434 patients greater than or equal to 65-year-old, among them 214 patients which account for 49.3% were considered at nutritional risk, which was significantly higher than that of patients younger than 65 years old(32.5%)(x2=32.969, P=0.000).
4. In the total 1190 patients, nutritional support was given to 435 patients that account for 36.6%.
5. In 460 patients with nutritional risk,270 of them which account for 58.7% received nutritional support, the nutritional support rate in 730 patients without nutritional risk was 22.6%.
6. BMI was measured in 1047 patients. Among them 316 ones with their BMI<18.5kg/m2 were judged as malnutrition which account for 30.2%.
7. In 316 patients judged as malnutrition by BMI 168 ones that account for 53.2% received nutritional support.
8. BMI was measured in 1047 patients. Among them 423 patients which account for 40.4% were considered at nutritional risk, and 224 of these 423 patients which account for 53.0% received nutritional support,624 of these 1047 patients mentioned above, which account for 60.0% were not considered at nutritional risk, and 164 of these 624 patients which account for 26.3% received nutritional support.
Conclusions:
1. The prevalence of nutritional risk and malnutrition were high in hospital patients of gastroenterology in Meizhou, but the rate of nutritional support was low. The results indicated that the actual nutritional support had not met the need of hospitalized patients.
2. The application rate of parenteral nutrition was higher than that of enteral nutrition.
3. The present study showed that the NRS2002 was simple, rapid and economic. Combining with the normal value of BMI, it was feasible to screen the nutritional risk of hospitalized patients in China.
使用营养风险筛查2002工具(Nutritional Risk Screening 2002,NRS2002)筛查消化内科住院患者营养风险率及临床营养支持使用率。
方法：
定点连续调查广东省梅州市两家医院消化内科住院患者共1190例。患者入院后应用NRS2002方法调查。根据患者疾病严重程度,营养状况受损以及年龄三方面,评定营养风险。营养风险总评分大于或等于3分者评定为有营养风险,总评分小于3分者评定为无营养风险。通过病历了解患者的营养支持情况。
结果：
1、在1190名患者中营养风险总评分大于或等于3分者共460例,占38.7%,营养风险总评分小于3分者共730例,占61.3%。
2、640例男性住院患者中有营养风险254例,占39.7%；550例女性患者中有营养风险的206例,占37.5%；不同性别间未见显著性差异(χ2=0.674,P=0.407)。
3、调查对象中大于或等于65岁的患者共434例,有营养风险214例,占49.3%；小于65岁的患者756例,有营养风险246例,占32.5%；大于等于65岁组患者营养风险发生率明显高于65岁以下组患者的营养风险发生率(χ2=26.345,P=0.000)。
4、1190例患者中,实施了营养支持的共435例,占36.6%。
5、在460例有营养风险的患者中实施了营养支持的共270例,占有营养风险患者总人数的58.7%；730例无营养风险的患者中实施了营养支持的中共有165例,占无营养风险患者总人数的22.6%。
6、在1047例可测体质指数(body mass index,BMI)的患者中,经BMI评定处于低体重者共316例,占30.2%；理想体重患者共545例,占52.1%；肥胖及超重患者共186例,占17.7%。
7、316例经BMI评定处于低体重者中共有168例患者实施了营养支持,占53.2%。
8、1190例患者中可计算BMI的患者共1047例；其中有营养风险者423例,占可测BMI患者总例数的40.4%；423例可测量BMI并有营养风险的患者中,营养支持率为53.0%；1047例可测量体质指数的患者中,共有624例患者无营养风险。在此624例可测量BMI、无营养风险的患者中,营养支持率为26.3%。
结论：
1、梅州市医院消化内科住院患者存在较高的营养风险率与营养不良的发生率,营养支持率低,临床营养支持远远没有满足目前住院患者的需要,既存在营养支持使用不足,同时也存在着滥用。
2、在已实施营养支持的患者中肠外营养应用率要高于肠内营养。
3、NRS2002是一个简便、快速、经济的营养风险筛查工具,该工具结合我国BMI的评定标准可用于筛查我国住院患者的营养风险。
Objective:
To assess the nutritional risk and the nutritional support rate in hospitalized patients of gastroenterology by Nutritional Risk Screening 2002(NRS2002).
