PICU危重患儿临床营养管理调查结果分析

Analysis on the results of clinical nutrition management survey in PICU critically ill children

目的了解目前我国PICU危重患儿临床营养的管理状况，为进一步促进儿科危重病临床营养的完善和发展提供数据。方法对PICU专科骨干采用问卷调查的方式调查国内PICU的危重患儿营养评估、营养干预、营养管理状况。结果共39家PICU的专科骨干参与调查。国内不同PICU中危重患儿常用营养评估和指南不统一。64．1％（25人）被调查者认为需要根据临床表现和量表作为共同决定危重患儿喂养的依据；所有被调查者均认为营养评估和干预时机需要根据病情来决定；58．9％（23人）被调查者所在科室仅以体重监测作为营养量化监测指标；71．8％（28人）被调查者认为经肖管喂养是危币患儿的首选喂养方式；51．3％（20人）被调查者认为危重患儿应该在24h内进行喂养，33．3％（12人）认为24—48h开始进行喂养，84．6％（33人）被调查者主张早期肠内营养；92．3％（36人）波捌查耆认为呕吐、腹胀、胃肠出血等临床表现之一是禁食的主要原因；71．8％（28人）被调查者认为需要根据胃肠功能评估结果来决定是否禁食；59．0％（23人）被调查者认为危重患儿的临床营养决定人应该足PICU专科医生；61．5％（24人）被调查者认为需要建立危重患儿营养管理常规。结论L1前我圈儿童危重病的营养评估、监测、早期肠内营养干预、管理等方面取得了一定成绩，但存在不同程度的认识不足，需要加强临床重症营养专科建设，在营养评估、营养干预模式上还有很大的研究和发展空间，建议建立中国相关指南或共识以提升危重患儿营养诊疗水平。

Objective To investigate the status of clinical nutrition management in patients in PICU, and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients. Methods A questionnaire survey was conducted on PICU specialists. The nutrition assessment, nutrition intervention and nutrition management of critically ill children in PICU were investigated. The results were summarized and analyzed. Results A total of 39 PICU specialists were involved in this survey. The nu- tritional assessment methods and guidelines in domestic P1CU were not unified. Twenty-five respondents （64. 1% ） believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not; all respondents believed that nutritional assessment and intervention time need to be de- termined by the needs of the patients; 23 respondents（58.9% ） used weight only as their nutritional monito- ring indicators. Twenty-eight respondents （71.8%） considered that gastric tube was the first choice way to feeding for the critically ill children; 20 respondents （51.3 % ） believed that critically ill children should be fed within 24 hours. Twelve respondents （33.3 % ） believed that critically ill children should be fed between 24 to 48 hours. Thirty-three respondents （84.6%） advocated early enteral nutrition; 36 respondents （92. 3% ） considered that the main reasons of fasting in critically ill children were vomiting or abdominal dis- tension or gastrointestinal bleeding. Twenty-eight respondents （71.8%） believed that according to the results of gastrointestinal function evaluation, they made decisions whether the patient to fast or not. Twenty-three re- spondents（59.0% ） considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children. Twenty-four （61.5%） of the respondents believed that we needed to establish our own routines in management of nutrition in PICU. Conclusion At present in China, a lot of achievements have been made in the nutritional assessment, monitoring, early enteral nutrition intervention and management incritically ill children, but it is not enough. We need to make more effort to enhance the critically nutrition level in PICU, and we have a lot of research to do about nutrition assessment and nutrition intervention mode. It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.