JCI 标准下营养管理应用于机械通气患儿的研究

Nutrition management for critically ill pediatric patients with mechanical ventilation in PICU based on JCI standards

目的：观察 JCI 标准下的营养管理对于机械通气患儿的影响。方法将我院 PICU 2012年1月至12月收治的330例机械通气患儿设为对照组,按常规实施营养管理；2013年1月至12月收治的359例机械通气患儿设为试验组,按 JCI 标准实施营养管理。比较两组患儿的机械通气时间、住ICU 时间、总住院时间、呼吸机相关性肺炎发生率、放弃和死亡数。结果对照组患儿的机械通气日（8.39±1.34）d、住 PICU 日（12.32±1.37）d、总住院时间（15.37±2.16）d,呼吸机相关性肺炎发生率9.7%,放弃或者死亡率8.48%；试验组患儿的机械通气日（5.69±1.12）d、住 PICU 日（9.42±1.53）d、总住院时间（12.63±2.29）d,呼吸机相关性肺炎发生率5.57%,放弃或者死亡率4.35%,两组比较差异均有统计学意义（P 均﹤0.01）。结论 JCI 标准下机械通气患儿的营养管理能降低机械通气患儿的机械通气时间、住 PICU 时间和住院时间,降低呼吸机相关性肺炎发生率,降低放弃或者死亡数。

Objective To observe the effect of the nutrition management according to the JCI（Joint Commission on Accreditation of Healthcare Organizations）management standard for critically ill pediatric patients with mechanical ventilation.Methods A total of 330 cases with mechanical ventilation were en-rolled in the control group from Hunan Province Children＇s Hospital PICU between Jan.2012 and Dec.2012, and these pediatric patients were managed with the conventional nutrient management.A total of 359 pediatric patients with mechanical ventilation were admitted to the experimental group from Jan.2013 to Dec.2013 and these patients were managed with nutrient management based on JCI standards.The length of mechanical venti-lation,stay in ICU,stay in hospital were compared between two groups,and the incidence of ventilator-associ-ated pneumonia,abandonment rate and mortality were also compared between experimental group and control group.Results The length of mechanical ventilation in control group[（8.39 ±1.34）days]was longer than that of experimental group[（5.69 ±1.12）days].The length of stay in PICU for control group[（12.32 ± 1.37）days]was more than that in experimental group[（9.42 ±1.53）days].The length of stay in hospital for control group [（15.37 ±2.16 ）days]was higher than that of experimental group [（12.63 ±2.29 ） days].The incidence of ventilator-associated pneumonia（9.7%）in control group was higher than that of ex-perimental group,and the giving up or mortality rate in control group（8.48%）was higher than that of exper-imental group（4.35%）.And there were significant differences by statistical analysis（P ﹤0.01 ,respective-ly）.Conclusion According to the nutritional management in JCI standard,the length of mechanical ventila-tion,stay in PICU and stay in hospital time,the incidence of ventilator-associated pneumonia,and the aban-doned or mortality rate were reduced for critically ill pediatric patients with mechanical ventilation.