• 四川大學(xué)華西醫(yī)院胃腸外科中心（四川成都 610041）;

目的介紹住院患者營養(yǎng)狀況的評(píng)估方法及其臨床應(yīng)用進(jìn)展。方法采用文獻(xiàn)復(fù)習(xí)的方法，對營養(yǎng)狀況 評(píng)估方法的相關(guān)文獻(xiàn)進(jìn)行綜述。 結(jié)果目前，住院患者中營養(yǎng)不良患者所占比例較高，眾多營養(yǎng)狀況評(píng)估工具適用人群各不相同，臨床醫(yī)護(hù)人員需要有針對性地使用這些工具才能達(dá)到快速、準(zhǔn)確和全面的評(píng)估效果。結(jié)論現(xiàn)階段推薦每位入院患者均要接受營養(yǎng)風(fēng)險(xiǎn)篩查，這樣有助于改善患者臨床結(jié)局，減少治療費(fèi)用。

引用本文： 陳博,伍曉汀. 住院患者營養(yǎng)狀況評(píng)估. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(4): 449-454. doi: 復(fù)制

1. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336．.
2. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
3. 王艷, 蔣朱明, Nolan MT, 等. 營養(yǎng)風(fēng)險(xiǎn)的概念分析 [J]. 中華臨床營養(yǎng)雜志, 2009, 17(2): 104106.
4. Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk [J]. Clin Nutr, 2004, 23(4): 539550.
5. 中華醫(yī)學(xué)會(huì). 臨床技術(shù)操作規(guī)范－腸外腸內(nèi)營養(yǎng)學(xué)分冊 [M]. 北京: 人民軍醫(yī)出版社, 2008: 159.
6. Green SM, Watson R. Nutritional screening and assessment tools for use by nurses: literature review [J]. J Adv Nurs, 2005, 50(1): 6983.
7. Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients [J]. JAMA, 1976, 235(15): 15671570.
8. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patient [J]. JPEN J Parenter Enteral Nutr, 1977, 1(1): 1122.
9. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital [J]. BMJ, 1994, 308(6934): 945948.
10. Fettes SB, Davidson HI, Richardson RA, et al. Nutritional status of elective gastrointestinal surgery patients pre and postoperatively [J]. Clin Nutr, 2002, 21(3): 249254.
11. 蔣朱明， 陳偉， 張澍田． 中國11個(gè)城市大醫(yī)院6個(gè)臨床?？? 303例住院患者營養(yǎng)不良風(fēng)險(xiǎn)篩查(期中小結(jié)摘要) [J]. 中國臨床營養(yǎng)雜志, 2006, 14(4): 263.
12. 蔣朱明， 陳偉， 朱賽楠， 等． 我國東、中、西部大城市三甲醫(yī)院營養(yǎng)不良（不足）、營養(yǎng)風(fēng)險(xiǎn)發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查 [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 335337.
13. 蔣朱明， 于康， 朱賽楠， 等． 我國東、中、西部中小醫(yī)院住院患者營養(yǎng)不良（不足）、營養(yǎng)風(fēng)險(xiǎn)、超重和肥胖發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查（中期小結(jié)） [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 338340.
14. Oliveira MR, Fogaa KC, LeandroMerhi VA. Nutritional status and functional capacity of hospitalized elderly [J]. Nutr J, 2009, 8: 54.
15. Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals [J]. Nutrition, 2008, 24(10): 969976.
16. Mackintosh MA, Hankey CR. Reliability of a nutrition screening tool for use in elderly day hospitals [J]. J Hum Nutr Diet, 2001, 14(2): 129136.
17. Campbell SE, Avenell A, Walker AE. Assessment of nutritional status in hospital inpatients [J]. QJM, 2002, 95(2): 8387.
18. 張明鳴, 周勇, 伍曉汀. 生長激素短期應(yīng)用對胃腸外科手術(shù)后患者營養(yǎng)狀況和血清IGF1的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(12): 968973.
