controlling nutritional status score
术前CONUT评分预测HBV相关的HCC患者术后生存率
术前CONUT评分预测HBV相关的HCC患者术后生存率周超军;陈磊;蔡斌斌;蔡秀鹏;林炜航;方冠;杨文军【摘要】目的了解控制营养状况(controlling nutritional status,CONUT)评分预测乙型肝炎病毒(HBV)相关的肝细胞性肝癌(HCC)患者术后总体生存率的能力,并将与常用分期评分标准进行比较.方法回顾性分析温州医科大学附属第一医院2007年1月至2013年6月收治的373例HBV相关的HCC患者临床资料.生成受试者工作特征曲线(ROC),并计算曲线下面积(AUC),评估不同评分系统辨别1、3、5年存活率的能力.再将患者分为高CONUT组(CONUT>2,n=15)和低CONUT组(CONUT≤2,n=216),比较两组的临床病理特征及术后总生存期(OS)的差异,通过Cox模型进行单因素、多因素分析,明确影响患者预后的独立危险因素.结果 ROC 曲线下面积比较显示,CONUT的AUC值始终较高.低CONUT组的5年OS高于高CONUT组(P<0.05).将临床病理特征以及CONUT和CLIP评分等进行OS的单因素和多因素分析,结果显示,CLIP评分(P=0.004,HR 1.400,95％CI 1.113～1.762),纤维蛋白原<1 g/L或>4 g/L(P=0.002,HR 1.976,95％CI 1.272～3.072),TNM分期(P=0.003,HR 1.767,95％CI 1.212～2.575)和CO-NUT>2(P=0.010,HR1.697,95％CI 1.132～2.544)为患者预后的独立危险因素.结论 CONUT>2分可以作为HBV相关HCC患者预后的独立危险因素;在与Okuda评分、CLIP评分、BCLC分期评分标准比较中,CONUT具有更好的预测价值.【期刊名称】《肝胆胰外科杂志》【年(卷),期】2019(031)006【总页数】6页(P329-334)【关键词】癌,肝细胞;控制营养状况评分;乙型肝炎病毒;总生存期【作者】周超军;陈磊;蔡斌斌;蔡秀鹏;林炜航;方冠;杨文军【作者单位】温州医科大学附属第一医院肝胆外科,浙江温州 325000;温州医科大学附属第一医院肝胆外科,浙江温州 325000;温州医科大学附属第一医院肝胆外科,浙江温州 325000;温州医科大学附属第一医院肝胆外科,浙江温州 325000;温州医科大学附属第一医院肝胆外科,浙江温州 325000;温州医科大学附属第一医院结直肠肛门外科,浙江温州 325000;温州医科大学附属第一医院肝胆外科,浙江温州325000【正文语种】中文【中图分类】R735.7肝细胞性肝癌（HCC）是最常见的恶性肿瘤之一，是第二大癌症死亡原因[1]。
基线控制营养状况(CONUT)评分与腹膜透析患者临床结局的相关性研究介绍演示培训课件
指导营养干预
通过定期监测患者的CONUT评 分变化，可以及时发现营养不良 并采取相应的营养干预措施，从
而改善患者的临床结局。Fra bibliotek腹膜透析患者营养状况特点
蛋白质能量营养不良
腹膜透析患者由于蛋白质丢失和能量消耗增加，容易出现 蛋白质能量营养不良。表现为血清白蛋白降低、体重下降 、肌肉萎缩等。
02
探索降低腹膜透析患者CONUT评分 的有效干预措施。虽然本研究证实了 CONUT评分与患者临床结局的相关 性，但如何有效降低患者的CONUT 评分仍需进一步探讨。未来研究可以 关注饮食调整、营养补充、运动锻炼 等方面的干预措施，为患者提供个性 化的营养管理方案。
03
开展多中心、大样本量的研究以验证 本研究的结论。虽然本研究取得了一 定的成果，但样本量相对较小，可能 存在一定的偏倚。未来可以开展多中 心、大样本量的研究，进一步验证 CONUT评分与腹膜透析患者临床结 局的相关性，提高研究的可靠性和普 适性。
THANKS
感谢观看
炎症与感染情况分析
探讨CONUT评分与患者炎症、感染等并发症发生率的关系。
生活质量评价
评估不同CONUT评分组患者的生活质量差异，如身体功能、心 理状况、社会功能等方面。
05
结果讨论与解释
结果展示与解读
基线CONUT评分与患者生存率的关系
研究发现，基线CONUT评分较高的患者生存率显著降低，提示营养不良可能是影响腹 膜透析患者预后的重要因素。
生存率分析
根据患者的CONUT评分，将其分为 不同组别，比较各组患者的生存率差 异。
影响因素分析
采用多因素分析方法，探讨CONUT 评分对患者生存率的影响程度，并考 虑其他潜在影响因素。
氨康源氨基酸固体饮料 中英文对照
1、解酒护肝型氨康源氨基酸固体饮料，以人体必需氨基酸为基础的科学配方，通过现代科技手段，充分的保证了氨基酸的多样性、必需性、高营养性，同时也解决了在饮料中的稳定性，并且可充分发挥氨基酸在溶液中易吸收性，是一种全新低热量高营养性护肝解酒饮料。
饮料中含有肝脏所需要的解救氨基酸，同时也含有人体肝脏细胞的功能性营养元素，对肝细胞是很好的保护作用，同时解决饮酒后对小脑和纹状体的损害，减少身体对酒精的依赖性，有减轻酒精中毒的作用，调节机体对酒精的刺激，促进酒后机体的恢复，减少酒后的疲乏、胃肠紊乱、记忆力下降等等的酒后症状，同时减轻因为酒精中毒引起的手震颤等等现象。
1. The solid drink of anti-inebriation and liver protective type employs the scientific formula based on the human essential amino acids, through modern scientific methods; it is fully guaranteed the variety, essentiality, and high nutrition. Meanwhile, it keeps stability of the amino acids in the solution, and fully takes the advantages of their solubility inside the solution. It is an all new low calories, high nutrition drink of anti-inebriation and liver protection.The drink contains amino acids of salvation pathway that are needed in the liver. There are also functional nutritious elements of human liver in the drink. At the same time, the drink solves the damage problems of alcohol to the cerebellum and corpus striatum. It decreases the dependence of the body to alcohol. It has the effects on alleviating the alcohol intoxication, body adjusting to the alcohol stimuli, improving the body recovery after alcohol, reducing the post-alcohol symptoms of fatigue, gastro-intestinal disorders, and memory decrease, etc. It can also ease the hand tremors caused by alcohol intoxication, etc2、氨康源氨基酸饮料，以人体必需氨基酸为基础的科学配方，通过现代科技手段，充分的保证了氨基酸的多样性、必需性、高营养性，同时也解决了在饮料中的稳定性，并且可充分发挥氨基酸在溶液中易吸收性，是一种全新低热量高营养性抗疲劳饮料。
不同术前营养评分系统在肝细胞癌切除术预后评估中的意义
doi:10.11659/jjssx.02E023029·临床研究·不同术前营养评分系统在肝细胞癌切除术预后评估中的意义陆明1,胡孔旺2,涂从银1 （1. 中国科学技术大学附属第一医院西区普外科，安徽合肥 230031；2. 安徽医科大学第一附属医院普外科，安徽合肥 230022）［摘要］ 目的 评估术前预后营养指数（PNI）、控制营养状态评分（CONUT）、那不勒斯预后评分（NPS）3种营养评分系统与肝细胞癌切除术患者临床病理特征及预后的关系。
方法 回顾性分析2016年1月至2019年12月在中国科学技术大学附属第一医院行肝细胞癌根治性切除术的122例原发性肝细胞癌患者的临床病理资料，分析术前PNI、CONUT和NPS与临床病理特征及预后之间的关系。
采用Kaplan-Meier法绘制生存曲线；Cox比例风险模型进行单因素及多因素分析肝细胞癌患者总生存期的影响因素。
受试者工作特征（ROC）曲线下面积（AUC）比较各评分系统的预测价值。
结果 术前PNI与肿瘤分化程度、微血管侵犯(MVI)、肝硬化、术前血红蛋白水平有关（P<0.05）；术前CONUT与肿瘤分化程度、肝硬化、术前血红蛋白水平有关（P<0.05）；术前NPS与肝硬化、术前血红蛋白水平有关（P<0.05）。
低PNI组、高CONUT组、高NPS组分别相较于高PNI组、低CONUT组、低NPS组的术后住院时间更长、术后并发症发生率更高，差异均具有统计学意义（P<0.05）。
Cox比例风险模型得出术前PNI、CONUT、NPS与肝细胞癌患者的预后相关（P<0.05）；但只有术前NPS是影响肝细胞癌患者预后的独立危险因素（P<0.05）。
ROC曲线结果显示，NPS的AUC高于PNI、CONUT。
结论 术前PNI、CONUT和NPS 3种营养评分系统均与行肝细胞癌切除术患者的预后有关，其中术前NPS的预测价值高于术前PNI和CONUT。
术前预后营养指数在高龄大肠癌患者预后中的临床价值
·临床论著·Clinical Article·40术前预后营养指数在高龄大肠癌患者预后中的临床价值侯伟李连谦武文龙肖博文赵丽萍盘锦市中心医院普通外科（辽宁盘锦124010）[作者简介]侯伟(1982-01~),男,辽宁大洼人,副主任医师,研究方向:胃肠道肿瘤疾病。
