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目的:探讨危重症营养风险评估(Nutric评分)在慢性阻塞性肺疾病(COPD)合并机械通气病人中的应用价值。方法:将入选的189例病人于住院当天分别测量并记录体重和身高,以计算病人的体重指数。次日清晨空腹抽取静脉血,测定血清清蛋白(ALB)和前清蛋白(PA)等营养指标。记录病人住院时间以及28 d内病人好转出院或死亡等病情转归情况。分析比较营养评分与营养指标(ALB和PA)、病人病情转归(4周后死亡/生存率、脱机率)以及与营养支持方式的关系。结果:入院时,Nutric评分低分与高分的病人入院时血清ALB、PA、Hb和转铁蛋白(TF)值均无显著性差异(P>0.05)。营养支持1周后,营养评分低分组与高分组病人间血清ALB、PA、Hb、TF值均有显著性差异(P<0.05)。与高分组病人比,低分组病人的病死率明显较低,脱机成功率明显较高(P<0.05)。结论:营养风险评估可对COPD合并机械通气病人营养支持的热量供给起临床指导作用。
Objective: To investigate the value of critical illness nutrition risk assessment (Nutric score) in patients with chronic obstructive pulmonary disease (COPD) complicated with mechanical ventilation. Methods: The selected 189 patients were measured on the day of hospitalization and record weight and height to calculate the patient’s body mass index. On the next morning, venous blood was drawn for fasting, and the nutrition indexes such as serum albumin (ALB) and prealbumin (PA) were measured. Record the patient’s hospitalization time and patients within 28 days of improvement such as discharge or death and other conditions to the situation. Nutritional and nutritional indicators (ALB and PA) were analyzed and compared. The patient’s condition (death / survival after 4 weeks, off-rate) and the relationship with nutritional support were analyzed. Results: There were no significant differences in the serum ALB, PA, Hb and TF between admission and Nutric scores at admission (P> 0.05). After one week of nutritional support, the serum ALB, PA, Hb, TF values between the low nutritional score group and the high group patients were significantly different (P <0.05). Compared with patients with high scores, the patients with low scores had a significantly lower case fatality rate and a significantly higher offline success rate (P <0.05). CONCLUSIONS: Nutritional risk assessment can provide a clinical guideline for caloric support of nutritional support in COPD patients with mechanical ventilation.