论文部分内容阅读
随着肠外和肠内营养支持的进展，住院和门诊病人营养支持治疗的管理也有调整，相应地，营养状况的评估也成为临床营养支持的关键问题。以往常用一些简单的指标模糊地评价病人的营养状况，特别是蛋白质营养情况，如体重和血清总蛋白。现在，我们都认识到使用简单、灵敏和准确的方法客观评价病人营养状况是非常必要的。已经有临床和基础的研究检验了以往使用的各种方法的实用性和局限性。这些测定指标可分为人类学、生化学、免疫学、生理学、放射核医学等。人类学测定指标简单易行，花费少，适合作为大群体的筛选，但缺乏精确度和灵敏度。生化指标中，血清白蛋白准确且稳定，但灵敏度差。血清中快速更新的蛋白或3．甲基组氨酸较白蛋白灵敏，但会受饮食和应激的影响而不稳定。免疫学指标有时很灵敏准确，但不总是能反应机体的营养状况。生理学指标，如伤口愈合情况、呼吸肌力量等，与上面情况类似。因此，目前看来还没有一个能准确反应营养状况的指标。最近，一些仪器提供了测定瘦体组织（leanbodymass）的新方法，可以更准确地测定人体组成。在一些研究机构已经在临床使用了生物电阻抗分析（BIA、电传导性测定（TOBEC）、双能量X钱吸收测定（DEXA）、体内中子活化分析（IVNA）、近红外线反射方法（NIR）等
As parenteral and enteral nutrition support progresses, the management of nutritional supportive care in inpatient and outpatient settings has also been adjusted, and accordingly, assessment of nutritional status has also become a key issue in clinical nutritional support. In the past, some simple indicators were used to vaguely evaluate the patient’s nutritional status, especially the nutritional status of the protein such as body weight and serum total protein. Now we all recognize that it is necessary to objectively evaluate the patient’s nutritional status using simple, sensitive and accurate methods. There are already clinical and basic studies that examine the usefulness and limitations of the various methods used in the past. These indicators can be divided into anthropology, biochemistry, immunology, physiology, radiation and nuclear medicine. Anthropological measures are simple, inexpensive and suitable for screening large groups, but lack the accuracy and sensitivity. Biochemical indicators, serum albumin accurate and stable, but poor sensitivity. Rapidly updated protein in serum or 3. Methyl histidine sensitive than albumin, but will be subject to diet and stress instability. Immunological indicators are sometimes very sensitive and accurate, but not always reflect the body’s nutritional status. Physiological indicators, such as wound healing, respiratory muscle strength, are similar to the above. Therefore, at present it seems that there is no one that can accurately reflect the nutritional status. Recently, some instruments have provided new ways to measure leanbody mass to determine body composition more accurately. Bioelectrical impedance analysis (BIA, Electrical Conductivity Assay (TOBEC), Dual Energy X Money Absorption Assay (DEXA), In Vivo Neutron Activation Analysis (IVNA), Near Infrared Reflectance Spectroscopy (NIR) Wait