E-mail:*********************大肠癌是全球癌症相关死亡的主要原因之一[1-2],过往肿瘤分期和分化程度被广泛用于评估大肠癌患者预后,但它并不精确,尤其是在伴有基础疾病的老年患者人群中[1-2]。
术前炎症反应和营养不良与肿瘤的免疫抑制状态密切相关,其为肿瘤术后复发提供了一个微环境[2-5],因此有研究认为术前炎症反应和营养不良与恶性肿瘤的长期预后有关[6-13]。
预后营养指数(prognostic nutritional index,PNI)是On⁃odera等[14]首次报道的一种同时包含营养(血清白蛋白水平)和免疫成分(外周血淋巴细胞计数)的预后指标,近年来多项研究表明,低PNI是大肠癌患者预后不佳的独立危险因素[13-17]。
随着人口老龄化的进展,高龄大肠癌的发病率也在迅速增加[18-20]。
现阶段高龄患者通常合并慢性炎症、营养不良等多种基础疾病[21]。
与中青年人群相比,高龄患者术前血清白蛋白和总淋巴细胞计数较低[21]。
然而,PNI和炎症指标在高龄大肠癌手术患者中的预测价值仍不清楚。
本研究旨在明确高龄大肠癌患者术前PNI与远期预后的相关性。
1资料与方法1.1一般资料回顾性分析2010年1月—2014年10月在盘锦市中心医院普通外科择期行根治性大肠癌切除术的超过80岁的154例患者的临床资料,男85例,女69例。
全部患者或家属知晓相关治疗计划,并签署知情同意书。
1.2排除标准符合以下标准之一的患者被排除本研究:(1)术前伴有其他感染性疾病;(2)大肠癌TNM分期为Ⅳ期;(3)临床资料不完整;(4)因伴有肠梗阻行急诊手术;(5)术后随访不足3个月。
个性化营养干预对结直肠癌患者围术期营养及生活质量的效果研究
生命科学-医药卫生生命科学仪器 2023年第21卷/第6期234作者简介:谭凤娟,(1987,04),女,本科,护师,主要从事胃肠外科的临床和教学工作㊂邮箱:x gr c b 6252@163.c o m ㊂个性化营养干预对结直肠癌患者围术期营养及生活质量的效果研究谭凤娟* 何业萍 龚 艳(中山市小榄人民医院胃肠外科,广东中山528415)摘要 目的探究在结直肠癌患者的围术期中实施个性化营养干预对患者营养状况和生活质量的效果㊂方法选择中山市小榄人民医院2021年1月至2023年6月80例接受手术治疗的结直肠癌患者㊂采用随机数字表法将选取的患者分为对照组(n =40,给予常规营养干预)和研究组(n =40,给予个性化营养干预)㊂对比分析两组患者的不良反应发生率㊁营养状况评分和胃肠道生活质量指数评分㊂结果研究组不良反应总发生率(7.50%,3/40)低于对照组(25.00%,10/40),差异有统计学意义(χ2=4.501,P =0.034)㊂干预后,研究组P A ㊁A L B 和T P 高于对照组(P <0.05)㊂研究组患者干预1周和干预2周G I Q L I 评分高于对照组(P <0.05)㊂结论结直肠癌患者术后易出现营养不良,需要给予营养干预,实施个性化营养干预可改善患者营养情况,保证患者安全,提高患者日常生活质量,效果显著㊂关键词 个性化营养干预;结直肠癌;围术期;生活质量E f f e c t o f p e r s o n a l i z e d n u t r i t i o n i n t e r v e n t i o n o n p e r i o pe r a t i v e n u t r i t i o n a n d q u a l i t y of l i f e i n p a t i e n t s w i t h c o l o r e c t a l c a n c e r T A N F e ng j u a n *,H E Y e p i n g,G O N G Y a n (S t o m a c h E n t e r o c h i r u r g i a ,Z h o n g s h a n X i a o l a n P e o p l e 's H o s p i t a ,Z h o n gs h a n 528415,C h i n a )*C o r r e s p o n d i n g a u t h o r :T A N F e n g j u a n ,S e n i o r n u r s e ;E -m a i l :x gr c b 6252@163.c o m ʌA b s t r a c t ɔO b je c t i v e :T o e x p l o r e t h e ef f e c t o f p e r s o n a l i z e d n u t r i t i o n i n t e r v e n t i o n o n t h e n u t r i t i o n a l s t a t u s a n d q u a l i t y o f l i f e o f p a t i e n t s w i t h c o l o r e c t a l c a n c e r d u r i ng p e r i o pe r a t i v e p e r i o d .M e t h o d s :80p a t i e n t s w i t h c o l o r e c t a l c a n c e r w h o r e c e i v e d s u r g i c a l t r e a t m e n t i n Z h o n g s h a n X i a o l a n P e o p l e 's H o s p i t a lf r o m J a n u a r y 2021t o J u n e 2023w e r e s e l e c t e d .R a n d o m i z e d n u m b e r t a b l e m e t h o d w a s u s e d t o d i v i d e t h e s e l e c t e d p a t i e n t s i n t o c o n t r o l g r o u p (n =40,r e c e i v i n gc o n -v e n t i o n a l n u t r i t i o n i n t e r v e n t i o n )a nd s t u d y g r o u p (n =40,re c e i v i n g pe r s o n a l i z e d n u t r i t i o n i n t e r v e n t i o n ).T h e i n c i -d e n c e of a d v e r s e r e a c t i o n s ,n u t r i t i o n a l s t a t u s s c o r e a n dg a s t r o i n t e s t i n a l q u a l i t y o f l i f e i n d e x s c o r e w e r e c o m pa r e db e -t w e e n t h e t w o g r o u p s .R e s u l t s :T h e t o t a l i nc ide n c e of a d v e r s e r e a c t i o n s i n t h e s t u d yg r o u p (7.50%,3/40)w a s l o w e r t h a n t h a t i n t h e c o n t r o l g r o u p (25.00%,10/40),t h e d i f f e r e n c e w a s s t a t i s t i c a l l y s i gn i f i c a n t (χ2=4.501,P =0.034).A f t e r i n t e r v e n t i o n ,P A ,A L B a n d T P i n t h e s t u d y g r o u p w e r e h i g h e r t h a n t h o s e i n t h e c o n t r o l g r o u p (P <0.05).G I Q L I s c o r e s i n t h e s t u d y g r o u p w e r e h i g h e r t h a n t h o s e i n t h e c o n t r o l g r o u p (P <0.05)a f t e r 1a n d 2w e e k s o f i n t e r v e n t i o n .C o n c l u s i o n :P a t i e n t s w i t h c o l o r e c t a l c a n c e r a r e p r o n e t o m a l n u t r i t i o n a f t e r s u r g e r y,a n d n u t r i t i o n a l i n t e r v e n t i o n i s n e e d e d .T h e i m p l e m e n t a t i o n o f p e r s o n a l i z e d n u t r i t i o n a l i n t e r v e n t i o n c a n i m pr o v e t h e n u t r i t i o n a l s t a -t u s o f p a t i e n t s ,e n s u r e t h e s a f e t y o f p a t i e n t s ,a n d i m p r o v e t h e q u a l i t y o f d a i l y l i f e o f p a t i e n t s ,w i t h s i g n i f i c a n t e f f e c t s .