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경정영양과 중심정맥영양을 공급받는 환자에서 질병의 상태(APACHEIII Score), 과대사 정도가 영양상태 및 임상적 결과에 미치는 영향
라미용,김은미,조영연,서정민,최혜미,Rha Mi yong,Kim Eun mi,Cho Young Y.,Seo Jeong Meen,Choi Hay mie 대한지역사회영양학회 2006 대한지역사회영양학회지 Vol.11 No.1
The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.
중환자의 초기 경장영양 공급 시 위잔여량에 따른 임상적 특징 분석
유소영 ( So Young Yu ),김은미 ( Eun Mee Kim ),조영연 ( Young Y Cho ),라미용 ( Mi Yong Rha ),김진용 ( Jin Young Kim ),장동경 ( Dong Kyung Chang ),서정민 ( Jeong Meen Seo ) 한국정맥경장영양학회 2010 한국정맥경장영양학회지 Vol.3 No.1
Purpose: A high gastric residual volume (GRV) occurs early and frequently in patients who are receiving nasogastric tube feeding in the intensive care unit (ICU). This study analyzed the clinical and nutritional characteristics of ICU patients who received nasogastric tube feeding according to the GRV. Methods: The subjects were 76 patients who were admitted to the ICU at S Medical Center from January, 2009 to May, 2009 and who received enteral nutrition (EN)support. Tube feeding was skipped when the GRV was over 50~100 cc. The patients who experienced meal skipping due to high GRVs comprised the GRV group, and the patients whose feeding was never skipped due to high GRVs comprised the non-GRV group. The general, clinical and nutritional characteristics were determined at the beginning of the EN support, and the method of EN was collected for the first 3 days of tube feeding. Results: Nine patients experienced meal skipping due to GRV. There were no significant differences between the GRV and NGRV group in terms of age (60.4 vs. 61.8 years for GRV and NGRV, respectively; same respective order hereafter), pre-npo (5.0 vs. 4.7 days) and the ICU stay (20.5vs. 23.7 days). Significant differences were evident in the GRV group concerning the ratio of male patients (55.2%vs. 88.9%; P<0.05), the medical-ICU patients (35.8% vs.88.9%; P<0.05) and the sedated patients (29.8% vs.66.7%; P<0.05). The BMI (22.4 vs. 21.8 kg/m2) and TLC(2,252 vs. 1,137 cells/mm3) values were not significantly different between the two groups. The serum albumin level(3.1 vs. 2.6 g/dl) was significantly lower in the GRV group(P<0.05) and the C-reactive protein level (8.11 vs. 19.02mg/dl) and the ratio of moderately and severely malnourished patients (25.4% and 77.8%) was significantly higher in the GRV group (P<0.05). The mean feeding volume (731vs. 688 cc) and ratio of the feeding rate (129 vs. 127 ml/h)during the first 3 days on EN was not significantly different between the two groups, nor was the required/maximum feeding volume (9.8 vs. 8.2 days).Conclusion: In the GRV group, the ratio of male to sedated patients was significantly higher than that in the other group. The ratio of moderately and severely malnourished patients was also significantly higher in the GRV group. There were no significant differences in the methods of EN support. (KJPEN 2010;3(1):50-53)
[논문철회]위암 수술 후 외래환자의 영양상태 평가: 5가지 영양검색도구의 비교연구
조재원,윤지영,최민규,라미용,이정은,Cho, Jae Won,Youn, Jiyoung,Choi, Min-Gew,Rha, Mi Young,Lee, Jung Eun 대한지역사회영양학회 2021 대한지역사회영양학회지 Vol.26 No.4
Objectives: This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools. Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools. Conclusions: Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.
