目的 探索微型營養評估簡易法（MNA-SF）能否客觀、正確地評估老年住院患者的營養狀況以及對臨床預后進行預測。 方法 選擇2012年3月－4月四川大學華西醫院新入院老年患者407例，平均年齡（75.4 ± 7.10）歲，以MNA-SF評估其營養狀態并根據營養狀態分為兩組，隨訪至出院或住院第30 d，分析其營養狀況與住院時間，住院費用，全身炎癥反應綜合征（SIRS），死亡等臨床結局的相關性。 結果 營養不良者22.6%（92例），營養不良風險者31.9%（130例），營養狀態良好者45.5%（185例）。其中34例營養不良者，18例營養不良風險者和4例營養良好者發生SIRS；另有11例營養不良者，7例營養不良風險者和1例營養良好者死亡。MNA-SF分值在0～7分的患者無論在發生SIRS還是臨床不良結局方面顯著高于分值為8～14分的患者（P＜0.05）。營養不良者住院時間為（14.6 ± 8.30）d，營養不良風險或營養良好者為（12.1 ± 7.99）d，差異具有統計學意義（P＜0.05）。 結論 MNA-SF是一可靠，簡便易行，可以預測老年住院患者臨床預后的營養評估工具。
With the acceleration of population aging, the health problems and care service needs of the elderly are increasing, while the capacity for family-based care is declining. To address these challenges, China has proposed the "integrated medical and nursing care" service model, which integrates medical and health services with elderly care. Geriatric medicine is one of the key technical components of this integrated service model. This study aims to construct a technical standard system for geriatric medicine within the integrated medical and elderly care services. It mainly includes the basic principles, overall framework, structure, and explanations of the geriatric medicine technical standard system, providing a technical and directional framework for the geriatric medicine technical standard system in the context of integrated medical and elderly care services.
ObjectiveTo develop a risk prediction scale for 6-month mortality in elderly patients with advanced chronic obstructive pulmonary disease (COPD), and provide a theoretical basis for creating tools to predict survival in this patient population. Methods A literature review was conducted to identify and extract risk factors associated with 6-month mortality in elderly patients with advanced COPD, forming the initial item pool for the scale. A Delphi method was employed, involving two rounds of correspondence with 17 multidisciplinary experts through a designed questionnaire. Items were comprehensively screened based on the arithmetic mean of item importance, coefficient of variation, and full score frequency to determine the final scale. ResultsThe effective response rates for the two rounds of expert correspondence were 94.12% and 100.00%, respectively. The expert authority coefficients were both ≥0.90 (0.93 and 0.90, respectively). The Kendall's coefficients of concordance were 0.28 and 0.26 (both P<0.05), indicating good coordination and authority among the experts and reliable results from the correspondence. The final constructed risk prediction scale for short-term mortality in elderly patients with advanced COPD includes 10 primary items and 55 secondary items. The 10 primary items are as follows: demographic characteristics, prognostic prediction, disease course, complications, comorbidity status, geriatric syndromes, signs/symptoms, COPD symptom scores, examination/laboratory indicators, and COPD treatment. ConclusionsThe Delphi-based risk prediction scale for 6-month mortality in elderly patients with advanced COPD is reliable and objective, and is expected to be a valuable tool to predict survival in this patient population.