ภาวะทุพโภชนาการและผลกระทบในผู้ป่วยที่รักษาในโรงพยาบาล: การทบทวนวรรณกรรมอย่างเป็นระบบ
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พ.ย. 16, 2019
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บทคัดย่อ
วัตถุประสงค์: เพื่อศึกษาผลของการคัดกรอง/ประเมินภาวะทุพโภชนาการ (malnutrition: MN) และผลกระทบของ MN ในผู้ป่วยที่รักษาในโรงพยาบาล วิธีการ: การศึกษาสืบค้นบทความจากฐานข้อมูลอิเล็กทรอนิกส์นานาชาติ ได้แก่ Medline, Cochrane Library และฐานข้อมูลภาษาไทย ได้แก่ Thai Library Integrated System (ThaiLIS), Thai Journal Citation Index Centre (TCI) และฐานข้อมูลวิทยานิพนธ์ของมหาวิทยาลัยต่างๆ ตั้งแต่เริ่มมีฐานข้อมูลจนถึงตุลาคม พ.ศ. 2559 และการสืบค้นด้วยมือ เกณฑ์การคัดเลือกงานวิจัย คือ เป็นการศึกษาที่คัดกรองและประเมิน MN ในผู้ป่วยที่รักษาในโรงพยาบาล รายงานผลลัพธ์เป็นความชุกของ MN และผลกระทบของ MN ได้แก่ อัตราตาย ระยะเวลานอนโรงพยาบาล และการเกิดภาวะแทรกซ้อน ผลการวิจัย: การศึกษาพบงานวิจัย 27 เรื่องที่ผ่านเกณฑ์การคัดเลือก การศึกษาต่าง ๆ มีการคัดกรองและประเมิน MN ในผู้ป่วยด้วยรูปแบบที่หลากหลาย ประกอบด้วย 1) การใช้ข้อมูลจากตัวบุคคล ได้แก่ การประเมินอาหารที่บริโภคและการตรวจร่างกาย 2) การใช้ข้อมูลจากการวัด ได้แก่ การวัดสัดส่วนของร่างกาย การตรวจทางชีวเคมี การประเมินจากหน้าที่ และ 3) แบบวัดซึ่งเก็บข้อมูลจากการวัดและจากตัวบุคคลขึ้นอยู่กับประเภทของแบบวัด เช่น Subjective Global Assessment, Nutritional Risk Screening, Nutrition Risk Index, Mini-nutritional Assessment ความชุกของ MN อยู่ในช่วงร้อยละ 0.5 – 85.5 โดยเป็นผลมาจากรูปแบบที่ใช้และความแตกต่างของผู้ป่วย ผู้ป่วยที่รักษาในโรงพยาบาลที่มี MN มีอัตราตายที่สูงและระยะเวลานอนโรงพยาบาลมากกกว่าผู้ป่วยที่มีภาวะโภชนาการปกติหรือ MN รุนแรงน้อยกว่า นอกจากนี้ MN ยังทำให้ผู้ป่วยมีการติดเชื้อและการกลับเป็นซ้ำที่เพิ่มขึ้น สรุป: ผู้ป่วยที่รักษาในโรงพยาบาลเป็นกลุ่มเสี่ยงที่จะเกิด MN การคัดกรองและประเมิน MN จึงมีความจำเป็นอย่างยิ่ง รูปแบบในการคัดกรองและประเมิน MN มีความหลากหลาย บุคลากรทางการแพทย์ที่เกี่ยวข้องควรพิจารณาเลือกใช้วิธีการคัดกรองและประเมินที่เหมาะสมให้เหมาะสมกับผู้ป่วย เพื่อลดผลกระทบต่อผู้ป่วยในด้านการเสียชีวิต การนอนโรงโรงพยาบาล การติดเชื้อ และการกลับเป็นซ้ำได้
Article Details
บท
บทความวิจัย
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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2. Kang MC, Kim JH, Ryu S-W, Moon JY, Park JH, Park JK, et al. Prevalence of malnutrition in hospitalized patients: a multicenter cross-sectional study. J Korean Med Sci. 2018;33:1-10.
3. Marshall S, Young A, Bauer J, Isenring E. Malnutrition in geriatric rehabilitation: prevalence, patient outcomes, and criterion validity of the scored patient-generated subjective global assess ment and the mini nutritional assessment. J Acad Nutr Diet. 2016;116:785-94.
4. Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, et al. Prevalence of mal- nutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017;8:79884-96.
5. Nazemi L, Skoog I, Karlsson I, Hosseini S, Moham madi MR, Hosseini M, et al. Malnutrition, prevalence and relation to some risk factors among elderly residents of nursing homes in Tehran, Iran. Iran J Public Health. 2015; 44:218-227.
6. Alvarez Hernandez J, Planas Vila M, Leon Sanz M, Garcia de Lorenzo y Mateos A, Celaya Pérez S, García Lorda P, et al. Prevalence and costs of multinutrution in hospitalized patients; the PREDy CES study. Nutr Hosp.2012; 27: 1049-59.
