肠外肠内营养支持对有营养风险的住院病人临床结局的影响：中美教学医院多中心队列研究
|
摘要
背景和目的:
欧洲肠外肠内营养学会推荐营养风险筛查工具(Nutritional Risk ScreeningTool 2002,NRS-2002)用于住院病人的营养筛查。对NRS-2002筛查为有营养风险者给予肠外肠内营养支持能否改善临床结局缺乏前瞻性研究报道,也没有中国和美国医院住院病人的相关资料。因此,本研究以NRS-2002为工具,比较北京和美国巴尔的摩的教学医院中住院病人营养风险状况及营养支持的使用情况;分析肠外肠内营养支持对有营养风险的患者临床结局的影响。
方法:
本研究为前瞻性队列研究,对北京协和医院、北京大学第三医院、美国约翰霍普金斯医院的消化内科、呼吸内科、腹部外科的住院病人,在入院24小时内以NRS-2002进行营养风险筛查(NRS评分≥3分为有营养风险),观察、记录住院期间肠外肠内营养支持的使用、手术、治疗、并发症、住院时间、死亡率等信息。分析营养风险、营养支持与并发症、住院时间的关系。
结果:
1、北京协和医院与美国约翰霍普金斯医院病人营养风险状况及营养支持应用情况的比较:共1041例病人纳入研究。营养风险的发生率两医院无显著差异(P=0.15),但肥胖病人的比例霍普金斯医院显著高于协和医院(P＜0.001)。内科病人营养支持的使用率两医院无显著差异(P=0.58),但协和医院以肠外营养为主,霍普金斯医院以肠内营养为主,差异显著(P=0.01)。腹部外科中,协和医院无营养风险的病人(尤其是胃肠手术病人)营养支持的使用率显著高于霍普金斯医院(P＜0.001)。
2、营养支持对有营养风险的患者临床结局的影响:三个医院共1831例患者纳入研究。有营养风险的病人中(n=827),得到营养支持者总并发症发生率显著低于无营养支持者(P=0.009);感染性并发症的发生率也显著低于无营养支持者(P＜0.001)。从营养支持的方式来看,肠内营养组总并发症率及感染性并发症率均显著低于无营养支持组;肠外营养组的并发症率与无营养支持组相比无显著差异。此外,入院前一周有明显饮食摄入减少(NRS评分中饮食评分≥1分)的患者中,三个医院的资料均显示营养支持组感染性并发症率显著低于无营养支持组(P=0.004,0.04,0.03)。对有营养风险者并发症率的多因素分析结果显示,营养支持是并发症的保护因素(OR:0.54,P＜0.001)。无营养风险(NRS评分＜3分)的患者中(n=1004),营养支持组与无营养支持组的并发症率无显著差异(P=0.12)。
3、术前营养支持对有营养风险的腹部手术病人临床结局的影响:1168例腹部手术患者纳入研究,其中556例有营养风险。NRS评分5-6分的病人中,规范的术前营养支持的应用率为37.8%(48/127)。术前营养支持组与无术前营养组相比,总并发症率、感染性并发症率、非感染性并发症率均显著降低(P=0.009,0.04,0.03),术后平均住院时间缩短4天(P=0.03),总住院时间无显著差异(P=0.84)。NRS评分3-4分的病人中,规范的术前营养支持的应用率为4.9%(21/429)。术前营养支持组与无术前营养组相比,总并发症率、感染性并发症率、非感染性并发症率均无显著差异(P=0.96,0.52,0.76),术后住院时间无显著差异(P=0.77)。
结论:
1、美国约翰普金斯医院与北京协和医院住院病人营养风险的发生率无显著差异,但肥胖病人的比例霍普金斯医院显著高于北京协和医院。
2、北京的医院中部分无营养风险的腹部外科病人也得到了肠外营养支持,尤其是胃肠道手术的病人。本研究发现营养支持对无营养风险的患者的并发症发生率没有明显影响。
3、内科病人中北京的医院营养支持以肠外营养为主,约翰霍普金斯医院以肠内营养为主。本研究发现肠内营养对临床结局的改善作用优于肠外营养。
4、对有营养风险的患者给予营养支持可以减少并发症(尤其是感染性并发症)的发生。其中有营养风险且伴有入院前一周饮食摄入明显减少的病人,从肠外肠内营养支持中获益的机会更大。
5、NRS≥5分的病例中,规范的术前营养支持能够显著减少并发症的发生,缩短术后住院时间,不延长总的住院时间。
Background:
Nutritional Risk Screening Tool 2002(NRS-2002) was recommended by E(?)can Socitey of Parenteral and Enteral Nutrtition for use in hospitalized patients.Th(?)as no prospective study on the effect of parenteral nutrition and enteral nutrition on(?)l outcome in patients at nutritional risk defined by NRS-2002,also no such data(?)e patients in China and the United States.The aim of this study was to compare(?) nutritional risk status and application of nutritional support in teaching hospita(?) China and the United States,to evaluate the effect of parenteral nutrition/enteral nutr(?)n clinical outcomes in patient at nutritional risk.
Methods:
In this prospective cohort study,patients admitted to departments of gastro(?)nal medicine,respiratory medicine and abdominal surgery in the Johns Hopkins H(?)al (JHH) in Baltimore in the US,in the Peking Union Medical College Hospital(PUMCH) and Beijing University Third Hospital(BUTH) in Beijing,China were recruited and received nutritional risk screening using NRS-2002 on admission.A NRS score of≥3 means at nutritional risk.Patients were monitored daily until discharge to collect data on the application of parenteral nutrition(PN) and enteral nutrition(EN),treatment(?)rgery, complications,mortality and length of stay(LOS).
Results:
1.The difference between the teaching hospitals in Beijing and Baltimore:Totally 1041 patients were recruited.The rate of nutritional risk was similar between PUMC(?)d JHH(P=0.15),although the rate of obesity was significantly higher in JHH(P＜(?)1). Among the medical patients,there was more frequent use of PN and less freq(?)se of EN in PUMCH(P=0.01).The application rate of nutritional support was sign(?)tly higher in PUMCH in surgical patients at no nutritional risk(P＜0.001),especi(?) patients undergoing gastrointestinal surgery(P＜0.001).
3.The impact of parenteral/enteral nutrition on clinical outcomes:Totally 18(?)tients were recruited.Among the "at risk" patients(n=827),the complication rate wa(?)er in the "nutritional support" group than that in the "no support" group(P=0.009),(?)ainly because of the significantly reduced rate of infectious complications(P＜0.001).Among the "at risk" patients with obviously reduced oral intake before admission,the association of nutritional support and the reduced rate of infectious complications was obs(?) in each hospital(P=0.004,0.04,0.03,respectively).In addition,the complicati(?)te was significantly lower in the patients who received EN but not in the patients who received PN when compared to the "no support" group.Among the patients without nutritional risk(n=1004),the complication rate was not different between the "nutritional support" group and the "no support" group(P=0.12).The multivariate analysis showed nutrition support was a protective factor for complication rate in the "at risk" patients when adjusted for confounders(odds ratio:0.54,P＜0.001).