Methods:
Nutritional risk screen and the status of nutrition support were evaluated in hospitalized patients in gastroenterology department of two hospitals in Meizhou city, Guangdong province. The NRS2002 includes three parts:①the severity of disease;②the nutrition status including BMI (or sALB);③the ages of patients. The total score greater than 3 was justified as at nutritional risk.
Results:
1. Totally 1190 patients were evaluated with NRS2002. Among them 460 patients which account for 38.7% were considered at nutritional risk, and 730 patients which account for 61.3% were not considered at nutritional risk.
2. There were 254 male patients that account for 39.7% of all male patients at nutrition risk, and 206 female patients that account for 37.5% of all female patients were at nutritional risk. There was no significant difference between male patients and female patients(x2=0.622, P =0.430).
3. There were 434 patients greater than or equal to 65-year-old, among them 214 patients which account for 49.3% were considered at nutritional risk, which was significantly higher than that of patients younger than 65 years old(32.5%)(x2=32.969, P=0.000).
4. In the total 1190 patients, nutritional support was given to 435 patients that account for 36.6%.
5. In 460 patients with nutritional risk,270 of them which account for 58.7% received nutritional support, the nutritional support rate in 730 patients without nutritional risk was 22.6%.
6. BMI was measured in 1047 patients. Among them 316 ones with their BMI<18.5kg/m2 were judged as malnutrition which account for 30.2%.
7. In 316 patients judged as malnutrition by BMI 168 ones that account for 53.2% received nutritional support.
8. BMI was measured in 1047 patients. Among them 423 patients which account for 40.4% were considered at nutritional risk, and 224 of these 423 patients which account for 53.0% received nutritional support,624 of these 1047 patients mentioned above, which account for 60.0% were not considered at nutritional risk, and 164 of these 624 patients which account for 26.3% received nutritional support.
Conclusions:
1. The prevalence of nutritional risk and malnutrition were high in hospital patients of gastroenterology in Meizhou, but the rate of nutritional support was low. The results indicated that the actual nutritional support had not met the need of hospitalized patients.
2. The application rate of parenteral nutrition was higher than that of enteral nutrition.
3. The present study showed that the NRS2002 was simple, rapid and economic. Combining with the normal value of BMI, it was feasible to screen the nutritional risk of hospitalized patients in China.
引文
[1]于康,赵维刚,阮晓兰.内分泌科住院患者营养风险筛查及营养支持应用状况.[J].中华临床营养杂志,2009,17(2)：712-74.
[2]梁晓坤,揭彬,蒋朱明.营养风险理念解读.[J].中国临床营养杂志,2002,15(3)：167-70.
[3]Bruce RS, Blackburn GL, Joseph V, et al. Prevalence of malnutrition in general medical patients.[J]. JAMA,1976,235(4):1567-70.
[4]MeWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital[J]. BMJ,1994,308(9):945-8.
[5]Jiang ZM, Chen W, Zhan WH, et al. Parenteral and enteral nutrition application in West Middle and East of China:a multi-centre investigation for 15098 patients in 13 metropoli-tansusing NRS tool[J]. Clin Nutr,2007,2(12):133-4.
[6]Wu GH,Liu ZH,Zheng LW,et al.Prevalence of malnutrition in general surgical patients:evaluation of nutrition status and prognosis[J].Zhonghua Wai ke za zhi,2005,43(11):693-6.
[7]Damulevieiene QLesauskaite V,Macijauskiene J.Nutritional states of elderly surgical patients[J].Medicina(Kaunas),2008,44(8):609-18.
[8]Raja R,lim AV,Lim YP,et al.Malnutrition screening in hospitalized patients and its implication on reimbursement [J].Intern Med J,2004,34(4):176-81.
[9]Bowers S. Nutrition support for malnourished,acutely ill adults[J]MEDSURG Nurs, 1999,8(3):145-64.
[10]TheVeterans AffairsTotal Parenteral Nutrition CooPeration Study Group.PerioPerative total Parenteral nutritionin surgieal Patients [J]. N Engl J Med,1991,325(8):525-32.
[11]Johansen N, Kondrup, Plum LM,et al.Effect of nutritional support on clinical outeome in patienis at nutritional risk[Jl.ClinNutr,2004,23(4):539-50.
[12]Corish C, Kennedy N. Protein-energy undernutrition in hospital in-patients[J]. Br J Nutr,2000,83(6):575-91.
[13]American Dietetic Associationl Identifying patients at risk:ADA's definitions for nutrition screening and nutrition assess2ment [J].J Am Diet Assoc,1994,94(8):838-39.