7. Mahakalkar CC, Modi S, Yeola M, Kaple MN, Patwardhan MA, Laddha P. Malnutrition in hospitalised patients; a real concern in surgical outcomes. Int J Res Med Sci. 2014;2:250-57.
8. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5-15.
9. Bauer J, Capra S, Ferguson M. Use of the scored Patients-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779-85.
10. Velasco C, Garcia E, Rodriguez V, Frias L, Garriga R, Alvarez J, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr. 2011;65:269-74.
11. Sureeporn Aiyakaew BM. Nutritional Status of Patients In Surgical Intensive Care Unit by using Udonthanihospital Nutrition Triage. Srinagarind Medical Journal. 2012; 27; 354-60.
12. Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clin Nutr. 2006;25:563-72.
13. Frew E, Cant R, Sequeira J. Capturing the data: nutrition risk screening of adults in hospital. Nutrients. 2010;2:438-48.
14. Aquino RdCd, Philippi ST. Identification of malnutrition risk factors in hospitalized patients. Revista da Associao Medica Brasileira. 2011; 57: 637-43.
15. Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet. 2008;21:575-83.
16. Cansado P, Ravasco P, Camilo M. A longitudinal study of hospital undernutrition in the elderly: comparison of four validated methods. J Nutr Health Aging. 2009;13:159-64.
17. Putwatana P, Reodecha P, Sirapo-ngam Y, Lertsithichai P, Sumboonnanonda K. Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment. Nutrition. 2005;21:691-7.
18. Raslan M, Gonzalez MC, Torrinhas RSMM, Ravacci GR, Pereira JCR, Waitzberg DL. Comple mentarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr. 2011;30:49-53.
19. Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 2010 ; 102: 966-71.
20. Anthony PS. Nutrition screening tools for hospi talized patients. Nutr Clin Pract. 2008;23:373-82.
21. Poulia K-A, Yannakoulia M, Karageorgou D, Gamaletsou M, Panagiotakos DB, Sipsas NV, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr. 2012;31: 378-85.
22. Charney P. Nutrition screening vs nutrition assess ment: how do they differ? Nutr Clin Pract. 2008;23: 366-72.
23. Mueller C, Compher C, Ellen DM. American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors. ASPEN clinical guidelines: Nutrition screening, assessment, and intervention in adults. J Parenter Enteral Nutr. 2011 ;35: 16-24.
24. Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr. 2016;62:9-25.
25. Donini LM, Savina C, Rosano A, Cannella C. Systematic review of nutritional status evaluation and screening tools in the elderly. J Nutr Health Aging. 2007;11:421-32.
26. van Bokhorst–de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. A systematic review of malnutrition screening tools for the nursing home setting. J Am Med Dir Assoc. 2014;15:171-84.
27. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011.
28. Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure in Europe: A systematic review and meta-analysis. PLoS ONE 2016; 11: e014760 1. doi.org/10.1371/journal.pone.0147601
29. Adejumo OL, Koelling TM, Hummel SL. Nutritional risk Index predicts mortality in hospitalized advanced heart failure patients. J Heart Lung Transplant. 2015; 34:1385-9.
30. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes. Clin Nutr. 2015;34: 745-51.
31. Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 tools to assess nutrition risk in the intensive care unit. J Parenter Enteral Nutr. 2015;39: 28-33.
32. Mogensen KM, Robinson MK, Casey JD, Gunase kera NS, Moromizato T, Rawn JD, et al. Nutritional status and mortality in the critically ill. Crit Care Med. 2015;43:2605-15.
33. Bassim CW, Fassil H, Dobbin M, Steinberg SM, Baird K, Cole K, et al. Malnutrition in patients with chronic GVHD. Bone Marrow Transplant. 2014; 49: 1300-6.
34. Drevet S, Bioteau C, Maziere S, Couturier P, Merloz P, Tonetti J, et al. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res. 2014;100:669-74.
35. Moriana M, Civera M, Artero A, Real JT, Caro J, Ascaso JF, et al. Validity of subjective global assessment as a screening method for hospital malnutrition. Prevalence of malnutrition in a tertiary hospital. Endocrinol Nutr 2014;61:184-9.
36. Tangvik RJ, Tell GS, Eisman JA, Guttormsen AB, Henriksen A, Nilsen RM, et al. The nutritional strategy: four questions predict morbidity, mortality and health care costs. Clin Nutr. 2014;33:634-41.
37. Rodrigues CS, Chaves GV. Patient-Generated Subjective Global Assessment in relation to site, stage of the illness, reason for hospital admission, and mortality in patients with gynecological tumors. Support Care Cancer. 2014;23:871-9.
38. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr. 2013;32:737-45.
39. Mauricio SF, da Silva JB, Bering T, Correia MI. Relationship between nutritional status and the Glasgow Prognostic Score in patients with colorectal cancer. Nutrition. 2013;29:625-9.
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