4.the impact of preoperative nutritional support on clinical outcomes:Among the patients with NRS score of≥5(n=127),the complication rate was lower in the "preoperative nutrition" group compared to the control group(P=0.009).The postoperative hospital stay was 4 days shorter in the "preoperative nutrition" group (P=0.03),while the LOS was similar in the two groups(P=0.84).Among the patients with NRS score of 3-4(n=429),the complication rate and postoperative hospital stay was similar between patients with or without preoperative nutrition(P=0.96,0.77).
Conclusions:
1.The rate of nutritional risk was similar between Beijing and Baltimore while there was more obesity in Baltimore.
2.Parenteral nutrition was overused in Beijing in surgical patients at no nutritional risk, especially among those undergoing gastrointestinal surgery.However,no effect of nutritional support on clinical outcome was found among the patients at no nutritional risk in this study.
3.Among the medical patients,there was more frequent use of PN and less frequent use of EN in Beijing when compared to Baltimore.It revealed that EN was associated with significantly reduced complication rate in this study.
4.This finding revealed that nutritional support was beneficial to the patients at nutritional risk by reduced rate of infectious complications,especially among the patients with obviously reduced oral intake before admission.
5.It suggests that preoperative nutritional support is beneficial to the patients with NRS score of≥5 by reduced complication rate.
欧洲肠外肠内营养学会推荐营养风险筛查工具(Nutritional Risk ScreeningTool 2002,NRS-2002)用于住院病人的营养筛查。对NRS-2002筛查为有营养风险者给予肠外肠内营养支持能否改善临床结局缺乏前瞻性研究报道,也没有中国和美国医院住院病人的相关资料。因此,本研究以NRS-2002为工具,比较北京和美国巴尔的摩的教学医院中住院病人营养风险状况及营养支持的使用情况;分析肠外肠内营养支持对有营养风险的患者临床结局的影响。
方法:
本研究为前瞻性队列研究,对北京协和医院、北京大学第三医院、美国约翰霍普金斯医院的消化内科、呼吸内科、腹部外科的住院病人,在入院24小时内以NRS-2002进行营养风险筛查(NRS评分≥3分为有营养风险),观察、记录住院期间肠外肠内营养支持的使用、手术、治疗、并发症、住院时间、死亡率等信息。分析营养风险、营养支持与并发症、住院时间的关系。
结果:
1、北京协和医院与美国约翰霍普金斯医院病人营养风险状况及营养支持应用情况的比较:共1041例病人纳入研究。营养风险的发生率两医院无显著差异(P=0.15),但肥胖病人的比例霍普金斯医院显著高于协和医院(P＜0.001)。内科病人营养支持的使用率两医院无显著差异(P=0.58),但协和医院以肠外营养为主,霍普金斯医院以肠内营养为主,差异显著(P=0.01)。腹部外科中,协和医院无营养风险的病人(尤其是胃肠手术病人)营养支持的使用率显著高于霍普金斯医院(P＜0.001)。
2、营养支持对有营养风险的患者临床结局的影响:三个医院共1831例患者纳入研究。有营养风险的病人中(n=827),得到营养支持者总并发症发生率显著低于无营养支持者(P=0.009);感染性并发症的发生率也显著低于无营养支持者(P＜0.001)。从营养支持的方式来看,肠内营养组总并发症率及感染性并发症率均显著低于无营养支持组;肠外营养组的并发症率与无营养支持组相比无显著差异。此外,入院前一周有明显饮食摄入减少(NRS评分中饮食评分≥1分)的患者中,三个医院的资料均显示营养支持组感染性并发症率显著低于无营养支持组(P=0.004,0.04,0.03)。对有营养风险者并发症率的多因素分析结果显示,营养支持是并发症的保护因素(OR:0.54,P＜0.001)。无营养风险(NRS评分＜3分)的患者中(n=1004),营养支持组与无营养支持组的并发症率无显著差异(P=0.12)。
3、术前营养支持对有营养风险的腹部手术病人临床结局的影响:1168例腹部手术患者纳入研究,其中556例有营养风险。NRS评分5-6分的病人中,规范的术前营养支持的应用率为37.8%(48/127)。术前营养支持组与无术前营养组相比,总并发症率、感染性并发症率、非感染性并发症率均显著降低(P=0.009,0.04,0.03),术后平均住院时间缩短4天(P=0.03),总住院时间无显著差异(P=0.84)。NRS评分3-4分的病人中,规范的术前营养支持的应用率为4.9%(21/429)。术前营养支持组与无术前营养组相比,总并发症率、感染性并发症率、非感染性并发症率均无显著差异(P=0.96,0.52,0.76),术后住院时间无显著差异(P=0.77)。
结论:
1、美国约翰普金斯医院与北京协和医院住院病人营养风险的发生率无显著差异,但肥胖病人的比例霍普金斯医院显著高于北京协和医院。
2、北京的医院中部分无营养风险的腹部外科病人也得到了肠外营养支持,尤其是胃肠道手术的病人。本研究发现营养支持对无营养风险的患者的并发症发生率没有明显影响。
3、内科病人中北京的医院营养支持以肠外营养为主,约翰霍普金斯医院以肠内营养为主。本研究发现肠内营养对临床结局的改善作用优于肠外营养。
4、对有营养风险的患者给予营养支持可以减少并发症(尤其是感染性并发症)的发生。其中有营养风险且伴有入院前一周饮食摄入明显减少的病人,从肠外肠内营养支持中获益的机会更大。
5、NRS≥5分的病例中,规范的术前营养支持能够显著减少并发症的发生,缩短术后住院时间,不延长总的住院时间。
Background:
Nutritional Risk Screening Tool 2002(NRS-2002) was recommended by E(?)can Socitey of Parenteral and Enteral Nutrtition for use in hospitalized patients.Th(?)as no prospective study on the effect of parenteral nutrition and enteral nutrition on(?)l outcome in patients at nutritional risk defined by NRS-2002,also no such data(?)e patients in China and the United States.The aim of this study was to compare(?) nutritional risk status and application of nutritional support in teaching hospita(?) China and the United States,to evaluate the effect of parenteral nutrition/enteral nutr(?)n clinical outcomes in patient at nutritional risk.
Methods:
In this prospective cohort study,patients admitted to departments of gastro(?)nal medicine,respiratory medicine and abdominal surgery in the Johns Hopkins H(?)al (JHH) in Baltimore in the US,in the Peking Union Medical College Hospital(PUMCH) and Beijing University Third Hospital(BUTH) in Beijing,China were recruited and received nutritional risk screening using NRS-2002 on admission.A NRS score of≥3 means at nutritional risk.Patients were monitored daily until discharge to collect data on the application of parenteral nutrition(PN) and enteral nutrition(EN),treatment(?)rgery, complications,mortality and length of stay(LOS).