[14]ASPEN. Board of directors. Definition of terms used in ASPEN.Guidelines and Standards [J]. Nutr Clin Pract,1995,10(1):1-3.
[15]Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002 [J].Clin Nutr,2003,22(4):415-21.
[16]Sungurtekin H, Sungurtekin U, HanciV, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J].Nutrition,2004,20(5):428-32.
[17]Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status[J].JPEN,1987,11(1):8-13.
[18]Guigoz Y, Vellas BJ, Garry PJ. Mini Nutritional Assessment:a practical assessment tool for grading the nutritional state of elderly patients[J]. Facts Res Gerontonol,1994,4(2):15-59.
[19]NC Shum,WWH Hui,FCS Chu,et al.Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital[J].Hong Kong Med Journal,2005,11(4):234-42.
[20]Masafumi Kuzuya,Shigeru Kand,Teruhiko Koike,et al.Evaluati on ofMini2 Nutriti on Assessment for Japanese frail elderly[J].2005,21(4):498-503.
[21]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):321-36.
[22]Johansen N, Kondrup J, Plum L, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk[J].Clin Nutr,2004:23 (4):539-50.
[23]Kondrup J, Allison P, Elia M. ESPEN Guidelines for nutrition screening 2002[J]. Clin Nutr, 2003,22(4):415-21.
[24]Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional suppo-between Beijing and Baltimore teaching hospitals[J]. Nutrition,2008,24(10):969-76.
[25]于康,夏莹,王孟昭.营养风险筛查和主观全面评定用于肺癌非手术患者营养筛查的比较[J].中国临床营养杂志2008,16(6)：349-52.
[26]于康,陈伟.外科老年住院病人的营养状况评定[J].营养学报,1999,21(2)：212-13.
[27]Kondrup J, Allison SP, EliaM, et al. ESPEN guidelines for nutrition screening 2002[J].Clin Nutr,2003,22(4):415-21.
[28]Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS2002):a new method based on an analysis of controlled clinical trial[J].Clin Nutr,2003,22(3):321-336.
[29]Johansen N, Kondrup J, Plum L, et all Effect of nutritional support on clinical outcome in patients at nutriti onal risk[J].Clin Nutr,2004,23(4):539-50.
[30]陈伟,蒋朱明,张咏梅.欧洲营养风险调查方法在中国住院患者的临床可行性研究[J].中国临床营养杂志,2005,13(3)：137-41.
[31]J iang Z M,ChenW,ZhanWH,et al.Parenteral and enteral nutrition app lication in west, middle and east China:a multi-center investigation for 15098 patients in 13 metropolitans using nutritional risk screening 2002 tool[J].Clin Nutr,2007,2 (1):133-4.
[32]Kyle UG, KossovskyMP, Karsegard VL, et al. Comparison of t ools for nutriti onal assessment and screening at hosp ital admission:a population study[J].Clin Nutr,2006, 25(3):409-17.
[33]崔丽英,张澍田,于康.北京大医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况[J].中国临床营养杂志,36(6)：341-5.
[34]Sorensen JM, Kondrup J, group. Es Abstract:EuroOOPS:an international, multicenter study to implement nutrition screening and evaluate clinical otrcome[J].Clin Nutr, 2005,24(4):538-9.
[35]Barreto Penie J.State of malnutrition in Cuban hospitals[J]. Nutrition,2005,21(4):487-497.
[36]Duddck SJ,Wilmore DW,Vars HM,et al.Long-term total parenteral nutrition with growth,development,and positive nitrogen balance[J].Surgey,1968,64(1):134-42.
[37]Albert RK.Comments on nutritional support guidelines[J].Cr it Care Med,2009,37(9):2679-80.
[38]Awad S,Herrod PJ,Forbes E,et al.Knowledge and attitudes of surgical trainees towards nutritional support:Food for thought[J].Clin Nutr,2009,29(2):243-8.
[39]KuJ,Yunshi Z,Li R.Immunonutrition in surgical patients[J].Curr Drug Targets,2009,10(8):771-7.
[1]于康,赵维刚,阮晓兰.内分泌科住院患者营养风险筛查及营养支持应用状况[J].中华临床营养杂志,2009,17(2)：712-74.
[2]Nor man K,Pichard C,Lochs H,et al.Prognostic impact of disease-related malnutrition[J].Clin Nutr,2008,27(1):5-15.