ʌK e y wo r d s ɔP e r s o n a l i z e d n u t r i t i o n i n t e r v e n t i o n ;C o l o r e c t a l c a n c e r ;P e r i o p e r a t i v e p e r i o d ;Q u a l i t y o f l i f e 中图分类号:R 322.4+5 文献标识码:A D O I :10.11967/2023211258结直肠癌是临床常见疾病,发病率㊁死亡率较高;临床治疗以手术切除根治术为主,且临床效果较佳,但患者术后易伴随免疫力下降㊁营养供应不足等情况,这对患者康复产生不良影响,且明显降低了患者生活质量,严重威胁患者生命安全;故于术后给予患者针对性个性化营养干预尤为重要[1-4]㊂本研究以我院选取80例结直肠癌患者为研究对象,应用个性化营养干预法探究其具体效果㊂1 资料与方法1.1 一般资料 选择中山市小榄人民医院2021年1月至2023年6月80例接受手术治疗的结直肠癌患者为研究对象㊂采用随机法将患者分为40例的研究组(n =40)和40例对照组(n =40)㊂研究组男26例㊁女14例;年龄48~88岁,平均(65.56ʃ5.45)岁;低分化16例㊁中分化14例㊁高生命科学仪器 2023年第21卷/第6期生命科学-医药卫生235分化10例㊂对照组男25例㊁女15例;年龄50~86岁,平均(65.99ʃ5.19)岁;低分化17例㊁中分化15例㊁高分化8例㊂两组患者一般资料比较,差异无统计学意义(P >0.05),表明两组患者的资料差异可忽略不计,研究成立㊂纳入标准:(1)患者入院后病理检查和影像学检查结果符合结直肠癌诊断指标[5-7];(2)患者体征稳定,可接受手术治疗;(3)患者能够配合试验,具有相关能力,而且主观表示同意㊂排除标准:(1)患者肿瘤已经发生转移,同时伴随多处病灶;(2)患者意识不清楚,无法保证理解能力;(3)患者合并脏器(肝脏㊁肾脏等)损伤问题㊂1.2 研究方法1.2.1 对照组接受常规营养干预,术后对患者情况进行观察,严格记录各项营养指标,同时结合实际为患者输注合适剂量的混合营养液(葡萄糖㊁氨基酸)㊂1.2.2 研究组给予个性化营养干预㊂术前风险评估:于患者术后对患者进行监测,针对临床营养不良发生率较高的因素,应用风险筛查评估量表对患者展开风险评估㊂并根据风险情况为患者制定个性化的营养干预方案,计算患者每日所需要的营养和热量,以便于日后严格按照标准给予患者营养治疗㊂可以口服的患者进行日常饮食,无法口服的患者采用肠内营养方式㊂术前健康宣教:给予患者饮食宣教,制作资料卡片或发放饮食指导手册,为患者讲解饮食对自身恢复的积极意义㊂通常此过程患者会提出多种疑问,可以引导和允许患者提问,给予详细解答,提高患者对饮食问题的重视㊂术前营养液配置:营养液需要满足患者日常中对水㊁钾离子㊁钠离子㊁钙离子㊁脂肪㊁糖类等成分的需求,严格根据患者体征进行营养成分占比配置,通常情况下,其对应的剂量分别为30m l ㊁0.7~0.9g ㊁1~1.4g㊁0.11g ㊁2g ㊁2g ㊂术后营养液输注:每日辅助给予患者营养液输注,需要结合患者情况展开,一般情况下,需要对其能量供给量进行设定,控制在10~12.5k J/(k g/d ),其中所对应的主要成分分别为氮量(0.15~0.2)g /(k g/d )和非蛋白热量(120~150)㊂术后饮食原则:术后早期需要给予患者肠内营养干预,逐渐恢复经口饮食㊂此过程中需要严格遵循饮食原则,结合患者的具体情况为其制定饮食计划,以米汤等流质饮食为主,随后逐渐过渡到米粥类半流质食物㊂为了满足患者营养所需,可以将鸡肉㊁蔬菜㊁水果等打成汁状或是糊状,补充患者营养成分㊂在营养干预过程中,还需要叮嘱患者多饮水,并遵循少食多餐原则,保证患者康复㊂1.3 观察指标 观察患者的不良反应,包括电解质紊乱㊁切口感染㊁切口愈合不良㊁吻合口瘘㊂干预前㊁干预后评价患者营养状况改善情况,采集患者5m l 空腹静脉血,离心(3500r /m i n ),10m i n 后取上清液进行生化检验,主要指标包括血清前白蛋白(P r e a l b u m i n ,P A )㊁白蛋白(A l b u -m i n ,A L B )和总蛋白(T o t a l pr o t e i n ,T P )[8-9]㊂干预前㊁干预1周和干预2周采用胃肠道生活质量指数量表(G a s t r o i n t e s t i n a l q a l i l y of l i f e i n -d e x ,G I Q L I)[10]评估患者生活质量㊂此量表涉及36个条目,评价采用5级评分法,计算分数最高为144分,测量分数越高,表明患者的生活质量越好㊂1.4 统计学方法 使用统计学软件S P S S 20.0进行数据处理㊂计量资料以(x ʃs)表示,组间比较采用t 检验,计数资料以例(%)表示,组间比较采用χ2检验,以P <0.05为差异有统计学意义㊂2 结果2.1 2组不良反应发生情况比较 研究组不良反应总发生率(7.50%,3/40)低于对照组(25.00%,10/40),差异有统计学意义(χ2=4.501,P=0.034)㊂见表1㊂2.2 2组营养状况比较 干预前,2组P A ㊁A L B和T P 比较,差异无统计学意义(P>0.05);干预后,研究组P A ㊁A L B 和T P 高于对照组,差异有统计学意义(P <0.05)㊂见表2㊂表1 2组不良反应发生情况比较[例(%)]组别例数电解质紊乱切口感染切口愈合不良吻合口瘘总发生率研究组401(2.50)1(2.50)0(0.00)1(2.50)3(7.50)对照组403(7.50)2(5.00)3(7.50)2(5.00)10(25.00)2.3 2组G I Q L I 评分比较 干预前两组患者G I Q L I 评分比较,差异无统计学意义(P>0.05);研究组患者干预1周和干预2周G I Q L I 评分高于对照组,差异有统计学意义(P <0.05)㊂见表3㊂3 讨论结直肠癌已经成为全球范围内对人体健康造成严重威胁的疾病种类㊂结直肠癌治疗难度系数大,且患者的术后恢复较慢,容易出现营养不良㊂生命科学-医药卫生生命科学仪器 2023年第21卷/第6期236因此,术后加强对患者的营养管理,及时补充营养液,并指导患者正确饮食对保证治疗成功尤为重要[11-13]㊂表2 2组患者营养状况比较(x ʃs)组别例数P A (m g/L )A L B (g/L )T P (g/L )干预前干预后干预前干预后干预前干预后研究组40181.66ʃ18.77284.45ʃ22.7737.66ʃ1.8840.45ʃ2.3366.55ʃ3.1262.34ʃ1.66对照组40181.23ʃ18.56245.45ʃ22.7737.67ʃ1.8732.23ʃ2.4466.44ʃ3.1153.23ʃ1.55t 0.1037.6600.02415.4090.15825.369P0.918<0.0010.981<0.0010.875<0.001注:P A 血清前白蛋白,A L B 白蛋白,T P 总蛋白表3 2组患者G I Q L I 评分比较(x ʃs)组别例数干预前干预1周干预2周研究组4082.23ʃ6.55102.23ʃ7.66105.45ʃ5.45对照组4082.33ʃ6.18112.34ʃ8.78116.78ʃ5.34t 0.0705.4889.391P0.944<0.001<0.001 个性化营养干预主要是从患者实际情况出发,结合患者具体患病情况及症状,为患者合理规划饮食,每日补充定量的维生素㊁脂肪㊁水等人体必需成分,促进机体恢复,为患者的康复提供基础㊂实施个性化营养干预后,患者可了解和掌握饮食的重要原则,保证健康饮食㊁促进机体恢复,临床应用价值较高[14-15]㊂本研究实施个性化营养干预,结果显示:两组患者均出现了不良反应,且研究组不良反应总发生率低于对照组(P<0.05);干预后,研究组患者的P A ㊁T P 和A L B 高于对照组(P<0.05)㊂研究组患者在干预1周和干预2周的评分显著高于对照组(P <0.05)㊂这结果表明在结直肠癌患者中实施个性化营养干预,更有利于保证患者的营养指标得到恢复,为患者及时补充所需营养,减少不良情况的发生,提高患者体质,意义显著㊂邱权威等[16]研究以结直肠癌患者为研究对象给予营养干预㊂结果显示试验组患者术后的P A ㊁T P 和A L B 均高于对照组(P<0.05)㊂且试验组患者术后1d ㊁术后1周㊁术后2周G I Q L I 评分分别为(100.26ʃ8.12)分㊁(112.46ʃ8.45)分和(116.26ʃ5.12)分,均高于对照组(P<0.05)㊂本研究结果与之一致,均证明了在结直肠癌患者术后实施个性化营养干预可促进患者恢复,提高患者生活质量㊂综上所述,在结直肠癌患者术后展开营养干预尤为重要,此过程中配合实施个性化营养实施,可更好的满足患者营养所需,提高患者生活质量,将并发症发生率进行有效控制,意义价值较高,可推广宣传㊂参考文献[1]中国抗癌协会肿瘤营养专业委员会,中华医学会肠外肠内营养学分会.结直肠癌患者的营养治疗专家共识[J ].肿瘤代谢与营养电子杂志,2022,9(6):735-740.[2]吴少彬,李艳芳,万婷,等.术前营养风险筛查对结直肠癌根治患者术后康复的影响及并发症发生的危险因素分析[J ].现代医学与健康研究电子杂志,2023,7(1):46-50.[3]霍耀亮,黄河,郭云童,等.全营养配方F S M P 在结直肠癌患者术后早期应用的随机对照研究[J ].肿瘤代谢与营养电子杂志,2023,10(4):530-536.[4]赵中海,刘秀,任丽,等.老年结直肠癌术后应用口服营养支持对患者营养状态及生活质量的影响[J ].中国临床医生杂志,2023,51(7):824-826.[5]刘浩燕,徐飞.术后规范化营养干预在老年结直肠癌患者中的应用效果[J ].医学临床研究,2023,40(10):1463-1470.[6]户艳丽,王月,袁翠玲.基于营养风险筛查下的营养支持对老年结直肠癌术后患者营养状态的影响[J ].中国疗养医学,2021,30(5):494-496.[7]容洁,钟倩,李玥镝,等.运动联合营养干预对结直肠癌患者术后恢复的影响[J ].当代临床医刊,2023,36(2):3-4.[8]刘晓微,王茜茜,郑文钦.早期肠内营养联合优化护理对结直肠肿瘤切除术后营养状态及康复的影响[J ].中外医学研究,2019,17(21):166-168.[9]李明晖,武雪亮,王立坤,等.某院结直肠肿瘤患者围术期营养风险筛查与营养支持的现状分析[J ].重庆医学,2020,49(12):1919-1922.[10]陈育珊.参与式培训模式对直肠癌术后心理状况及生存质量的影响[J ].中国医学创新,2017,14(7):4.D O I :10.3969/j.i s s n .1674-4985.2017.07.027.[11]谢大伟.术前营养风险评估的老年结直肠癌患者接受营养支持对术后肠功能恢复情况及相关营养指标的影响[J ].中国医学创新,2023,20(11):141-145.[12]宋丽,叶家慧.营养状态对结直肠癌患者术后手术部位感染的影响[J ].中国肛肠病杂志,2023,43(2):44-46.[13]吴惠芳,廖柳荫,卢琳媚.结直肠癌病人术前营养风险与术后并发症的相关性[J ].护理研究,2023,37(15):2826-2830.[14]赵阳昱,朱忠华.药物治疗管理在结直肠肿瘤病人围手术期营养支持治疗中的实践[J ].安徽医药,2023,27(9):1881-1885.[15]李朋,尹磊.老年结直肠癌行回肠造口术患者术前和术后营养评估[J ].浙江临床医学,2023,025(005):718-720.[16]邱权威,杨一群,刘全丽,等.腹腔镜结直肠癌根治术后口服肠内营养对术后康复作用的临床研究[J ].包头医学院学报,2023,39(9):40-43+63.。