Results:
1.The difference between the teaching hospitals in Beijing and Baltimore:Totally 1041 patients were recruited.The rate of nutritional risk was similar between PUMC(?)d JHH(P=0.15),although the rate of obesity was significantly higher in JHH(P＜(?)1). Among the medical patients,there was more frequent use of PN and less freq(?)se of EN in PUMCH(P=0.01).The application rate of nutritional support was sign(?)tly higher in PUMCH in surgical patients at no nutritional risk(P＜0.001),especi(?) patients undergoing gastrointestinal surgery(P＜0.001).
3.The impact of parenteral/enteral nutrition on clinical outcomes:Totally 18(?)tients were recruited.Among the "at risk" patients(n=827),the complication rate wa(?)er in the "nutritional support" group than that in the "no support" group(P=0.009),(?)ainly because of the significantly reduced rate of infectious complications(P＜0.001).Among the "at risk" patients with obviously reduced oral intake before admission,the association of nutritional support and the reduced rate of infectious complications was obs(?) in each hospital(P=0.004,0.04,0.03,respectively).In addition,the complicati(?)te was significantly lower in the patients who received EN but not in the patients who received PN when compared to the "no support" group.Among the patients without nutritional risk(n=1004),the complication rate was not different between the "nutritional support" group and the "no support" group(P=0.12).The multivariate analysis showed nutrition support was a protective factor for complication rate in the "at risk" patients when adjusted for confounders(odds ratio:0.54,P＜0.001).
4.the impact of preoperative nutritional support on clinical outcomes:Among the patients with NRS score of≥5(n=127),the complication rate was lower in the "preoperative nutrition" group compared to the control group(P=0.009).The postoperative hospital stay was 4 days shorter in the "preoperative nutrition" group (P=0.03),while the LOS was similar in the two groups(P=0.84).Among the patients with NRS score of 3-4(n=429),the complication rate and postoperative hospital stay was similar between patients with or without preoperative nutrition(P=0.96,0.77).
Conclusions:
1.The rate of nutritional risk was similar between Beijing and Baltimore while there was more obesity in Baltimore.
2.Parenteral nutrition was overused in Beijing in surgical patients at no nutritional risk, especially among those undergoing gastrointestinal surgery.However,no effect of nutritional support on clinical outcome was found among the patients at no nutritional risk in this study.
3.Among the medical patients,there was more frequent use of PN and less frequent use of EN in Beijing when compared to Baltimore.It revealed that EN was associated with significantly reduced complication rate in this study.
4.This finding revealed that nutritional support was beneficial to the patients at nutritional risk by reduced rate of infectious complications,especially among the patients with obviously reduced oral intake before admission.
5.It suggests that preoperative nutritional support is beneficial to the patients with NRS score of≥5 by reduced complication rate.
引文
1.Kyle UG,Genton L and Pichard C.Hospital length of stay and nutritional status.Current Opinion in Clinical Nutrition and Metabolic Care 2005;8:397-402.
2.Middleton MH,Nazarenko G,Nivison-Smith I,et al.Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals.Intern Med J 2001;31:455-461.
3.Z Jiang,W Chen,W Zhan et al.Parenteral & Enteral Nutrition Application in West,Middle & East of China:a Multi-centre Investigation for 15098 patients in 13 Metropolitans Using NRS Tool.Clin Nutr Suppl 2007;2:133-134.
4.Gallagher-Allred CR,Voss AC,Finn SC.Malnutrition and clinical outcomes:the case for medical nutrition therapy.J Am Diet Assoc 1996;96:361-361,369.
5.Watters JM,Kirkpatrick SM,Norris SB,Shamji FM,Wells GA.Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.Ann Surg 1997;226(3):369-77;discussion 377-80.
6.Gianotti L,Braga M,Nespoli L,Radaelli G,Beneduce A,Di Carlo V.A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer.Gastroenterology 2002;122 (7):1763-70.
7.The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.Perioperative total parenteral nutrition in surgical patients.N Engl J Med 1991:325(8):525-32.
8.Green SM,Watson R.Nutritional screening and assessment tools for use by nurses:literature review.Journal of Advanced Nursing 2005;50(1):69-83.
9.Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients,J Parenter Enteral Nutr 2002;26 (Suppl.1):1SA-138SA.
10.Detsky AS,McLaughlin JR,Baker JP,et al.What is subjective global assessment of nutritional status.JPEN J Parenter Enteral Nutr 1987;11(1):8-13.
11.Kyle UG,Genton L and Pichard C.Hospital length of stay and nutritional status.Current Opinion in Clinical Nutrition and Metabolic Care 2005;8:397-402.
12.Harris DG,Davies C,Ward H,Haboubi NY.An observational study of screening for malnutrition in elderly people living in sheltered accommodation.J Hum Nutr Diet 2008;21(1):3-9;quiz 10-2.
13.GazzottiC,Albert A,Pepinster A,et al.Clinical usefulness of the mini nutritional assessment(MNA) scale in geriatric medicine.J Nuix Health Aging 2000;4(3):176-181.
14.Kondrup J,Rasmussen H H,Hamberg O,Stanza Z.Nutritional Risk Screening (NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr 2003;22(3):321-336.
15.Kondrup J,Allison SP,Elia MB,Vellas B,Plauth M.ESPEN guidelines for nutrition screening 2002.Clin Nutr 2003;22(4):415-421.
]6.Kyle,UG,Kossovsky MP,Karsegard VL,Pichard C.Comparison of tools for nutritional assessment and screening at hospital admission:A population study.Clin Nutr 2006;25(3):409-17.
17.蒋朱明,陈伟,朱赛楠,姚晨,营养风险及营养支持调查协作组.我国东、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.中国临床营养杂志,2008:16(6):335-337.
18.Sorensen J,Kondrup J,Prokopowicz J,Schiesser M,Kr(a|¨)henb(u|¨)hl L,Meier R,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr 2008;27(3):340-9.
19.Schiesser M,Mallet S,Kirchhoff P,Breitenstein S,Sch(a|¨)fer M,Clavien PA.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
20.Johansen N,Kondrup J,Plum LM,Bak L,Norregaard P,Bunch E,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4),539-50.
21.MullerJ,Keller H,Brenner U,et al.Indications and effects of preoperative parenteral nutrition.World J Surg 1986;10:53-63.
22.Muller J,Brenner U,Dienst C,et al.Preoperative parenteral feeding in patients with gastrointestinal carcinoma.Lancet 1982;1:68-71.
23.Heatley RV,Williams RHF1 Lewis MH.Pre-operative intravenous feeding:A controlled trial.Postgrad Med J 1979;55:541-545.
24.Fan 5,Lo C,Lai E,et al.Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma.N Engl J Med 1994;331:1547-1552.