[3]Amaral TF,Matos LC,Tavares MM,et al.The economic impact disease-related malnutrition at hospital admission[J].Clin Nu,2007,26(6):778-84.
[3]Raja R,lim AV,Lim YP,et al.Malnutrition screening in hospitalized patients and its implica-tion on reimbursement[J].Intern Med J,2004,34(4):176-81.
[4]Canovas Pareja C,Sanjoaquin Romero AC,Val lafaja AD,et al.Impact of malnuatrition on clinical outcome in hospitalized elderly patients[J].Med Clin(Barc),2009,doi:10.1016.
[5]Sara Pasquinelli CS.Nutritional assessment and malnutrition in multiple sclerosis[J].Neurol Sci,2008,29:S367-9.
[6]吴肇汉.外科病人的代谢及营养评价闭.外科杂志.1997：2(2)：114-16.
[7]Cooper A,Jakobowski D,Spiker J,et al.Nutritional assessment:an integral part of the preoperative surgical evaluation[J].J Pediatr Surg,1981,16(4):554-61.
[8]Sanchez Munoz LA,Cruz Calvo Reyes M,Barbado Ajo J,et al.Screening tools for hospital malnutrition[J].Med Clin(Barc),2009,9(18):867-72..
[9]Tsai AC,Chang TL,Chen JT,et al.Population-specific modifications of the short-form Mini Nutritional Assessment and Malnutrition Universal Screening Tool for elderly Taiwangese[J].Int J Nurs Stud,2009,46(11):143-8.
[10]Awad S,Herrod PJ,Forbes E,et al.Knowledge and attitudes of surgical trainees towards nutritional support:Food for thought[J].Clin Nutr,2009,29(2):243-8.
[11]Bistrian BR.Brief history of parenteral and enteral nutrition in the hospital in the USA[J].Nestle Nutr Workshop Ser Clin Perform Programme,2009,12(20):127-36.
[12]Duddck SJ,Wilmore DW, Vars HM, et al.Long-term total parenteral nutrition with growth,development,and positive nitrogen balance[J].Surgey,1968,64(1):134-142.
[13]陈溉,姚健,官禹.食管癌患者术后EN与肠外营养支持的效果比较[J].西部医学,2009,21(6)：918-22.
[14]Heyland DK,MacDonald S, Keefe L, et al. Total parenteral nutri-tion in the critically ill patient:a meta-analysis [J]. JAMA,1998,280 (23):2013-9.
[15]Albert RK. Comments on nutritional support guidelines[J].Crit Care Med.2009,37(9):2679-80.
[16]Barrera S,Demark-Wahnefride W.Nutrition during and after cancer therapy[J].Oncolog-y(Williston Park),2009,23(2):15-21.
[17]Ku J,Yunshi Z,Li R.Immunonutrition in surgical patients[J].Curr Drug Targets,2009,10(8):771-7.
[18]Koretz RL.Enteral nutrition:a hard look at some soft evidence [J].Nutr Clin Pract.2009,24(3):335-43.
[19]Singh N,Gupta D,Aggarwal AN,et al.An sssessment of nutrtional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit[J].Respir Care,2009,54(12):1688-96.,
[20]Sriram K,Cyriac T,Fogg LF.Effect of nutritional team restructuring on the use of parenteral nutrition[J].Nutrition,2009,8(12):1-5.
[2]梁晓坤,揭彬,蒋朱明.营养风险理念解读.[J].中国临床营养杂志,2002,15(3)：167-70.
[3]Bruce RS, Blackburn GL, Joseph V, et al. Prevalence of malnutrition in general medical patients.[J]. JAMA,1976,235(4):1567-70.
[4]MeWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital[J]. BMJ,1994,308(9):945-8.
[5]Jiang ZM, Chen W, Zhan WH, et al. Parenteral and enteral nutrition application in West Middle and East of China:a multi-centre investigation for 15098 patients in 13 metropoli-tansusing NRS tool[J]. Clin Nutr,2007,2(12):133-4.
[6]Wu GH,Liu ZH,Zheng LW,et al.Prevalence of malnutrition in general surgical patients:evaluation of nutrition status and prognosis[J].Zhonghua Wai ke za zhi,2005,43(11):693-6.
[7]Damulevieiene QLesauskaite V,Macijauskiene J.Nutritional states of elderly surgical patients[J].Medicina(Kaunas),2008,44(8):609-18.
