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Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.
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OBJECTIVE：To evaluate the economy of pe rospirone in the treatment of schizophrenia ，to provide guidance for clinically proper use of medications more cost-effectively ，and related health decision-making . METHODS ：A short-term decision tree model was constructed from the perspective of medical insurance payer to calculate the cost and health outcomes of different treatment plans considering major adverse events including extrapyramidal reaction ，weight gain ，diabetes，hyperlipidemia. The cost-utility of perospirone were compared with quetiapine ，aripiprazole and olanzapine respectively ，using QALYs as the measure of health outcomes ，3 times GDP per capita as the willingness-to-pay threshold ；probability sensitivity analysis was performed. RESULTS：The results of base-case analysis showed that the cost of perospirone （6 688.25 yuan）was lower than those of quetiapine （9 887.45 yuan），aripiprazole（13 284.65 yuan）and olanzapine （15 332.80 yuan）. The utility of perospirone （0.79 QALYs）was better than those of quetiapine （0.76 QALYs），aripiprazole（0.77 QALYs）and olanzapine （0.75 QALYs）. Compared with quetiapine ， aripiprazole and olanzapine ，peropirone had lower cost and higher health outcome ，which indicated that strong dominance favors perospirone over the other 3 drugs. The results of sensitivity analysis were consistent with those of base-case analysis. CONCLUSIONS：Perospirone has economic advantages in treating schizophrenia patients compared to other commonly used atypical antipsychotic drugs.
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Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.
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Objective To explore the safety of enteral nutrition(EN)support in non-blood circulation disorders of elderly patients with intestinal obstruction.Methods A total of 40 patients (22 men and 18 women aged 62-84 years)with intestinal obstruction were enrolled in this study.Ileus tubes were rapidly placed in these patients with the assistance of endoscopy and X-ray.Afterwards patients were equally randomized into parenteral nutrition(PN)and EN(PN+EN)group and PN only group.The clinical outcomes and complications were recorded and compared.Results The average time for catheter placement was(24.83 4±7.95)minutes.Abdominal pain were relieved within 1-2 hours in26 pafienta(65.0%)and within 48 hours in 11 patients(27.5%).In the PN+EN group,EN was provided(25.25±8.17)hours after catheter placement,and most patients could tolerate EN.Laboratory findings were not significantly different at admission between two groups.The mean prealbumin leveh were below than normal level at admission but returned normal after one week,which were significantly different inside each group(P<0.05)but were not significantly different between these two groups.The triglyceride leveh were higher than the normal level at admission but returned normal after treatment;however,the difference between the two groups was not significant.The laboratories tests were also not significantly different between two groups one week after admission.Conclusion EN support is safe for elderly patients with intestinal obstruction after effective gastrointestinal decompression.
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Objective To investigate the nutritional risks, undernutrition, and nutritional support among inpatients in tertiary hospitals in Tianjin using Nutritional Risk Screening 2002 (NRS2002). Methods Inpatients in six departments in two tertiary hospitals in Tianjin (Tianjin Nankai Hospital and Tianjin Chest Hospital ) were consecutively enrolled from March 2005 to March 2006. Their nutritional risks were screened using NRS 2002, and the nutritional support was investigated. Results A total of 1200 inpatients received nutritional screening, and 93.0% of them underwent NRS 2002 scoring. The prevalence of undernutrition was 9. 8% and the prevalence of nutritional risk was 42. 8%. Of these patients, 241 patients (46.4%) with NRS2002≥3 received nutrition support, and 244 patients (35.9%) with NRS2002 ＜3 received nutritional support Conclusions NRS2002 is suitable for nutritional risk screening among inpatients. Inpatients usually have nutritional risks or undernutrition. However, physicians at different levels in different regions have different awareness of such risks or conditions, and the clinical application of nutritional supports sometimes are inappropriate.
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ObjectiveTo investigate the current situation of postoperative fluid therapy in general surgery department of grade Ⅲ-A general hospitals in Beijing and Tianjin. Methods Postoperative patients in general surgery department who were fasting for 3 days were retrospectively investigated, and 600 cases were recruited without considering age, gender, denomination of disease and operation type.The general information of patients, laboratory examination before and after operation, postoperative fluid therapy for 3 days, postoperative complications and infusion reaction were collected.Results In total 588 valid cases, the volume of average fluids supplement was (3030±638)ml per day, With the prescribed glucose (142+67)g per day, potassium chloride (59.9±23.9) mmol per day and sodium chloride (179.5±66.7) mmol per day. 85.2 % of total patients received nutrition support and the ratio of parenteral nutrition/enteral nutrition (PN/EN) was 28/1.There were 549 patients with BMI>18.5 before operation, and among them, 470 cases (85.6%)received parenteral and enteral nutrition treatment. There were 39 patients with BMI < 18.5 and 27 cases (69.2%) received parenteral nutrition support without enteral nutrition treatment. During the 3 days after operation, there were 36 cases with fluid therapy without potassium chloride supplement.ConclusionsThe proportions of receiving nutrition support and parenteral nutrition treatment are relatively high in grade Ⅲ-A general hospitals in Beijing and Tianjin. Ready-to-use preparation canreduce mistake and will be benefit to patients.
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Objectives:In this study,the effects of glutamine(Gln) and branched chain amino acids(BCAA) enriched formulas on free radical metabolism and immunity in traumatized rats were investigated. Methods:After injury,twenty one male Wistar rats were randomly divided into three groups,and fed with rations containing casein,a commercial amino acids(17AA),and a new amino acids formula(20 AA) respectively.The rations were isonitrogenous and isocaloric.Before operation and on days 3,7,14 postoperation,body weight,dietary intake,the concentrations of MDA,the activities of SOD in plasma were measured.At last,the animals were killed,the hydroyproline and spleen lymphocyte blastogenesis were determined. Results:①After injury,body weight of rats were reduced significantly,the concentrations of MDA in plasma were increased,while the SOD activities were decreased. ②Compared with 17AA group, the levels of hydroyproline in sponge were increased in 20AA group.③There were better effects of reducing plasma MDA levels and enhancing plasma antioxidase activities in 20 AA group than 17 AA group.④The weight of thymus and spleen and spleen lymphocyte blastogenesis were more obviously increased in 20AA group than in 17AA group. Conclusions:The new amino acids preparations can increase the antioxidase activities,enhance immunity and promote wound healing.