25.Meguid M,Curtas M,Meguid V,et al.Effects of pre-operative TPN on surgical risk-preliminary status report.Br J Clin Prac 1988;42(Suppl):53-58.
26.Bellantone R,Doglietto G,Bossola M,et al.Preoperative parenteral nutrition of malnourished patients.Acta Chir Scand 1988;22:249-251.
27.Fan W,Lau W,Wong K,et al.Ike-operative parenteral nutrition in patients with oesophageal cancer:A prospective,randomised clinical trial.Clin Nutr 1989;8:23-27.
28.Thompson B,Julian T,Stremple J.Perioperative total parenteral nutrition in patients with gastrointestinal cancer.J Surg Res 1981;30:497-450.
29.Muller J,Keller H,Brenner U,et al.Indications and effects of preoperative parenteral nutrition.World J Surg 1986;10:53-63.
30.Bellantone R,Doglietto G,Bossola M,et al.Preoperative parenteral nutrition in the high risk surgical patients.JPEN 1988;12:195-197.
31.Smith R,Hartemink R.Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index:A randomized controlled trial.JPEN 1988;12:587-91.
32.von Meyenfeldt M,Meijerink W,Rouflart M,et al.Perioperative flutritional support:a randomised clinical trial.Clin Nutr 1992;11:180-186.
33.Klein S,Kinney J,Jeejeebhoy K,Alpers D,Hellerstein M,Murray M,Twomey P.Nutrition support in clinical practice:review of published data and recommendations for future research directions.Clin Nutr 1997;16(4):193-218.
34.Satyanarayana R,Klein S.Clinical efficacy of perioperative nutrition support.Curr Opin Clin Nutr Metab Care 1998;1(1):51-58.
35.Weimann A,Braga M,Harsanyi L,et al.ESPEN Guidelines on Enteral Nutrition:Surgery including Organ Transplantation.Clin Nutr 2006;25(2):224-244.
36.Bozzetti F.Nutrition and gastrointestinal cancer.Curr Opin Clin Nutr Metab Care 2001;4(6):541-6.
37.国际生命科学学会中国办事处中国肥胖问题_T-作组联合数据汇总分析协作组.中国成人体质指数分类的推荐意见简介.中华预防医学杂志,2001;35(5):349-350.
38.WHO.Report of a WHO consultation on obesity.Obesity:preventing and managing the global epidemic.WHO 894.Genf:Ref Type:Report,2000.
39.American Gastroenterological Association(AGA).American Gastroenterological Association medical position statement:Parenteral nutrition.Gastroenterology 2001;121(4):966-969.
40.Lochs H,Allison SP,Meier R,Pirlich M,Kondrup J,Schneider S,van den Berghe G,Pichard C.Introductory to the ESPEN Guidelines on Enteral Nutrition:Terminology,Definitions and General Topics.Clin Nutr 2006;25(2):180-186.
41.Buzby GP,Knox LS,Crosby LO,Eisenberg JM,Haakenson CM,McNeal GE,Page CP,Peterson Oh,Reinhardt GF,et al.Study protocol:a randomized clinical trial of total parenteral nutrition in malnourished surgical patients.Am J Clin Nutr 1988;47(2 Suppl):366-81.
42.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference:Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Crit Care Med 1992;20(6):864-873.
43.Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240(2):205-13.
44.Liang X,Jiang ZM,Nolan MT,Efron DT,Kondrup J.Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals.Nutrtion 2008;24(10):969-76.
45.Komorowski AL,hobaziewicz W,Kolodziejski L,Duda K,Darasz Z.Early results of esophagectomy and total or proximal gastrectomy without perioperative administration of total parenteral nutrition.Wiad Lek 2003;56(3-4):122-6.
46.Dickerson NR.Specialized nutrition support in the hospitalized obese patient.Nutr Clin Pract 2004;19(3):245-254.
47.Flegal KM,Carroll MD,Ogden CL,Johnson CL.Prevalence and trends in obesity among US adults,1999-2000.JAMA 2002;288:1723-1727.
48.武阳丰,马冠生,胡永华,李艳平,李贤,崔朝辉,等.中国居民的超重和肥胖流行现状.中华预防医学杂志,2005;39(5):316-320.
49.中华医学会肠外肠内营养学分会.肠外肠内营养临床指南及操作规范.中国临床营养杂志,2006;14(增刊):39-83.
50.Braunschweig CL,Levy P,Sheean PM,Wang X..Enteral compared with parenteral nutrition:a meta-analysis.Am J Clin Nutr 2001;74(4):534-42.
51.蒋朱明,王秀荣,等.肠内、肠外营养对术后病人肠通透性等影响的随机、多中心临床研究.中国临床营养杂志,2001;9(1):7-11.
52.Feo CV,Romanini B,Sortini D,et al.Early oral feeding after colorectal resection:a randomized controlled study.ANZ J Surg 2004;74(5):298-301.
53.Jeffery KM,Harkins B,Cresci GA,Martindale RG.The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients.Am Surg 1996;62(3):167-170.
54.Reissman P,Teoh TA,Cohen SM,Weiss EG,Nogueras JJ,Wexner SD.Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial.Ann Surg 1995;222(1):73-77.
55.Lewis SJ,Egger M,Sylvester PA,Thomas S.Early enteral feeding versus "nil by mouth" after gastrointestinal surgery:systematic review and meta-analysis of controlled trials.BMJ 2001;323(7316):773-776.
56.Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth 1997;78(5):606-617.
57.Fearon KC,Ljungqvist O,Von Meyenfeldt M,Revhaug A,Dejong CH,Lassen K,et al.Enhanced recovery after surgery:A consensus review of clinical care for patients undergoing colonic resection.Clin Nutr 2005,24(1):466-477.
58.Foltz MB,Schiller MR,Ryan AS.Nutrition screening and assessment:current practices and dietitian' leadership roles.J Am Diet Assoc 1993;93:1388-95.
59.姜英俊,孔心涓,田字彬,王培戈.消化道术后肠内营养与肠外营养联合应用与单纯肠外营养的比较.中国临床营养杂志,2006;14(1):18-2.
60.李涛,李莉,何铁汉,王云海.进展期胃癌术后早期肠内一肠外营养联合应用与肠外营养的临床比较.中国临床营养杂志;2004,12(3):202-205.
61.孟铭伦,王化忠,王玉萍.500例住院患者的营养调查分析.中国临床营养杂志,1999:7(1):15-17.
62.孙丽凤,朴辉日.血清前白蛋白检测及其临床意义.中国实验诊断学2005;9(5):753.
63.周紫娟 李莉 李学旺.腹膜透析患者蛋白摄入与血浆前白蛋白的相关分析.现代护理2006;12(11):989-991.
64.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.Z Gerontol Geriat 2005;38:322-327.