19. 黃承鈺. 實(shí)用臨床營養(yǎng)學(xué) [M]. 成都: 四川大學(xué)出版社, 2006： 6983.
20. Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications [J]. JPEN J Parenter Enteral Nutr, 2003, 27(1): 19.
21. Jones JM. The methodology of nutritional screening and assessment tools [J]. J Hum Nutr Diet， 2002, 15(1): 5971.
22. Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980, 139(1): 160167.
23. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? [J]. JPEN J Parenter Enteral Nutr, 1987, 11(1): 813.
24. Sacks GS, Dearman K, Replogle WH, et al. Use of subjective global assessment to identify nutritionassociated complications and death in geriatric longterm care facility residents [J]. J Am Coll Nutr, 2000, 19(5): 570577.
25. Thoresen L, Fjeldstad I, Krogstad K, et al. Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool [J]. Palliat Med, 2002, 16(1): 3342.
26. Norman K, Schütz T, Kemps M, et al. The subjective global assessment reliably identifies malnutritionrelated muscle dysfunction [J]. Clin Nutr, 2005, 24(1): 143150.
27. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
28. Sungurtekin H, Sungurtekin U, Hanci V, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J]. Nutrition, 2004, 20(5): 428432.
29. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
30. Guigoz Y, Vellas BJ, Garry PJ. Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients [J]. Facts Res Gerontol, 1994, 4(Suppl 2): 1559.
31. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation [J]. Nutr Rev, 1996, 54(1 Pt 2): S59S65.
32. Shum NC, Hui WW, Chu FC, et al. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital [J]. Hong Kong Med J, 2005, 11(4): 234242.
33. Barone L, Milosavljevic M, Gazibarich B. Assessing the older person: is the MNA a more appropriate nutritional assessment tool than the SGA? [J]. J Nutr Health Aging, 2003, 7(1): 1317.
34. Vedantam A, Subramanian V, Rao NV, et al. Malnutrition in freeliving elderly in rural south India: prevalence and risk factors [J]. Public Health Nutr, 2010, 13(9): 13281332.
35. Bauer JM, Vogl T, Wicklein S, et al. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients [J]. Z Gerontol Geriatr, 2005, 38(5): 322327.
36. 吳萍, 卞大榮. 微型營養(yǎng)評(píng)價(jià)法與主觀全面評(píng)價(jià)法的比較 [J]. 同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 30(3): 125128.
37. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the shortform mininutritional assessment (MNASF) [J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6): M366M372.
38. Kuzuya M, Kanda S, Koike T, et al. Evaluation of MiniNutritional Assessment for Japanese frail elderly [J]. Nutrition, 2005, 21(4): 498503.
39. Phillips MB, Foley AL, Barnard R, et al. Nutritional screening in communitydwelling older adults: a systematic literature review [J]. Asia Pac J Clin Nutr, 2010, 19(3): 440449.
40. Malnutrition Advisory Group. A consistent and reliable tool for malnutrition screening [J]. Nurs Times, 2003, 99(46): 2627.
41. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (“MUST”) for adults [J]. Br J Nutr, 2004, 92(5): 799808.
42. Stratton RJ, King CL, Stroud MA, et al. “Malnutrition Universal Screening Tool” predicts mortality and length of hospital stay in acutely ill elderly [J]. Br J Nutr, 2006, 95(2): 325330.
43. Amaral TF, Antunes A, Cabral S, et al. An evaluation of three nutritional screening tools in a Portuguese oncology centre [J]. J Hum Nutr Diet, 2008, 21(6): 575583.
44. 傅曉瑾, 路潛. 三種營養(yǎng)篩查工具在外科術(shù)前患者中的應(yīng)用 [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 353356.
45. Kondrup J, Allison SP, Elia M, et al, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002 [J]. Clin Nutr, 2003, 22(4): 415421.
46. Sorensen J, Kondrup J, Prokopowicz J, et al; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
47. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
48. Valero MA, Díez L, El Kadaoui N, et al. Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status? [J]. Nutr Hosp, 2005, 20(4): 259267.
