先天性心脏病住院患儿营养风险筛查及其临床意义

Screening for nutritional risk in hospitalized children with congenital heart disease

目的调查先天性心脏病患儿的营养风险及其临床结局的相关性，为临床营养管理提供科学依据。方法应用Strongkid营养风险筛查方法对我院460例先天性心脏病患儿进行营养风险评估，分析营养风险评分的影响因素；调查患儿在住院期间营养支持、术后感染、术后住院时间、监护室时间及治疗费用，阐明不同营养风险对临床结局的影响。结果460例先天性心脏病患儿入院时高度营养风险的发生率为32．2％，中度营养风险发生率为67．8％。其中48．5％高度营养风险患儿发生在0～1岁。高度营养风险患儿的术后住院时间[（12．65±6．66）d比（10．44±5．22）d二、监护室时间[（3．29±2．21）d比（2．17±1．79）d]、术后发生感染率（45．9%比32．1％）明显高于中度风险的患儿，治疗费用亦高于中度营养风险患JL（F=9．145，P％0．05）。中度营养风险患儿营养支持率53．2％（166／312），高度营养风险患儿营养支持率73．6％（109／148）。结论先天性心脏病患儿尤其是婴儿入院时存在高度营养风险。Strongkid筛查方法与临床结局有较好的相关性。目前先天性心脏病患儿的营养治疗仍不规范，需推广建立营养支持小组以保证合理规范的营养管理的进行。

Objective To determine the heart disease, and to correlate its relationship nutritional risk in hospitalized children with congenital with the clinical outcome. Methods 460 hospitalized children with congenital heart disease in Nanjing Medical University Affiliated Nanjing Children Hospital were consecutively enrolled in the study. The children were screened using STRONG （Screening Tool for Risk on Nutritional status and Growth）. Data were collected on the anthropometric measurement and biochemical indicators, need for nutrition support during hospitalization, postoperative infection rate, length of stay postoperatively and ICU care and hospital charges. Results High nutritional risks were found in 32. 2% and moderate nutritional risk in 67. 8%. High nutritional risk was more common in younger infants （48.5%）. Children with high nutritional risk had longer length of stay postoperatively [（12. 65 ± 6.66） days vs （10. 44± 5.22） days,P〈0. 05and ICU care E（3.29± 2. 21） days vs （2. 17 ± 1.79） days,P〈0. 0011. There were more hospital charges, as well as higher postoperative infection rate （45.9% vs 32. 1%, P〈0. 05）. 166 （53. 2%） children of moderate nutritional risk and 109 （73. 6%） with high nutrition risk received nutrition support during hospitalization. Conclusions STRONG is correlated with the clinical outcome. Nutrition support is not yet appropriately performed. Evidence-based guideline is needed to improve this situation.