65.Martins CP,Correia JR,do Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
66.Amaral TF,Matos LC,Tavares MM,Subtil A,Martins R,Nazare M,Sousa PN.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-84.
67.Clarke T,Sohn H,Kelso R,Petrosyan M,Towfigh S,Mason R.Planned early discharge-elective surgical readmission pathway for patients with gallstone pancreatitis.Arch Surg 2008;143(9):901-5;discussion 905-6.
68.Varela JE,Asolati M,Huerta S,Anthony T.Outcomes of laparoscopic and open colectomy at academic centers.Am J Surg 2008;196(3):403-6.
69.McKay CA,Crippen L.Collaboration through clinical integration.Nurs Adm Q 2008;32(2):109-16.
70.Keusch GT.The history of nutrition:malnutrition,infection and immunity.J Nutr 2003;133(1):336S-340S.
71.Shike M,Russel DM,Detsky AS,Harrison JE,McNeil KG..Changes in body composition in patients with small-cell lung cancer.The effect of total parenteral nutrition as an adjunct to chemotherapy.Ann Intern Med 1984:101(3):303-9.
72.Braunschweig CL,Levy P,Sheean PM,Wang X.Enteral compared with parenteral nutrition:a meta-analysis.Am J Clin Nutr 2001;74(4):534-42.
73.Mullen JL,Buzby GP,Waldman MT,Gertner HM,Hobbs CL,Rosato EF.Prediction of operative morbidity and mortality by preoperative nutritional assessment.Surg Forum 1979;30:80-82.
74.Parekh NR,Steiger E.Percentage of weight loss as a predictor of surgical risk:from the time of Hiram Studley to today.Nutr Clin Pract 2004;19(5):471-6.
1.Edington J,Boorman J,Durrant ER.Prevalence of malnutrition on admission to four hospitals in England.The malnutrition prevalence group.Clin Nutr 2000;19(3):191-195.
2.Stratton RJ,Green CJ,Elia M.Disease-related malnutrition:an evidence-based approach to treatment,CABI Publishing,Wallingford (2003).
3.Kyle UG,Genton L,Pichard C.Hospital length of stay and nutritional status.Curr Opin Clin Nutr Metab Care 2005;8:397-402.
4.Kondrup J,Rasmussen H H,Hamberg 0,et al.Nutritional Risk Screening (NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr 2003;22:321-336.
5.Jones J M.The methodology of nutritional screening and assessment tools.J Hum Nutr Diet 2002;15:59-71
6.Kyle,UG,Kossovsky MP,Karsegard VL,Pichard C.Comparison of tools for nutritional assessment and screening at hospital admission:A population study.Clin Nutr 2006;25(3):409-17.
7.Kondrup J,Johansen N,Plum L M,et al.Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.Clin Nutr 2002;21:461-468.
8.Z Jiang,W Chen,W Zhan et al.Parenteral & Enteral Nutrition Application in West,Middle & East of China:a Multi-centre Investigation for 15098 patients in 13 Metropolitans Using NRS Tool.Clin Nutr Suppl 2007;2:133-134.
9.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.Z Gerontol Geriat 2005;38:322-327.
10.Kondrup J,Allison SP,Elia MB,Vellas B,Plauth M.ESPEN guidelines for nutrition screening 2002.Clin Nutr 2003;22(4):415-421.
11.Correia MI,Waitzberg DL.The impact of malnutrition on morbidity,mortality,length of hospital stay and costs evaluated through a multivariate model analysis.Clin Nutr 2003;22:235-239.
12.Pi chard C,Kyle UG,Morabia A,et al.Nutritional assessment:lean body mass depletion at hospital admission is associated with increased length of stay.Am J Clin Nutr 2004;79:613-618.
13.Pirlich M,Schutz T,Kemps M,et al.Prevalence of malnutrition in hospitalized medical patients:impact of underlying disease.Dig Dis 2003;21:245-251.
14.Schneider SM,Veyres P,Pivot X,et al.Malnutrition is an independent factor associated with nosocomial infections.Br J Nutr 2004;92:105-111.
15.Kyle UG,Pirlich M,Schuetz T,et al.Is nutritional depletion by Nutritional Risk Index (NRI)associated with increased length of stay (LOS):a population study.J Parenter Enter Nutr 2004;28:99-104.
16.Edington J,Boorman J,Durrant E,et al.Prevalence of malnutrition on admission to four hospitals in England.Clin Nutr 2000;19:191-195.
17.Sorensen J,Kondrup J,Prokopowicz J,Schiesser M,Krahenbtihl L,Meier R,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr.2008;27(3):340-9.
18.Schiesser M,MUller S,Kirchhoff P,Breitenstein S,Schafer M,Clavien PA.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
19.Martins CP,Correia JR,do Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
20.Amaral TF,Matos LC,Tavares MM,Subtil A,Martins R,Nazare M,Sousa PN.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-84.
21.Johansen N,Kondrup J,Plum LM,Bak L,Norregaard P,Bunch E,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4):539-50.
22.Rasmussen HH,Kondrup J,Staun M,et al.A method for implementation of nutritional therapy in hospitals.Clin Nutr 2006;25(3):515-23.
1.Sobotka L.Basics in clinical nutrition[M].3rd.London:Galen,2004:11-18.
2.中华医学会.临床诊疗指南-肠外肠内营养学分册[M].北京:人民卫生出版社,2007:15-19.
3.Kondrup J,Rasmussen H,Hamberg O,et al.Nutritional risk screening(NRS 2002):a new method based on ana nalysis of controlled clinical trials.Clin Nutr 2003;22(3):321-336.
4.Jiang Z,Chen W,Zhan W,et al.Parenteral and enteral nutrition application in West,Middle and East of China:a multi-centre investigation for 15098patients in 13 metropolitans using NRS tool.Clin Nutr 2007;2(Suppl):133-134.
5.Kondrup J,Allison SP,Elia MB,et al.ESPEN guidelines for nutrition screening 2002.ClAn Nutr 2003;22(4):415-421.
6.Detsky AS,McLaughlin JR,Baker JP,et al.What is subjective global assessment of nutritional status.JPEN 1987;11(1):8-13.
7.Gazzotti C,Albert A,Pepinster A,et al.Clinical usefulness of the mini nutritional assessment(MNi)scale in geriatric medicine.J Nuix Health Aging 2000;4(3):176-181.
8.Orrevall Y,Tishelman C,Permert J,et al.Nutritional support and risk status among cancer patients in palliative home care services.Support Care Cancer 2009;17(2):153-61.
9.Haldun G,Eren E,Recep A,et al.Evaluation of nutritional risk on admission to the general surgery department.Bratisl Lek Listy 2008;109(2):57-60.
10.Bauer JM,Sieber CC.Significance and diagnosis of malnutrition in the elderly.Z Arztl Fortbild Qualitatssich 2007;101(9):605-609.