49. 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.
50. Raslan M, Gonzalez MC, Dias MC, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients [J]. Nutrition, 2010, 26(78): 721726.
51. 于康, 夏瑩, 王孟昭, 等. 營養(yǎng)風(fēng)險(xiǎn)篩查和主觀全面評(píng)定用于肺癌非手術(shù)患者營養(yǎng)篩查的比較 [J]. 中國臨床營養(yǎng)雜志， 2008, 16(6): 349352.
52. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.
  1. 1. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336．.
  2. 2. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
  3. 3. 王艷, 蔣朱明, Nolan MT, 等. 營養(yǎng)風(fēng)險(xiǎn)的概念分析 [J]. 中華臨床營養(yǎng)雜志, 2009, 17(2): 104106.
  4. 4. Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk [J]. Clin Nutr, 2004, 23(4): 539550.
  5. 5. 中華醫(yī)學(xué)會(huì). 臨床技術(shù)操作規(guī)范－腸外腸內(nèi)營養(yǎng)學(xué)分冊 [M]. 北京: 人民軍醫(yī)出版社, 2008: 159.
  6. 6. Green SM, Watson R. Nutritional screening and assessment tools for use by nurses: literature review [J]. J Adv Nurs, 2005, 50(1): 6983.
  7. 7. Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients [J]. JAMA, 1976, 235(15): 15671570.
  8. 8. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patient [J]. JPEN J Parenter Enteral Nutr, 1977, 1(1): 1122.
  9. 9. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital [J]. BMJ, 1994, 308(6934): 945948.
  10. 10. Fettes SB, Davidson HI, Richardson RA, et al. Nutritional status of elective gastrointestinal surgery patients pre and postoperatively [J]. Clin Nutr, 2002, 21(3): 249254.
  11. 11. 蔣朱明， 陳偉， 張澍田． 中國11個(gè)城市大醫(yī)院6個(gè)臨床?？? 303例住院患者營養(yǎng)不良風(fēng)險(xiǎn)篩查(期中小結(jié)摘要) [J]. 中國臨床營養(yǎng)雜志, 2006, 14(4): 263.
  12. 12. 蔣朱明， 陳偉， 朱賽楠， 等． 我國東、中、西部大城市三甲醫(yī)院營養(yǎng)不良（不足）、營養(yǎng)風(fēng)險(xiǎn)發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查 [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 335337.
  13. 13. 蔣朱明， 于康， 朱賽楠， 等． 我國東、中、西部中小醫(yī)院住院患者營養(yǎng)不良（不足）、營養(yǎng)風(fēng)險(xiǎn)、超重和肥胖發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查（中期小結(jié)） [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 338340.
  14. 14. Oliveira MR, Fogaa KC, LeandroMerhi VA. Nutritional status and functional capacity of hospitalized elderly [J]. Nutr J, 2009, 8: 54.
  15. 15. Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals [J]. Nutrition, 2008, 24(10): 969976.
  16. 16. Mackintosh MA, Hankey CR. Reliability of a nutrition screening tool for use in elderly day hospitals [J]. J Hum Nutr Diet, 2001, 14(2): 129136.
  17. 17. Campbell SE, Avenell A, Walker AE. Assessment of nutritional status in hospital inpatients [J]. QJM, 2002, 95(2): 8387.
  18. 18. 張明鳴, 周勇, 伍曉汀. 生長激素短期應(yīng)用對胃腸外科手術(shù)后患者營養(yǎng)狀況和血清IGF1的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(12): 968973.
  19. 19. 黃承鈺. 實(shí)用臨床營養(yǎng)學(xué) [M]. 成都: 四川大學(xué)出版社, 2006： 6983.
  20. 20. Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications [J]. JPEN J Parenter Enteral Nutr, 2003, 27(1): 19.
  21. 21. Jones JM. The methodology of nutritional screening and assessment tools [J]. J Hum Nutr Diet， 2002, 15(1): 5971.