PYMS小儿约克希尔营养不良评分信息和用户指南说明书
PYMS Paediatric Yorkhill Malnutrition ScoreInformation and User’s Guide2009© Nutrition Tool Steering Group, Women and Children’s Directorate, NHS Greater Glasgow and Clyde, 2009.The content of this booklet is provided for general information only and should not be relied upon. Whilst we use all reasonable efforts to ensure that the information contained in the booklet is current, accurate and complete at the date of publication, no representations or warranties are made (express or implied) as to the reliability, accuracy or completeness of such information. Greater Glasgow Health Board cannot therefore be held liable for any loss arising directly or indirectly from the use of, or any action taken in reliance on, any information appearing in the booklet.The information in this booklet is designed to comply with the laws and regulations of the United Kingdom. Although accessible by users from other countries, it and its content is intended for access and use by residents of the United Kingdom only. Disclaimer:- ALL RIGHTS RESERVED. No part of this publication may be copied, modified, reproduced, stored in a retrieval system or transmitted in any material form or by any means (whether electronic, mechanical, photocopying, recording or otherwise and whether or not incidentally to some other use of this publication) without the prior written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988.ContentsPage Introduction (3)Development of the Paediatric Yorkhill Malnutrition Score (PYMS) (5)Validation of the Paediatric Yorkhill Malnutrition Score (PYMS) (5)PYMS User’s Guide (6)The PYMS Form Explained (13)PYMS Form (15)Nurse’s Quick Reference Guide (17)Quick Guides for Measuring Heights/Lengths and Weights (19)References (23)“Freedom from…malnutrition is a basic human right”(World Health Organisation, 20081).IntroductionThe Paediatric Yorkhill Malnutrition Score (PYMS) has been developed to assist nursing staff and other health professionals identify hospitalised children, between the ages of 1-16 years, who are at risk of malnutrition and offer them appropriate care. The following explanatory notes offer an overview of malnutrition and provide information on the development and use of PYMS.MalnutritionIdentification of children at risk of malnutrition is essential in treating disease-related malnutrition and optimising the health of all hospitalised patients. Malnutrition is: “the state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body function and clinical outcome”2. The term malnutrition refers to both over-nutrition and under-nutrition but, for the purposes of this document it only refers to energy/protein under-nutrition.Malnutrition continues to be a significant health issue in developed countries, with an estimated cost in the UK of approximately £13 billion3. Despite this malnutrition continues to be largely unrecognised and under treated4. It has been estimated that up to 30%5-10 of hospitalised patients are at risk of malnutrition and this figure can be as high as 60% in some paediatric patient groups11,12.Why is Malnutrition Important?Malnutrition is undesirable, not only because it leads to weight loss, but also because it is a recognised risk factor for the development of complications of disease. These include increased morbidity and mortality, longer duration of hospitalisation and increased health care costs13. In children, there are additional concerns as malnutrition can potentially lead to long-term effects on brain development, linear growth and bone health that impact on health later in life14.Failure to consider nutritional status may also have medico-legal consequences, with an increasing number of cases of nutritional neglect being pursued within the judicial system15.In the general population approximately 2.5% of children have a body weight which is below the reference range for their age and gender. However, a much larger proportion (16%) of children attending hospital are underweight and malnutrition remains largely undiagnosed and untreated amongst