11.Berthod G,Roduit J,Roulet M,et al.Hospital undernutrition:how not to ignore it any more.Rev Med Suisse 2007;3(131):2466,2468,2470-2471.
12.Elkan AC,Engvall IL,Tengstrand B,et al.Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools.Eur J Clin Nutr 2008;62(10):1239-47.
13.Kondrup J,Johansen N,Plum LM,et al.Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.Clin Nutr 2002;21(6):461-468.
14.Matos LC,Tavares MM,Amaral TF.Handgrip strength as a hospital admission nutritional risk screening method.Eur J Clin Nutr 2007;61(9):1128-35.
15.Sorensen J,Kondrup J,Prokopowicz J,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr 2008;27(3):340-349.
16.Schiesser M,Müller S,Kirchhoff P,et al.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
17.Kyle UG,Kossovsky MP,Karsegard VL,et al.Comparison of tools for nutritional assessment and screening at hospital admission:a population study.Clin Nutr 2006;25(3):409-417.
18.Bauer JM,Vogl T,WickleinS,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.Z Gerontol Geriat 2005;38(5):322-327.
19.Martins CP,Correia JR,Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
20.Amaral TF,Matos LC,Tavares MM,et al.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-784.
21.Johansen N,Kondrup J,Plum LM,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4):539-550.
22.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Criti Care Med 1992;20 (6):864-873.
2.Middleton MH,Nazarenko G,Nivison-Smith I,et al.Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals.Intern Med J 2001;31:455-461.
3.Z Jiang,W Chen,W Zhan et al.Parenteral & Enteral Nutrition Application in West,Middle & East of China:a Multi-centre Investigation for 15098 patients in 13 Metropolitans Using NRS Tool.Clin Nutr Suppl 2007;2:133-134.
4.Gallagher-Allred CR,Voss AC,Finn SC.Malnutrition and clinical outcomes:the case for medical nutrition therapy.J Am Diet Assoc 1996;96:361-361,369.
5.Watters JM,Kirkpatrick SM,Norris SB,Shamji FM,Wells GA.Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.Ann Surg 1997;226(3):369-77;discussion 377-80.
6.Gianotti L,Braga M,Nespoli L,Radaelli G,Beneduce A,Di Carlo V.A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer.Gastroenterology 2002;122 (7):1763-70.
7.The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.Perioperative total parenteral nutrition in surgical patients.N Engl J Med 1991:325(8):525-32.
8.Green SM,Watson R.Nutritional screening and assessment tools for use by nurses:literature review.Journal of Advanced Nursing 2005;50(1):69-83.
9.Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients,J Parenter Enteral Nutr 2002;26 (Suppl.1):1SA-138SA.
10.Detsky AS,McLaughlin JR,Baker JP,et al.What is subjective global assessment of nutritional status.JPEN J Parenter Enteral Nutr 1987;11(1):8-13.
11.Kyle UG,Genton L and Pichard C.Hospital length of stay and nutritional status.Current Opinion in Clinical Nutrition and Metabolic Care 2005;8:397-402.
12.Harris DG,Davies C,Ward H,Haboubi NY.An observational study of screening for malnutrition in elderly people living in sheltered accommodation.J Hum Nutr Diet 2008;21(1):3-9;quiz 10-2.
13.GazzottiC,Albert A,Pepinster A,et al.Clinical usefulness of the mini nutritional assessment(MNA) scale in geriatric medicine.J Nuix Health Aging 2000;4(3):176-181.
14.Kondrup J,Rasmussen H H,Hamberg O,Stanza Z.Nutritional Risk Screening (NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr 2003;22(3):321-336.
15.Kondrup J,Allison SP,Elia MB,Vellas B,Plauth M.ESPEN guidelines for nutrition screening 2002.Clin Nutr 2003;22(4):415-421.
]6.Kyle,UG,Kossovsky MP,Karsegard VL,Pichard C.Comparison of tools for nutritional assessment and screening at hospital admission:A population study.Clin Nutr 2006;25(3):409-17.
17.蒋朱明,陈伟,朱赛楠,姚晨,营养风险及营养支持调查协作组.我国东、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.中国临床营养杂志,2008:16(6):335-337.
18.Sorensen J,Kondrup J,Prokopowicz J,Schiesser M,Kr(a|¨)henb(u|¨)hl L,Meier R,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr 2008;27(3):340-9.
19.Schiesser M,Mallet S,Kirchhoff P,Breitenstein S,Sch(a|¨)fer M,Clavien PA.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
20.Johansen N,Kondrup J,Plum LM,Bak L,Norregaard P,Bunch E,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4),539-50.
21.MullerJ,Keller H,Brenner U,et al.Indications and effects of preoperative parenteral nutrition.World J Surg 1986;10:53-63.
22.Muller J,Brenner U,Dienst C,et al.Preoperative parenteral feeding in patients with gastrointestinal carcinoma.Lancet 1982;1:68-71.
23.Heatley RV,Williams RHF1 Lewis MH.Pre-operative intravenous feeding:A controlled trial.Postgrad Med J 1979;55:541-545.
24.Fan 5,Lo C,Lai E,et al.Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma.N Engl J Med 1994;331:1547-1552.
25.Meguid M,Curtas M,Meguid V,et al.Effects of pre-operative TPN on surgical risk-preliminary status report.Br J Clin Prac 1988;42(Suppl):53-58.
26.Bellantone R,Doglietto G,Bossola M,et al.Preoperative parenteral nutrition of malnourished patients.Acta Chir Scand 1988;22:249-251.
27.Fan W,Lau W,Wong K,et al.Ike-operative parenteral nutrition in patients with oesophageal cancer:A prospective,randomised clinical trial.Clin Nutr 1989;8:23-27.
28.Thompson B,Julian T,Stremple J.Perioperative total parenteral nutrition in patients with gastrointestinal cancer.J Surg Res 1981;30:497-450.
29.Muller J,Keller H,Brenner U,et al.Indications and effects of preoperative parenteral nutrition.World J Surg 1986;10:53-63.
30.Bellantone R,Doglietto G,Bossola M,et al.Preoperative parenteral nutrition in the high risk surgical patients.JPEN 1988;12:195-197.
31.Smith R,Hartemink R.Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index:A randomized controlled trial.JPEN 1988;12:587-91.
32.von Meyenfeldt M,Meijerink W,Rouflart M,et al.Perioperative flutritional support:a randomised clinical trial.Clin Nutr 1992;11:180-186.
33.Klein S,Kinney J,Jeejeebhoy K,Alpers D,Hellerstein M,Murray M,Twomey P.Nutrition support in clinical practice:review of published data and recommendations for future research directions.Clin Nutr 1997;16(4):193-218.
34.Satyanarayana R,Klein S.Clinical efficacy of perioperative nutrition support.Curr Opin Clin Nutr Metab Care 1998;1(1):51-58.