  22. 22. Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980, 139(1): 160167.
  23. 23. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? [J]. JPEN J Parenter Enteral Nutr, 1987, 11(1): 813.
  24. 24. Sacks GS, Dearman K, Replogle WH, et al. Use of subjective global assessment to identify nutritionassociated complications and death in geriatric longterm care facility residents [J]. J Am Coll Nutr, 2000, 19(5): 570577.
  25. 25. Thoresen L, Fjeldstad I, Krogstad K, et al. Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool [J]. Palliat Med, 2002, 16(1): 3342.
  26. 26. Norman K, Schütz T, Kemps M, et al. The subjective global assessment reliably identifies malnutritionrelated muscle dysfunction [J]. Clin Nutr, 2005, 24(1): 143150.
  27. 27. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
  28. 28. Sungurtekin H, Sungurtekin U, Hanci V, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J]. Nutrition, 2004, 20(5): 428432.
  29. 29. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
  30. 30. Guigoz Y, Vellas BJ, Garry PJ. Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients [J]. Facts Res Gerontol, 1994, 4(Suppl 2): 1559.
  31. 31. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation [J]. Nutr Rev, 1996, 54(1 Pt 2): S59S65.
  32. 32. Shum NC, Hui WW, Chu FC, et al. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital [J]. Hong Kong Med J, 2005, 11(4): 234242.
  33. 33. Barone L, Milosavljevic M, Gazibarich B. Assessing the older person: is the MNA a more appropriate nutritional assessment tool than the SGA? [J]. J Nutr Health Aging, 2003, 7(1): 1317.
  34. 34. Vedantam A, Subramanian V, Rao NV, et al. Malnutrition in freeliving elderly in rural south India: prevalence and risk factors [J]. Public Health Nutr, 2010, 13(9): 13281332.
  35. 35. Bauer JM, Vogl T, Wicklein S, et al. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients [J]. Z Gerontol Geriatr, 2005, 38(5): 322327.
  36. 36. 吳萍, 卞大榮. 微型營養(yǎng)評(píng)價(jià)法與主觀全面評(píng)價(jià)法的比較 [J]. 同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 30(3): 125128.
  37. 37. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the shortform mininutritional assessment (MNASF) [J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6): M366M372.
  38. 38. Kuzuya M, Kanda S, Koike T, et al. Evaluation of MiniNutritional Assessment for Japanese frail elderly [J]. Nutrition, 2005, 21(4): 498503.
  39. 39. Phillips MB, Foley AL, Barnard R, et al. Nutritional screening in communitydwelling older adults: a systematic literature review [J]. Asia Pac J Clin Nutr, 2010, 19(3): 440449.
  40. 40. Malnutrition Advisory Group. A consistent and reliable tool for malnutrition screening [J]. Nurs Times, 2003, 99(46): 2627.
  41. 41. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (“MUST”) for adults [J]. Br J Nutr, 2004, 92(5): 799808.
  42. 42. Stratton RJ, King CL, Stroud MA, et al. “Malnutrition Universal Screening Tool” predicts mortality and length of hospital stay in acutely ill elderly [J]. Br J Nutr, 2006, 95(2): 325330.
  43. 43. Amaral TF, Antunes A, Cabral S, et al. An evaluation of three nutritional screening tools in a Portuguese oncology centre [J]. J Hum Nutr Diet, 2008, 21(6): 575583.
  44. 44. 傅曉瑾, 路潛. 三種營養(yǎng)篩查工具在外科術(shù)前患者中的應(yīng)用 [J]. 中國臨床營養(yǎng)雜志, 2008, 16(6): 353356.
  45. 45. Kondrup J, Allison SP, Elia M, et al, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002 [J]. Clin Nutr, 2003, 22(4): 415421.
  46. 46. Sorensen J, Kondrup J, Prokopowicz J, et al; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
  47. 47. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
  48. 48. Valero MA, Díez L, El Kadaoui N, et al. Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status? [J]. Nutr Hosp, 2005, 20(4): 259267.
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