hospitalised children9-10. This is mainly due to a lack of nutritional training and awareness amongst staff and can also be attributed to a lack of established protocols for screening, assessment and action15.Introduction to Nutritional ScreeningFood and water are essential elements of care and failure to detect malnutrition or the risk of becoming malnourished has the potential to cause patients considerable harm. The Nursing and Midwifery Council (NMC) Code of Conduct requires all nursing staff to ‘protect and promote the health and well being of those their care’16. This responsibility is detailed in NHS Quality Improvement Scotland Guidelines (2003) which state that because high quality nutritional care is crucial for the well being of patients, all patients should be screened using a validated tool that is appropriate to the patient population17. Such screening should be carried out on admission and regularly during a patient’s hospital stay. Nutritional screening provides a means of ensuring that patients, who following screening appear to be at high risk, will be assessed by dietetic staff and managed appropriately.Screening tools validated in adult patients18-19 areinappropriate for use in children, as malnutrition presentsdifferently within the paediatric population. Thus far,nutritional screening in paediatrics has been hindered due toa lack of a valid generic paediatric screening tool15.Development of the Paediatric Yorkhill Malnutrition Score (PYMS)A multidisciplinary healthcare team from the Royal Hospital for Sick Children, Glasgow and Royal Alexandra Hospital, Paisley, both part of the Women and Children’s Directorate NHS Greater Glasgow and Clyde, was assigned to develop a local paediatric malnutrition screening tool. The project team consisted of senior nursing, dietetic, research, academic and medical staff.The primary purpose of the project team was to develop and validate a tool that would be simple, quick to use, user and patient friendly and would detect the majority of children at risk of malnutrition. The tool would be used by nursing staff to screen patients on admission and at intervals during their hospital stay. The tool was developed for use in children aged 1-16 years. A separate tool was considered necessary to assess neonates and infants under the age of 1 year, due to their rapid growth during the first year of life and complex issues surrounding prematurity.A preliminary malnutrition screening tool was developed based on the guidelines for nutritional screening from the European Society of Clinical Nutrition and Metabolism15. The PYMS was designed to incorporate questions/measurements to address the following four principles:1. The current nutritional status2. The stability of nutritional status3. The recent changes to nutritional status4. The likelihood of the acute disease condition to affect the nutritional statusadversely.Validation of the Paediatric Yorkhill Malnutrition Score (PYMS)Following the development of the tool a 4 month validation study was undertaken, within 4 paediatric wards (3 medical, 1 surgical) of a tertiary paediatric hospital and the general paediatric ward of a district general hospital. The diagnostic accuracy and performance of PYMS was evaluated through a four stage validation study, the results of which have been presented20-22 and are expected to be published in due course.PYMS User’s GuideDescription of the PYMS FormThe PYMS form is presented as a simple structured questionnaire, consisting of four questions (steps) which are strong predictors/symptoms of malnutrition. Each of these steps bears a score from 0 to 2 and an overall nutritional risk score (step 5) is calculated based on the sum of the results of steps 1-4. An action plan follows according to the overall nutrition score. The four steps are outlined below:Step 1: Body Mass Index (BMI)•BMI is a useful measure of nutritional risk and is based on height and weight.•Height and weight should be obtained according to local hospital guidelines.•Weight must be repeated each time PYMS is carried out and it is recommended that for long term admissions, height/length should be recorded monthly for infants and three-monthly for older children.