35.Weimann A,Braga M,Harsanyi L,et al.ESPEN Guidelines on Enteral Nutrition:Surgery including Organ Transplantation.Clin Nutr 2006;25(2):224-244.
36.Bozzetti F.Nutrition and gastrointestinal cancer.Curr Opin Clin Nutr Metab Care 2001;4(6):541-6.
37.国际生命科学学会中国办事处中国肥胖问题_T-作组联合数据汇总分析协作组.中国成人体质指数分类的推荐意见简介.中华预防医学杂志,2001;35(5):349-350.
38.WHO.Report of a WHO consultation on obesity.Obesity:preventing and managing the global epidemic.WHO 894.Genf:Ref Type:Report,2000.
39.American Gastroenterological Association(AGA).American Gastroenterological Association medical position statement:Parenteral nutrition.Gastroenterology 2001;121(4):966-969.
40.Lochs H,Allison SP,Meier R,Pirlich M,Kondrup J,Schneider S,van den Berghe G,Pichard C.Introductory to the ESPEN Guidelines on Enteral Nutrition:Terminology,Definitions and General Topics.Clin Nutr 2006;25(2):180-186.
41.Buzby GP,Knox LS,Crosby LO,Eisenberg JM,Haakenson CM,McNeal GE,Page CP,Peterson Oh,Reinhardt GF,et al.Study protocol:a randomized clinical trial of total parenteral nutrition in malnourished surgical patients.Am J Clin Nutr 1988;47(2 Suppl):366-81.
42.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference:Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Crit Care Med 1992;20(6):864-873.
43.Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg 2004;240(2):205-13.
44.Liang X,Jiang ZM,Nolan MT,Efron DT,Kondrup J.Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals.Nutrtion 2008;24(10):969-76.
45.Komorowski AL,hobaziewicz W,Kolodziejski L,Duda K,Darasz Z.Early results of esophagectomy and total or proximal gastrectomy without perioperative administration of total parenteral nutrition.Wiad Lek 2003;56(3-4):122-6.
46.Dickerson NR.Specialized nutrition support in the hospitalized obese patient.Nutr Clin Pract 2004;19(3):245-254.
47.Flegal KM,Carroll MD,Ogden CL,Johnson CL.Prevalence and trends in obesity among US adults,1999-2000.JAMA 2002;288:1723-1727.
48.武阳丰,马冠生,胡永华,李艳平,李贤,崔朝辉,等.中国居民的超重和肥胖流行现状.中华预防医学杂志,2005;39(5):316-320.
49.中华医学会肠外肠内营养学分会.肠外肠内营养临床指南及操作规范.中国临床营养杂志,2006;14(增刊):39-83.
50.Braunschweig CL,Levy P,Sheean PM,Wang X..Enteral compared with parenteral nutrition:a meta-analysis.Am J Clin Nutr 2001;74(4):534-42.
51.蒋朱明,王秀荣,等.肠内、肠外营养对术后病人肠通透性等影响的随机、多中心临床研究.中国临床营养杂志,2001;9(1):7-11.
52.Feo CV,Romanini B,Sortini D,et al.Early oral feeding after colorectal resection:a randomized controlled study.ANZ J Surg 2004;74(5):298-301.
53.Jeffery KM,Harkins B,Cresci GA,Martindale RG.The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients.Am Surg 1996;62(3):167-170.
54.Reissman P,Teoh TA,Cohen SM,Weiss EG,Nogueras JJ,Wexner SD.Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial.Ann Surg 1995;222(1):73-77.
55.Lewis SJ,Egger M,Sylvester PA,Thomas S.Early enteral feeding versus "nil by mouth" after gastrointestinal surgery:systematic review and meta-analysis of controlled trials.BMJ 2001;323(7316):773-776.
56.Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth 1997;78(5):606-617.
57.Fearon KC,Ljungqvist O,Von Meyenfeldt M,Revhaug A,Dejong CH,Lassen K,et al.Enhanced recovery after surgery:A consensus review of clinical care for patients undergoing colonic resection.Clin Nutr 2005,24(1):466-477.
58.Foltz MB,Schiller MR,Ryan AS.Nutrition screening and assessment:current practices and dietitian' leadership roles.J Am Diet Assoc 1993;93:1388-95.
59.姜英俊,孔心涓,田字彬,王培戈.消化道术后肠内营养与肠外营养联合应用与单纯肠外营养的比较.中国临床营养杂志,2006;14(1):18-2.
60.李涛,李莉,何铁汉,王云海.进展期胃癌术后早期肠内一肠外营养联合应用与肠外营养的临床比较.中国临床营养杂志;2004,12(3):202-205.
61.孟铭伦,王化忠,王玉萍.500例住院患者的营养调查分析.中国临床营养杂志,1999:7(1):15-17.
62.孙丽凤,朴辉日.血清前白蛋白检测及其临床意义.中国实验诊断学2005;9(5):753.
63.周紫娟 李莉 李学旺.腹膜透析患者蛋白摄入与血浆前白蛋白的相关分析.现代护理2006;12(11):989-991.
64.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.Z Gerontol Geriat 2005;38:322-327.
65.Martins CP,Correia JR,do Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
66.Amaral TF,Matos LC,Tavares MM,Subtil A,Martins R,Nazare M,Sousa PN.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-84.
67.Clarke T,Sohn H,Kelso R,Petrosyan M,Towfigh S,Mason R.Planned early discharge-elective surgical readmission pathway for patients with gallstone pancreatitis.Arch Surg 2008;143(9):901-5;discussion 905-6.
68.Varela JE,Asolati M,Huerta S,Anthony T.Outcomes of laparoscopic and open colectomy at academic centers.Am J Surg 2008;196(3):403-6.
69.McKay CA,Crippen L.Collaboration through clinical integration.Nurs Adm Q 2008;32(2):109-16.
70.Keusch GT.The history of nutrition:malnutrition,infection and immunity.J Nutr 2003;133(1):336S-340S.
71.Shike M,Russel DM,Detsky AS,Harrison JE,McNeil KG..Changes in body composition in patients with small-cell lung cancer.The effect of total parenteral nutrition as an adjunct to chemotherapy.Ann Intern Med 1984:101(3):303-9.
72.Braunschweig CL,Levy P,Sheean PM,Wang X.Enteral compared with parenteral nutrition:a meta-analysis.Am J Clin Nutr 2001;74(4):534-42.
73.Mullen JL,Buzby GP,Waldman MT,Gertner HM,Hobbs CL,Rosato EF.Prediction of operative morbidity and mortality by preoperative nutritional assessment.Surg Forum 1979;30:80-82.
74.Parekh NR,Steiger E.Percentage of weight loss as a predictor of surgical risk:from the time of Hiram Studley to today.Nutr Clin Pract 2004;19(5):471-6.
1.Edington J,Boorman J,Durrant ER.Prevalence of malnutrition on admission to four hospitals in England.The malnutrition prevalence group.Clin Nutr 2000;19(3):191-195.
