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主觀整體營養評估與客觀臨床數值與外科重症病人預後相關性探討

Relationship between subjective global assessment (SGA) and objective clinical value and prognosis of surgical critically ill patients

摘要


目的:加護病房病人營養不良的發生率約30-50%,營養不良風險與病人預後有密切相關性。研究目的為探討SGA分級對外科重症病人客觀臨床數據及預後相關性。方法:本研究以病歷回溯方式,在2010年1月至2013年6月共收集1646位外科重症個案,以主觀整体營養評估(Subjective Global Assessment, SGA)分級營養狀況,SGA:A級為營養狀況良好、SGA:B及C級為營養狀況不佳。所使用之客觀臨床指標包含:急性生理和慢性健康評估系統(Acute physiology and chronic Health Evaluation, APACHE-II)、治療介入系統指標(Therapeutic Intervention Scoring System, TISS)及住院天數,而營養指標包含:體重、身體質量指數(body mass index, BMI)白蛋白(albumin)、前白蛋白(prealbumin)及總淋巴球計數(total lymphocyte count, TLC)單變量分析顯示,並使用Propensity score match case control,以減少性別與年齡偏差。將收案對象營養狀況佳(SGA:A級)與營養狀況不佳(SGA:B及C級),分別取約600位個案,依據性別及年齡進行配對分析,p<0.05表示具有統計上意義。結果:營養狀況不佳病人有較差的APACHEII及TISS指數,及較長的住加護病房日數及總住院天數。利用多變量迴歸分析調整干擾因子後,BMI<18.5kg/m2、albumin<3.5 g/dl、pre-albumin<20 mg/dl及TLC<900 cell/mm3及TLC 900~1500 cell/mm3皆有較高之營養不良風險(SGA:B及C級)。結論:藉由主觀整體營養評估或客觀的臨床或營養數值觀察入住外科重症病人之營養不良狀態扮演十分重要的角色,營養師須注意營養不良相關指標之變化,以提供即時及營養醫療治療方針來降低營養不良比率,以及期待未來減少醫療相關花費。這些指標能提供即時的營養狀態訊息,有助於營養介入策略之擬定。

並列摘要


Purpose: The incidence rate of malnutrition is approximately 30-50% in intensive care units (ICU). The risk of malnutrition is closely associated with patient prognosis. The purpose of this study is to investigate the relationship between SGA grading and the objective clinical data and prognosis of critically ill surgical patients. Method: In this study, a retrospective chart review was conducted on 1646 critically ill surgical cases between January 2010 and June 2013. The nutritional status of the patients was assessed and classified using the Subjective Global Assessment (SGA). Patients were classified into Class SGA:A (well-nourished) and Class SGA:B & C (malnourished). The objective clinical indicators used in this study include the Acute Physiology and Chronic Health Evaluation (APACHE-II), the Therapeutic Intervention Scoring System (TISS) and the length of hospital stay. Nutrition indicators include body weight, body mass index (BMI), albumin, pre-albumin and total lymphocyte count (TLC). Univariate analysis was performed on the data, and propensity score-matched case-control was used to reduce gender and age bias. Approximately 600 cases each were selected from the cases classified as Class SGA:A and Class SGA:B & C, and matched-pair analysis was performed according to gender and age. Differences were considered statistically significant for p-values <0.05. Results: Malnourished patients had poorer APACHE-II and TISS scores, and had a longer length of stay in ICU and a longer total length of hospital stay.After adjustments for interference factors were performed using multivariate regression analysis, it was determined that BMI<18.5kg/m2, albumin<3.5 g/dl, pre-albumin<20 mg/dl and TLC<900 cell/mm3 and TLC between 900 and 1500 cell/mm3 were associated with a higher risk of malnutrition (Class SGA: B & C). Conclusion: The assessment of malnutrition status of critically ill surgical patients through the Subjective Global Assessment or objective clinical or nutrition indicators is extremely important. Dietitians must be aware of changes in malnutrition indicators, so as to provide immediate nutrition therapy for the reduction of malnutrition rate, with the aim of reducing relevant health care costs in the future. These indicators can provide real-time nutritional status information, which is useful for the formulation of nutrition intervention strategies.

參考文獻


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