住院患儿营养风险筛查及营养评估

Clinical application of the nutritional risk screening and nutrition assessment in hospitalized children

目的 调查住院患儿的营养风险及营养不良发生情况,为临床进行营养支持提供依据.方法 采用STRONGkids营养风险筛查工具对651例住院患儿进行营养风险筛查,并通过体格测量评估儿童营养状况,同时记录住院期间患儿的诊断、住院时间等资料并进行分析.结果 651例住院患儿中,7.07％（46例）存在高度营养风险,80.95％（527例）存在中度营养风险,11.98％（78例）为低度营养风险.营养不良检出率是22.58％,其中中度营养不良111例（17.05％）,重度营养不良36例（5.53％）.先天性心脏病、慢性肝病、慢性肾病为存在高度营养风险疾病前3位（x2=21.43,P＜0.01）;根据营养评价的结果显示患有先天性心脏病、慢性肾病的患儿发生重度营养不良的比例远高于其他疾病（x2=16.53,P＜0.05）.高度营养风险患儿住院期间较低度营养风险患儿更容易出现体质量丢失（P＜0.05）,其住院时间明显长于中、低度营养风险患儿（P＜0.05）.结论 住院患儿营养不良发生率高,营养风险不同导致临床结局不同;STRONGkids评分法评估住院儿童的营养风险,能早期发现住院期间营养不良以及有恶化可能的患者,有利于及时给予全面的营养评估以及早期合理的营养治疗,改善临床结局.

Objective To investigate hospitalized children＇s nutritional risk and malnutrition occurrence,and to provide clinical basis for nutrition support.Methods Nutritional risk screening tool STRONGkids was applied to 651 cases of hospitalized children with nutritional risk screening,and through physical measurement to assess children＇ s nutritional status,at the same time during the patient＇s diagnosis,the length of time data for analysis was recorded.Results Of 651 cases of hospitalized children,7.07% （46 cases） were of highly nutritional risk,80.95% （527 cases） with moderate nutrition risk,and 11.98% （78 cases） were of low nutrition risk.Malnutrition rate was 22.58%,moderate malnutrition in 111 cases （17.05%）,severe malnutrition in 36 cases （5.53%）.The first three high risk diseases were congenital heart disease,chronic liver disease and chronic kidney disease（x2 =21.43,P 〈0.01）.According to the result of nutrition evaluation concluded with congenital heart disease,chronic kidney disease occurred with severe malnutrition was far higher than other diseases（x2 =16.53,P 〈 0.05）.Children with highly nutritional risk were more likely to have weight loss than the children with relatively low nutritional risk （P 〈 0.05）,and their length of hospital stay were obviously longer than the children with low or moderate nutritional risk （P 〈 0.05）.Conclusions The hospitalized children have high incidence of malnutrition,and different nutritional risks lead to different clinical outcomes.STRONGkids score method helps to evaluate nutritional risk in hospitalized children and detect malnutrition and potential deterioration,which is conducive to early comprehensive nutritional assessment and proper nutritional treatment,thus to improve their clinical outcomes.