2.Stratton RJ,Green CJ,Elia M.Disease-related malnutrition:an evidence-based approach to treatment,CABI Publishing,Wallingford (2003).
3.Kyle UG,Genton L,Pichard C.Hospital length of stay and nutritional status.Curr Opin Clin Nutr Metab Care 2005;8:397-402.
4.Kondrup J,Rasmussen H H,Hamberg 0,et al.Nutritional Risk Screening (NRS 2002):a new method based on an analysis of controlled clinical trials.Clin Nutr 2003;22:321-336.
5.Jones J M.The methodology of nutritional screening and assessment tools.J Hum Nutr Diet 2002;15:59-71
6.Kyle,UG,Kossovsky MP,Karsegard VL,Pichard C.Comparison of tools for nutritional assessment and screening at hospital admission:A population study.Clin Nutr 2006;25(3):409-17.
7.Kondrup J,Johansen N,Plum L M,et al.Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.Clin Nutr 2002;21:461-468.
8.Z Jiang,W Chen,W Zhan et al.Parenteral & Enteral Nutrition Application in West,Middle & East of China:a Multi-centre Investigation for 15098 patients in 13 Metropolitans Using NRS Tool.Clin Nutr Suppl 2007;2:133-134.
9.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.Z Gerontol Geriat 2005;38:322-327.
10.Kondrup J,Allison SP,Elia MB,Vellas B,Plauth M.ESPEN guidelines for nutrition screening 2002.Clin Nutr 2003;22(4):415-421.
11.Correia MI,Waitzberg DL.The impact of malnutrition on morbidity,mortality,length of hospital stay and costs evaluated through a multivariate model analysis.Clin Nutr 2003;22:235-239.
12.Pi chard C,Kyle UG,Morabia A,et al.Nutritional assessment:lean body mass depletion at hospital admission is associated with increased length of stay.Am J Clin Nutr 2004;79:613-618.
13.Pirlich M,Schutz T,Kemps M,et al.Prevalence of malnutrition in hospitalized medical patients:impact of underlying disease.Dig Dis 2003;21:245-251.
14.Schneider SM,Veyres P,Pivot X,et al.Malnutrition is an independent factor associated with nosocomial infections.Br J Nutr 2004;92:105-111.
15.Kyle UG,Pirlich M,Schuetz T,et al.Is nutritional depletion by Nutritional Risk Index (NRI)associated with increased length of stay (LOS):a population study.J Parenter Enter Nutr 2004;28:99-104.
16.Edington J,Boorman J,Durrant E,et al.Prevalence of malnutrition on admission to four hospitals in England.Clin Nutr 2000;19:191-195.
17.Sorensen J,Kondrup J,Prokopowicz J,Schiesser M,Krahenbtihl L,Meier R,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr.2008;27(3):340-9.
18.Schiesser M,MUller S,Kirchhoff P,Breitenstein S,Schafer M,Clavien PA.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
19.Martins CP,Correia JR,do Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
20.Amaral TF,Matos LC,Tavares MM,Subtil A,Martins R,Nazare M,Sousa PN.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-84.
21.Johansen N,Kondrup J,Plum LM,Bak L,Norregaard P,Bunch E,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4):539-50.
22.Rasmussen HH,Kondrup J,Staun M,et al.A method for implementation of nutritional therapy in hospitals.Clin Nutr 2006;25(3):515-23.
1.Sobotka L.Basics in clinical nutrition[M].3rd.London:Galen,2004:11-18.
2.中华医学会.临床诊疗指南-肠外肠内营养学分册[M].北京:人民卫生出版社,2007:15-19.
3.Kondrup J,Rasmussen H,Hamberg O,et al.Nutritional risk screening(NRS 2002):a new method based on ana nalysis of controlled clinical trials.Clin Nutr 2003;22(3):321-336.
4.Jiang Z,Chen W,Zhan W,et al.Parenteral and enteral nutrition application in West,Middle and East of China:a multi-centre investigation for 15098patients in 13 metropolitans using NRS tool.Clin Nutr 2007;2(Suppl):133-134.
5.Kondrup J,Allison SP,Elia MB,et al.ESPEN guidelines for nutrition screening 2002.ClAn Nutr 2003;22(4):415-421.
6.Detsky AS,McLaughlin JR,Baker JP,et al.What is subjective global assessment of nutritional status.JPEN 1987;11(1):8-13.
7.Gazzotti C,Albert A,Pepinster A,et al.Clinical usefulness of the mini nutritional assessment(MNi)scale in geriatric medicine.J Nuix Health Aging 2000;4(3):176-181.
8.Orrevall Y,Tishelman C,Permert J,et al.Nutritional support and risk status among cancer patients in palliative home care services.Support Care Cancer 2009;17(2):153-61.
9.Haldun G,Eren E,Recep A,et al.Evaluation of nutritional risk on admission to the general surgery department.Bratisl Lek Listy 2008;109(2):57-60.
10.Bauer JM,Sieber CC.Significance and diagnosis of malnutrition in the elderly.Z Arztl Fortbild Qualitatssich 2007;101(9):605-609.
11.Berthod G,Roduit J,Roulet M,et al.Hospital undernutrition:how not to ignore it any more.Rev Med Suisse 2007;3(131):2466,2468,2470-2471.
12.Elkan AC,Engvall IL,Tengstrand B,et al.Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools.Eur J Clin Nutr 2008;62(10):1239-47.
13.Kondrup J,Johansen N,Plum LM,et al.Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.Clin Nutr 2002;21(6):461-468.
14.Matos LC,Tavares MM,Amaral TF.Handgrip strength as a hospital admission nutritional risk screening method.Eur J Clin Nutr 2007;61(9):1128-35.
15.Sorensen J,Kondrup J,Prokopowicz J,et al.EuroOOPS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clin Nutr 2008;27(3):340-349.
16.Schiesser M,Müller S,Kirchhoff P,et al.Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.Clin Nutr 2008;27(4):565-70.
17.Kyle UG,Kossovsky MP,Karsegard VL,et al.Comparison of tools for nutritional assessment and screening at hospital admission:a population study.Clin Nutr 2006;25(3):409-417.
18.Bauer JM,Vogl T,WickleinS,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.Z Gerontol Geriat 2005;38(5):322-327.
19.Martins CP,Correia JR,Amaral TF.Undernutrition risk screening and length of stay of hospitalized elderly.J Nutr Elder 2005;25(2):5-21.
20.Amaral TF,Matos LC,Tavares MM,et al.The economic impact of disease-related malnutrition at hospital admission.Clin Nutr 2007;26(6):778-784.
21.Johansen N,Kondrup J,Plum LM,et al.Effect of nutritional support on clinical outcome in patients at nutritional risk.Clin Nutr 2004;23(4):539-550.
22.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.Criti Care Med 1992;20 (6):864-873.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |