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目的分析临床营养诊疗对肝硬化患者的价值,为规范临床营养诊疗提供参考依据。方法收集2013年4月~2015年3月在消化内科住院并进行临床营养诊疗的肝硬化患者131例。根据临床营养诊疗实施进程分为3组:A组入院24 h内由临床营养师进行营养风险筛查(NRS2002)确定无营养风险30例;B组经筛查确定存在营养风险,给予进一步营养评估后制订并实施营养治疗62例;C组经筛查确定存在营养风险,给予进一步营养评估后拒绝营养治疗39例。比较3组的住院时间、住院总费用及药占比;观察B组入院次日及营养治疗第7 d的血清白蛋白(ALB)、前蛋白(PA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)指标的变化。结果 C组的住院时间、住院费用、药占比均高于A、B组(P<0.05或P<0.01),A组与B组的住院时间、住院费用、药占比均无统计学差异(P>0.05);B组营养治疗第7 d与入院次日相比,PA升高,AST降低(P<0.01)。结论临床营养诊疗可判断肝硬化患者是否存在营养风险,降低存在营养风险患者的住院时间、住院费用及药占比,并可改善其营养状况及肝脏功能。
Objective To analyze the value of clinical nutrition diagnosis and treatment for cirrhotic patients and provide reference for standardizing clinical nutrition diagnosis and treatment. Methods A total of 131 patients with cirrhosis who were admitted to the Department of Gastroenterology and Clinical Nutrition from April 2013 to March 2015 were collected. According to clinical nutrition diagnosis and treatment implementation process is divided into three groups: A group of patients within 24 h nutrition risk screening by clinical nutritionists (NRS2002) identified no nutritional risk in 30 cases; B group identified by screening screening for nutritional risk, given further nutritional assessment After the formulation and implementation of nutritional therapy in 62 cases; C group was identified by screening risk of nutrition, nutritional assessment after further nutritional evaluation rejected 39 cases. The hospitalization time, the total cost of hospitalization and the proportion of medicine in the three groups were compared. The levels of serum albumin (ALB), pre-protein (PA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) index changes. Results The hospitalization time, hospitalization expense and medicine proportion in group C were higher than those in group A and B (P <0.05 or P <0.01). There was no significant difference in hospitalization time, hospitalization cost and medicine between group A and group B (P> 0.05). On the 7th day of nutrition treatment in group B, PA increased and AST decreased (P <0.01). Conclusion Clinical nutrition diagnosis and treatment can determine whether patients with liver cirrhosis have nutritional risk, reduce the hospitalization time, hospitalization cost and drug proportion in patients with nutritional risk, and can improve their nutritional status and liver function.