[8]Raja R,lim AV,Lim YP,et al.Malnutrition screening in hospitalized patients and its implication on reimbursement [J].Intern Med J,2004,34(4):176-81.
[9]Bowers S. Nutrition support for malnourished,acutely ill adults[J]MEDSURG Nurs, 1999,8(3):145-64.
[10]TheVeterans AffairsTotal Parenteral Nutrition CooPeration Study Group.PerioPerative total Parenteral nutritionin surgieal Patients [J]. N Engl J Med,1991,325(8):525-32.
[11]Johansen N, Kondrup, Plum LM,et al.Effect of nutritional support on clinical outeome in patienis at nutritional risk[Jl.ClinNutr,2004,23(4):539-50.
[12]Corish C, Kennedy N. Protein-energy undernutrition in hospital in-patients[J]. Br J Nutr,2000,83(6):575-91.
[13]American Dietetic Associationl Identifying patients at risk:ADA's definitions for nutrition screening and nutrition assess2ment [J].J Am Diet Assoc,1994,94(8):838-39.
[14]ASPEN. Board of directors. Definition of terms used in ASPEN.Guidelines and Standards [J]. Nutr Clin Pract,1995,10(1):1-3.
[15]Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002 [J].Clin Nutr,2003,22(4):415-21.
[16]Sungurtekin H, Sungurtekin U, HanciV, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J].Nutrition,2004,20(5):428-32.
[17]Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status[J].JPEN,1987,11(1):8-13.
[18]Guigoz Y, Vellas BJ, Garry PJ. Mini Nutritional Assessment:a practical assessment tool for grading the nutritional state of elderly patients[J]. Facts Res Gerontonol,1994,4(2):15-59.
[19]NC Shum,WWH Hui,FCS Chu,et al.Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital[J].Hong Kong Med Journal,2005,11(4):234-42.
[20]Masafumi Kuzuya,Shigeru Kand,Teruhiko Koike,et al.Evaluati on ofMini2 Nutriti on Assessment for Japanese frail elderly[J].2005,21(4):498-503.
[21]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):321-36.
[22]Johansen N, Kondrup J, Plum L, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk[J].Clin Nutr,2004:23 (4):539-50.
[23]Kondrup J, Allison P, Elia M. ESPEN Guidelines for nutrition screening 2002[J]. Clin Nutr, 2003,22(4):415-21.
[24]Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional suppo-between Beijing and Baltimore teaching hospitals[J]. Nutrition,2008,24(10):969-76.
[25]于康,夏莹,王孟昭.营养风险筛查和主观全面评定用于肺癌非手术患者营养筛查的比较[J].中国临床营养杂志2008,16(6)：349-52.
[26]于康,陈伟.外科老年住院病人的营养状况评定[J].营养学报,1999,21(2)：212-13.
[27]Kondrup J, Allison SP, EliaM, et al. ESPEN guidelines for nutrition screening 2002[J].Clin Nutr,2003,22(4):415-21.
[28]Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS2002):a new method based on an analysis of controlled clinical trial[J].Clin Nutr,2003,22(3):321-336.
[29]Johansen N, Kondrup J, Plum L, et all Effect of nutritional support on clinical outcome in patients at nutriti onal risk[J].Clin Nutr,2004,23(4):539-50.
[30]陈伟,蒋朱明,张咏梅.欧洲营养风险调查方法在中国住院患者的临床可行性研究[J].中国临床营养杂志,2005,13(3)：137-41.
[31]J iang Z M,ChenW,ZhanWH,et al.Parenteral and enteral nutrition app lication in west, middle and east China:a multi-center investigation for 15098 patients in 13 metropolitans using nutritional risk screening 2002 tool[J].Clin Nutr,2007,2 (1):133-4.
[32]Kyle UG, KossovskyMP, Karsegard VL, et al. Comparison of t ools for nutriti onal assessment and screening at hosp ital admission:a population study[J].Clin Nutr,2006, 25(3):409-17.
[33]崔丽英,张澍田,于康.北京大医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况[J].中国临床营养杂志,36(6)：341-5.
[34]Sorensen JM, Kondrup J, group. Es Abstract:EuroOOPS:an international, multicenter study to implement nutrition screening and evaluate clinical otrcome[J].Clin Nutr, 2005,24(4):538-9.