체외막형 산화기를 시행한 심장내과 중환자실 입원 환자의 경장영양 지원: 관찰 연구
김성혜 ( Sung Hye Kim ),신윤진 ( Yoonjin Shin ),라미용 ( Mi Yong Rha ),조영연 ( Young Yun Cho ),양정훈 ( Jeong Hoon Yang ),조양현 ( Yang-hyun Cho ),서지영 ( Ji Young Seo ),강보리 ( Bori Kang ),김양하 ( Yangha Kim ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.3
Purpose: Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU). Methods: Adult patients admitted to the CCU undergoing ECMO from January 2014 to May 2015 were included. Patients with <48 hours of support, undergoing ECMO at another hospital, and inaccurate medical records were excluded. Results: Among the 14 patients undergoing ECMO in the CCU, 2 patients were diagnosed with malnutrition and the others were in the normal state in the initial assessment. On the other hand, they had the malnutrition risk factors (anorexia, weight loss, fluid retention, and hypermetabolic state). Thirteen patients received enteral nutrition and 1 patient had possible oral intake. The average initiation day of enteral nutrition was 2.0±1.6 days on ECMO. The mean duration of enteral nutrition was 5.2±4.9 days and the target goal was achieved within 3 days. There were no serious adverse effects for enteral nutrition but 3 patients had gastrointestinal problems (diarrhea and anorexia), and gastrointestinal bleeding occurred in 1 patient. In 1 case, enteral nutrition had to be stopped due to the prone position. Overall, 5 patients were cured, 3 patients recovered through heart transplantation, and 6 patients died. Conclusion: Most CCU patients receiving ECMO were well nourished but had the malnutrition risk factors in progress. These results suggest that enteral feeding might be safe and feasible in patients treated with ECMO but there were minor side effects.
장은희 ( Eun Hee Jang ),류은순 ( Eun Soon Lyu ),이송미 ( Song Mi Lee ),박유경 ( Yoo Kyung Park ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Young Rha ),이승민 ( Seung Min Lee ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.4
The objective of this study was to examine job satisfaction status and its related factors among dietitians working in hospitals. A survey questionnaire was sent to dietitians working in tertiary, general, and convalescent hospitals in Korea. The study sample hospitals included all tertiary hospitals (n=43), and the sample of general hospitals (n=114) and convalescent hospitals (n=240) was randomly selected using a stratified sampling method. A total of 665 dietitians completed the survey questionnaire. The questionnaire included27 job satisfaction questions on task, stability·vision, working conditions, and relationship areas, and the questions on task improvement need. The job satisfaction scores in all four areas ranged from2.53/5.00 to 3.89/5.00, implying generally low job satisfaction level in hospital dietitians. The job satisfaction levels in the convalescent hospital group were significantly lower compared to those in the tertiary and general hospital groups. Whereas job satisfaction levels of tertiary and convalescent hospital groups did not differ by number of beds, those of the general hospital group increased significantly with the number of beds for all four areas. Multivariate regression analysis results showed that hospital type was a significant predictor of job satisfaction level for all four areas. Job satisfaction of relationship area was also significantly affected by the number of beds, whereas that of working conditions was influenced by annual income and working experience. The study findings provide useful information in planning clinical dietitians` optimal supply outlook for the improvement of clinical nutrition services.
2018 ESPEN Guideline을 중심으로 본 중환자의 영양집중치료에 대한 최근 동향
이아론 ( Ahron Lee ),김은미 ( Eun-mee Kim ),박치민 ( Chimin Park ),라미용 ( Mi-young Rha ) 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.2
As the significance of nutrition in intensive care unit grows, large prospective randomized controlled trials on nutrition therapy have been performed and recently published. Each society for Parenteral and Enteral Nutrition designated recommendations for clinical practice based on the best available evidence and the consensus of experts. The European Society for Parenteral and Enteral Nutrition (ESPEN) has released a new guideline that has been updated from the previous ESPEN guidelines on enteral nutrition and parenteral nutrition in adult critically ill patients published in 2006 and 2009, respectively. This study examined the latest trends of nutrition guidelines, and especially those of the ESPEN 2018, for intensive care units as compared to guidelines of other societies and older previous guidelines.