(N.B. please follow local hospital policy).Instructions outlining the correct procedure for obtaining weights and heights/lengths are included in this information & users guide (page 21-24) (N.B. please follow local hospital guidelines). Once measurements have been correctly obtained, they should be recorded in the appropriate boxes on the PYMS form. After that, the Body Mass Index (BMI) for the patient can be calculated using a BMI calculation wheel.The BMI calculation wheel consists of two wheels (see figure 1).To use:•Locate the weight (kilograms) of the patient on the outer wheel and the height/length (centimetres) of the patient on the inner wheel.•Rotate the inner wheel until child’s weight and height are aligned.•The BMI value is displayed in the window by the red arrow, record the value obtained in the appropriate box on the PYMS form.Figure 1: BMI Calculation Wheel(Produced with permission from Blundell Harling Ltd.)Normal BMI values vary according to age and gender and therefore a scoring guide located on the back of the PYMS form, gives the minimum acceptable BMI values. The age of the child should not be rounded up when referring to this scoring guide. A BMI below the minimum acceptable value indicates a possible risk factor for malnutrition. The following scoring should be used for step 1:i. Score 0 if BMI value is greater than that shown for age and gender according to the scoring guide.ii. Score 2 if BMI value is below that shown for the age and gender according to the scoring guide.NB : If it is NOT POSSIBLE TO OBTAIN A HEIGHT, a member of medical staff should be asked to plot the patient’s weight on a growth chart. If the weight is below the 2nd centile, a SCORE of 2 should be entered for step 1.The reason why a height could not be obtained should be documented in the comments table on the back of the form.STEP 2: Recent Weight LossUnintentional weight loss may indicate that a child is at nutritional risk. Ask parents/guardians if they have noticed any recent weight loss, or compare current weight with previously documented weights. These should be recorded in the patient’s notes or parent hand held record.If the child is under 2 years of age, parents/guardians should be asked if they have any concerns about the child’s weight gain recently. Failure to gain weight may also be an indication of nutritional risk in very young children (<2 years).i. Score 0 if:a. Weight is increasingb. Weight is static and child is more than 2 years oldc. Weight loss is intentional as the child has been or is overweight andis on a calorie restricted diet.ii. Score 1 if:a. Unintentional weight loss noticed by the child/carers or has beenidentified after comparing with previously documented weightsb. Weight static in a child less than 2 years oldc. Clothes have become more ill fitting due to noted weight lossd. Intentional weight loss because of eating disorderse.g. if the childsuffers from anorexia nervosa.STEP 3: Assess Recent Change in Diet/Nutritional Support (for at least the last week)A decreased nutritional intake may increase the risk of developing malnutrition. Ask carers/child about food intake for at least the last week. If the child is usually on any artificial feeds (enteral feeds, dietary supplements or parenteral nutrition) then ask whether there has been any change in the amount taken and/or tolerated.i. Score 0 if:a. There has been no change to normal diet or enteralnutrition, dietary supplements or parenteral nutritionii. Score 1 if:a. There has been a decrease in usual dietary intake, enteralfeeds, dietary supplements or parenteral nutrition for a minimum of thelast 7 days (unless health professional instructed decrease to restrictcalorie intake).iii. Score 2 if:a. There has been no or minimal intake over the last week, includingintake from oral feeds, enteral nutrition, dietary supplements orparenteral nutrition.N.B. If there is very minimal intake (only a few sips of feed per day) this should be counted as no intake (score 2).STEP 4: Acute Admission/Condition Effect on Nutrition (at least the next week) Some patients may be at risk of becoming undernourished during their hospital admission or soon after their discharge, because of the effect of the medical condition on their nutritional status. This may be due to decreased intake, increased gut losses and increased energy requirements.i. Score 0 if:a. The patient’s nutritional status is unlikely to be unchanged duringthis admission or soon after their discharge.ii. Score 1 if at least one or more of the following is expected over at least the next week:a. Decreased intake from oral, enteral or parenteral nutrition(e.g. orofacial disease or trauma, severe nausea)b. Increased gut losses (e.g. significant ongoing diarrhoea or vomiting,large stoma losses)c. Increased energy requirements (e.g. major trauma, burns, sepsis,pyrexia).iii. Score 2 if for the next week:a. No or minimal intake is expected from oral, enteral orparenteral nutrition (e.g. major abdominal surgery).N.B. If there is very minimal intake (only a few sips of feed per day) this should be counted as no intake (score 2).STEP 5: Total Nutrition Risk Score and Action PlanOnce all the above scores have been entered onto the PYMS form add them together to provide a total score (step 5). A total score of 2 or more reflects significant nutritional risk.i. If the score is 2 or more, a request for dietetic review should bemade according to the established hospital request system andthe medical/surgical team should also be informed. PYMSshould be repeated weekly.ii. If the score is 1, then the child should be observed for any further deterioration of intake. The quantity and type of food andfluid consumed should be recorded. PYMS should be repeatedin 3 days and medical staff informed.iii. If the score is 0, then no further action is required at this time but PYMS should be repeated weekly.N.B.If there are clinical concerns about a patient’s nutritional status, a dietetic review MUST be requested and medical staff informed even if the child has scored less than 2.Local policies and clinical judgement are not replaced by this scoring system and children should be managed following local guidelines for nutrition management. This should include plotting of height and weight on a growth chart and any additional nutritional concerns discussed with the medical/surgical team and a request made to dietetics if deemed necessary (e.g. food allergies, special diets etc).PYMS is designed to detect children at risk of energy/protein under-nutrition (malnutrition) only, and will therefore not detect children with vitamin and/or mineral deficiencies. It is not designed to detect children at risk of over-nutrition (obesity).The PYMS Form ExplainedLocal hospital policy may require that 2 peoplecheck weight and height measurementsObtain each time PYMS is calculatedRecord calculated BMI here- obtain using BMI wheel.Age required to calculate BMI and compare against cut off valueMeasure length/ height monthly in infants and 3 monthly in older childrene.g; • Major trauma• Major burns • Sepsis • Pyrexiae.g;• Persistent diarrhoea • Persistent vomitinge.g;• orofacial disease/ trauma • severe nauseaUnless a health professional hasinstructed reduction in calorie intake.Use BMIscoring guide overleafStanding Height MeasurementFeet straight together with soles touching the boardBare feet, legs togetherHeels, calves, buttocks, shoulder, head touching theback plateReference List1. World Health Organisation (WHO) (2008) Nutrition for health and development. [online] http://www.who.int/nutrition/nhd/en/index.html Accessed 28th April 2008.2. Elia M, Ljungqvist O and Dowsett J (2005) Principal of Clinical Nutrition: Contrasting the Practice of Nutrition in Health and Disease. Oxford, Blackwell Science Ltd.3. Bapen (2009) Combating Malnutrition Recommendations for Action. Executive summary. Redditch, British Association of Parenteral and Enteral Nutrition (BAPEN) [online] /pdfs/reports/advisory_group_report.pdf Accessed 15th July 2009.4. McWhirter JP and Pennington CR (1994) Incidence and recognition of malnutrition in hospital. British Medical Journal 308 945-948.5. Hendricks KM, Duggan C, Gallacher L, Carlin AC, Richardson DS, Collier SB, Simpson W and Lo C (1995) Malnutrition in hospitalized paediatric patients: current prevalence. Archives of Pediatrics and Adolescent Medicine 149 (10) 1118-1122.6. Joosten KFM, Zwart H, Hop WC and Hulst JM (2009) National malnutrition screening days in hospitalized children in the Netherlands. Archives of Diseases in Childhood[published online 3 May 2009] doi:10.1136/adc.2008.157255.7. Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R, Thomson JM, Oldroyd JC, Smith JC, Torrance AD, Blackshaw V, Green S, Hill CJ, Berry C, McKenzie C, Vicca N, Ward JE and Coles SJ (2000) Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clinical Nutrition 19 191-195.8. Moy RJD, Smallman S and Booth IW (1990) Malnutrition in a UK children’s hospital. Journal of Human Nutrition and Dietetics 9 93-100.9. Pawelleck I, Dokoupil K and Koletzko B. (2008) Prevalence of malnutrition in paediatric hospital patients. Clinical Nutrition 27 72-76.10. Hendriske WH, Reilly JJ and Weaver LT (1997) Malnutrition in a children’s hospital. Clinical Nutrition 16 13-18.11. Cameron JW, Rosenthal A and Olson AD (1995) Malnutrition in hospitalised children with congenital heart disease. Archives of Pediatrics and Adolescent Medicine 149 (10) 1098-1102.12. De Staebel O (2000) Malnutrition in Belgian children with congenital heart disease on admission to hospital. Journal of Clinical Nursing 9 (5) 784-791.13. Correia MI and Waitzberg DL. (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical Nutrition 22 235-9.14. Lucas A, Morley R and Cole TJ (1998) Randomised trial of early diet in preterm babies and later intelligence quotient. British Medical Journal 317 1481-1487.15. Kondrupt J, Allison SP, Elia M, Vellas B and Plauth M. (2003) ESPEN Guidelines for Nutrition Screening 2002. Clinical Nutrition 22 415-421.16. Nursing and Midwifery Council (NMC) (2008) The Code. Standards of Conduct, Performance and Ethics for Nurses and Midwives. London, Nursing and Midwifery Council.17. NHS Quality Improvement Scotland (QIS) (2003) Food, fluid and nutritional care in hospitals. Edinburgh, NHS QIS.18. Gerasimidis K, Drongitis P, Murray, L, Young D and McKee R (2007) A local nutritional screening tool compared to malnutrition universal screening tool. European Journal of Clinical Nutrition 61 916-921.19. Green SM and Watson R (2005) Nutritional screening and assessment tools for use by nurses: literature review. Journal of Advanced Nursing 50 (1) 69-83.20. Gerasimidis K, Macleod I, McGrogan P, Maclean A, Buchanan E, McAuley M, Stewart G, Wright C and Flynn D (2009) Development and Performance of a New Paediatric Nutritional Screening Tool in a Tertiary and District General Hospital. The PYMS Project. British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) winter meeting (Sheffield), oral presentation.21. Gerasimidis K, Keane O, Macleod I, Buchanan E, Maclean A, McGrogan P, Stewart G, McAuley M, Flynn D and Wright C (2009) Criterion validity and inter-rater reliability of the Paediatric Yorkhill Malnutrition Score. European Society of Paediatic Gastroenterology, Hepatology and Nutrition (ESPGHAN) annual meeting (Budapest), oral presentation, abstract in press.22. Macleod I, Gerasimidis K, Purcell O, Mohammed T, Swinbank I, Wright C, FlynnD and McAuley M (2009) Implementing a novel paediatric nutritional screening tool (Paediatirc Yorkhill Malnutrition Score) in nursing practice.Challenges and impact in paediatric nursing practice. European Society of Paediatic Gastroenterology, Hepatology and Nutrition (ESPGHAN) annual meeting (Budapest), poster presentation, abstract in press.NotesProduced by The Nutrition Tool Steering Group,Women and Children’s Directorate,NHS Greater Glasgow and Clyde.Medical Illustration, Job No. 20584727。
一例胃癌术后化疗患者的营养护理体会
一例胃癌术后化疗患者的营养护理体会发布时间：2022-12-06T06:57:35.662Z 来源：《护理前沿》2022年23期作者：李莉[导读] 目的:总结分析1例胃癌术后化疗患者的营养护理体会。
方法：对我院2022.01.20收治1例胃癌术后化疗患者的临床资料进行回顾性分析总结，对其机体营养状况进行评估筛查，并针对性的给予营养护理，最后总结分析该患者的营养护理体会，以为临床胃癌术后化疗患者的营养护理提供些许实际参考意义。
李莉江西省肿瘤医院消内二病区 330000【摘要】目的:总结分析1例胃癌术后化疗患者的营养护理体会。
方法：对我院2022.01.20收治1例胃癌术后化疗患者的临床资料进行回顾性分析总结，对其机体营养状况进行评估筛查，并针对性的给予营养护理，最后总结分析该患者的营养护理体会，以为临床胃癌术后化疗患者的营养护理提供些许实际参考意义。
【关键词】胃癌；术后化疗；营养护理；护理体会胃癌即病变于胃黏膜上皮的恶性肿瘤，属于临床消化系统最为常见的恶性肿瘤之一，患病率与病亡率均较高，其病亡率目前居于消化道肿瘤的首位[1]。
目前针对胃癌的治疗主要以手术结合化疗为主，可有效的延长患者生命周期。
但是由于疾病原因、胃部组织的切除，加之化疗引发的一系列不良反应等，会影响患者的正常进食，继而导致其机体容易出现营养不良状况[2,3]。
相关研究表明，胃癌为一种消耗性疾病，胃癌患者营养不良的占比高达60%-85%，患者一旦出现营养不良，可直接影响患者的后续的化疗以及预后生存质量[4]。
因此，对于胃癌术后化疗患者需要营养科学合理的营养护理支持，以改善患者胃肠道功能，促进其营养吸收，继而达到改善预后的目的[5]。
故该次个案以2022.01.20收治1例胃癌术后化疗患者为研究对象，就对患者进行营养评估后为其制定针对性的营养护理支持，现将营养护理的具体体会整理如下。
具体情况报告如下：1、病例摘要患者姓名常**，女，31岁。
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controlling nutritional status score Controlling Nutritional Status Score (CONUT)是一种评估患者营养状态的方法，可以用于预测手术后并发症和死亡率。
下面将从CONUT 的定义、评估方法、临床应用等几个方面进行阐述。
一、CONUT的定义
CONUT是Controlling Nutritional Status Score的缩写，意为控制营养状况评分，是一种用于评估患者的营养状态的方法。
通过评估血清白蛋白、总胆固醇和淋巴细胞计数三个指标，计算出CONUT分数。
CONUT分数越高，代表患者的营养状态越差。
二、CONUT的评估方法
1. 血清白蛋白：正常值为35-50g/L，低于该范围表示营养不良。
2. 总胆固醇：正常值为
3.10-5.17mmol/L，低于该范围也表示营养不良。
3. 淋巴细胞计数：正常值为1.0-3.5×109/L，低于该范围则反映免疫功能低下，提示营养不良。
通过对以上三个指标的评估，计算出CONUT的分数，分为0-4分，分数越高，患者的营养状态越差。
一般来说，CONUT分数在0-1分代表正常营养，1-2分表示轻度营养不良，2-4分则为中度至严重营养不良。
三、CONUT在临床中的应用
CONUT可以在手术前评估患者的营养状况，并预测手术后的并发症和死
亡率。
一些研究表明，CONUT分数较高的患者在手术后的感染和器官衰竭等并发症发生率较高，并且预后差。
除此之外，在长期康复期的评估中，CONUT也可以为临床医生提供可靠的指导。
对于患有肝病、营养不良等慢性疾病的患者，CONUT也可以作为评估治疗效果的一种方法。
总之，CONUT是一种简便、可重复性好的评估患者营养状态的方法，可以在临床中用于预测手术后的并发症和死亡率，对于营养不良等慢性疾病的康复期也有良好的应用。