肺部感染合并急性呼吸衰竭患者营养不良的影响因素及营养治疗效果分析

Influencing factors of malnutrition and the therapeutic effect of nutrition in patients with pulmonary infection complicated with acute respiratory failure

摘要

目的 调查肺部感染合并急性呼吸衰竭(ARF)患者的营养状况,探讨其营养不良的影响因素及营养治疗效果。方法 选取2024年1月至2024年12月在西安交通大学第二附属医院呼吸与危重症医学科住院治疗,且通过成人营养风险筛查表(NRS-2002)筛查具有营养风险的肺部感染合并 ARF患者157例,采用营养不良诊断标准(GLIM)进行营养评估及诊断并进行分组,对其进行影响因素分析,并进行个体化的营养治疗,分析营养治疗前后患者的营养指标、炎症指标、血气指标的改善效果。结果 ①研究对象评估为无营养不良占比40.8%,营养不良占比59.2%(中度营养不良占比21.0%,重度营养不良占比38.2%)。②Logistic回归分析显示,身体质量指数(BMI)及白蛋白(ALB)是营养不良的影响因素(P＜0.05),BMI每升高1个单位,患者营养不良的发生率降低44.6%,ALB 每升高1个单位,患者营养不良的发生率降低19.2%。③对研究对象行营养治疗后,前白蛋白(PALB)指标显著提高( t=12.219,P＜0.001),C-反应蛋白(CRP)指标降低(Z=-4.039,P＜0.001)。④分层分析发现,无营养不良组及中度营养不良组营养治疗后PALB显著提高(P＜0.05)；中度营养不良组及重度营养不良组营养治疗后CRP显著降低(P＜0.05)。结论 肺部感染合并 ARF患者易发生营养不良,建议患者入院24 h内行营养风险筛查,筛查阳性患者尤其是伴低BMI或低蛋白血症的患者需尽早使用 GLIM 量表进行标准化评估并给予营养治疗,营养治疗可有效提高患者的PALB水平,降低CRP水平,但对于血气指标的改善有限。

Abstract

Objective To investigate the nutritional status of patients with pulmonary infection complicated with acute respiratory failure (ARF), and to explore the influencing factors of malnutrition and the effect of nutritional therapy. Methods We selected a total of 157 patients with pulmonary infection complicated with ARF who were hospitalized in the Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, from January 2024 to December 2024, and who were identified as at nutritional risk through the Nutritional Risk Screening 2002 (NRS-2002). The Global Leadership Initiative on Malnutrition (GLIM) scale was used for nutritional assessment and diagnosis, and then the patients were grouped. The influencing factors were analyzed. Individualized nutritional therapy was carried out, and the improvement effects of nutritional indicators, inflammatory indicators and blood gas indicators of the patients before and after nutritional therapy were analyzed. Results (1) The proportion of the research subjects evaluated as having no malnutrition was 40.8%, and the proportion of those with malnutrition was 59.2% (the proportion of moderate malnutrition and severe malnutrition was 21.0% and 38.2%, respectively). (2) Logistic regression analysis showed that BMI and albumin (ALB) were influencing factors of malnutrition (P ＜0.05). For every one-unit increase in BMI, the incidence of malnutrition in patients decreased by 44.6%, and for every one-unit increase in ALB, the incidence of malnutrition in patients decreased by 19.2%. (3) After nutritional therapy for the research subjects, their prealbumin (PALB) index significantly increased (t=12.219, P＜0.001), while the C-reactive protein (CRP) index decreased (Z=-4.039, P＜0.001). (4) Stratified analysis revealed that PALB significantly increased after nutritional treatment in the non-malnutrition group and the moderate malnutrition group (P＜0.05). However, CRP in the moderate malnutrition group and the severe malnutrition group decreased significantly after nutritional treatment (P ＜0.05). Conclusion Patients with pulmonary infection complicated with ARF are prone to malnutrition. It is recommended that patients undergo nutritional risk screening within 24 hours of admission. Patients with positive screening results, especially those with low BMI or hypoproteinemia, need to be evaluated in a standardized manner using the GLIM scale as soon as possible and receive nutritional therapy. Nutritional therapy can effectively increase the PALB level of patients and reduce the CRP level. However, the improvement of blood gas indicators is limited.

关键词

营养不良诊断标准(GLIM) / 肺部感染 / 急性呼吸衰竭(ARF) / 影响因素 / 个体化 / 营养治疗

Key words

Global Leadership Initiative on Malnutrition (GLIM) / pulmonary infection / acute respiratory failure (ARF) / influencing factor / individualized / nutritional therapy

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基金资助

陕西省自然科学基础研究计划-面上项目(2023-JC-YB-767)

西安市科技计划项目(22YXYJ0140)