[35]Barreto Penie J.State of malnutrition in Cuban hospitals[J]. Nutrition,2005,21(4):487-497.
[36]Duddck SJ,Wilmore DW,Vars HM,et al.Long-term total parenteral nutrition with growth,development,and positive nitrogen balance[J].Surgey,1968,64(1):134-42.
[37]Albert RK.Comments on nutritional support guidelines[J].Cr it Care Med,2009,37(9):2679-80.
[38]Awad S,Herrod PJ,Forbes E,et al.Knowledge and attitudes of surgical trainees towards nutritional support:Food for thought[J].Clin Nutr,2009,29(2):243-8.
[39]KuJ,Yunshi Z,Li R.Immunonutrition in surgical patients[J].Curr Drug Targets,2009,10(8):771-7.
[1]于康,赵维刚,阮晓兰.内分泌科住院患者营养风险筛查及营养支持应用状况[J].中华临床营养杂志,2009,17(2)：712-74.
[2]Nor man K,Pichard C,Lochs H,et al.Prognostic impact of disease-related malnutrition[J].Clin Nutr,2008,27(1):5-15.
[3]Amaral TF,Matos LC,Tavares MM,et al.The economic impact disease-related malnutrition at hospital admission[J].Clin Nu,2007,26(6):778-84.
[3]Raja R,lim AV,Lim YP,et al.Malnutrition screening in hospitalized patients and its implica-tion on reimbursement[J].Intern Med J,2004,34(4):176-81.
[4]Canovas Pareja C,Sanjoaquin Romero AC,Val lafaja AD,et al.Impact of malnuatrition on clinical outcome in hospitalized elderly patients[J].Med Clin(Barc),2009,doi:10.1016.
[5]Sara Pasquinelli CS.Nutritional assessment and malnutrition in multiple sclerosis[J].Neurol Sci,2008,29:S367-9.
[6]吴肇汉.外科病人的代谢及营养评价闭.外科杂志.1997：2(2)：114-16.
[7]Cooper A,Jakobowski D,Spiker J,et al.Nutritional assessment:an integral part of the preoperative surgical evaluation[J].J Pediatr Surg,1981,16(4):554-61.
[8]Sanchez Munoz LA,Cruz Calvo Reyes M,Barbado Ajo J,et al.Screening tools for hospital malnutrition[J].Med Clin(Barc),2009,9(18):867-72..
[9]Tsai AC,Chang TL,Chen JT,et al.Population-specific modifications of the short-form Mini Nutritional Assessment and Malnutrition Universal Screening Tool for elderly Taiwangese[J].Int J Nurs Stud,2009,46(11):143-8.
[10]Awad S,Herrod PJ,Forbes E,et al.Knowledge and attitudes of surgical trainees towards nutritional support:Food for thought[J].Clin Nutr,2009,29(2):243-8.
[11]Bistrian BR.Brief history of parenteral and enteral nutrition in the hospital in the USA[J].Nestle Nutr Workshop Ser Clin Perform Programme,2009,12(20):127-36.
[12]Duddck SJ,Wilmore DW, Vars HM, et al.Long-term total parenteral nutrition with growth,development,and positive nitrogen balance[J].Surgey,1968,64(1):134-142.
[13]陈溉,姚健,官禹.食管癌患者术后EN与肠外营养支持的效果比较[J].西部医学,2009,21(6)：918-22.
[14]Heyland DK,MacDonald S, Keefe L, et al. Total parenteral nutri-tion in the critically ill patient:a meta-analysis [J]. JAMA,1998,280 (23):2013-9.
[15]Albert RK. Comments on nutritional support guidelines[J].Crit Care Med.2009,37(9):2679-80.
[16]Barrera S,Demark-Wahnefride W.Nutrition during and after cancer therapy[J].Oncolog-y(Williston Park),2009,23(2):15-21.
[17]Ku J,Yunshi Z,Li R.Immunonutrition in surgical patients[J].Curr Drug Targets,2009,10(8):771-7.
[18]Koretz RL.Enteral nutrition:a hard look at some soft evidence [J].Nutr Clin Pract.2009,24(3):335-43.
[19]Singh N,Gupta D,Aggarwal AN,et al.An sssessment of nutrtional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit[J].Respir Care,2009,54(12):1688-96.,
[20]Sriram K,Cyriac T,Fogg LF.Effect of nutritional team restructuring on the use of parenteral nutrition[J].Nutrition,2009,8(12):1-5.