重症肺炎患儿的营养风险筛查及其临床意义

Nutritional risk screening and its clinical value in children with severe pneumonia

目的研究重症肺炎住院患儿营养风险,探讨其与临床结局相关性,为临床营养治疗提供科学依据。方法采用儿童营养风险及发育不良筛查工具对236例于2016年9月-2018年2月在枣强县人民医院儿科住院的1~14岁重症肺炎患儿进行营养风险筛查,根据筛查评分分为低营养风险组、中度营养风险组和高度营养风险组。空腹抽血检测总蛋白、白蛋白、前白蛋白和血红蛋白水平,同时记录机械通气时间、感染并发症、住院时间、住院总费用和营养支持应用情况等资料进行分析。结果低营养风险患儿有28.4%(67/236),中度营养风险的有48.7%(115/236),重度营养风险的有22.9%(54/236)。1~2岁组和3~5岁组高度营养风险发生率明显高于其他两个年龄组(P<0.05);6~10岁组中度营养风险发生率明显高于其他三个年龄组(P<0.05);11~14岁组低营养风险发生率明显高于其他三个年龄组(P<0.05)。有14.0%接受全肠外营养支持,25.5%接受肠外结合肠内营养支持,24.5%接受全肠内营养支持,36.0%没有给予任何营养支持。高度营养风险组患儿总蛋白、白蛋白、前白蛋白和血红蛋白均低于低营养风险组和中度营养风险组。高度营养风险组感染性并发症、住院时间以及住院总费用均明显高于中、低度营养风险组(P<0.05)。结论重症肺炎患儿营养风险和临床结局密切相关,在临床上应引起重视尽快给予合理营养干预。

Objective To explore the nutritional risk of hospitalized children with severe pneumonia and its correlation with clinical outcome,so as to provide scientific basis for clinical nutritional treatment.Methods Totally 236 children with severe pneumonia aged 1 to 14 years in Pediatrics Department of People′s Hospital in Zaoqiang County were screened for nutritional risk using the child nutrition risk and dysplasia screening tool.Total protein,albumin,prealbumin and hemoglobin levels were tested by fasting blood sampling,and data such as mechanical ventilation time,infection complications,hospitalization time,total hospitalization cost and application of nutritional support were recorded for analysis.Results Children with low,moderate and severe nutrition risk accounted for 28.4%(67/236),48.7%(115/236)and 22.9%(54/236),respectively.The rate of severe nutrition risk in children aged 1 to 2 years and 3 to 5 years was obviously higher than the other two age groups(P<0.05).Also,the low nutrition risk in children 11 to 14 year-old children was significantly higher than that in the other three age groups(P<0.05).Moreover,14.0%received total parenteral nutrition support,25.5%had parenteral combined with enteral nutrition support,24.5%underwent total enteral nutrition support,and 36.0%were not given any nutritional support.The levels of total protein,albumin,prealbumin and hemoglobin in high nutrition risk group were lower than those in low nutrition risk group and moderate nutrition risk group.Likewise,high nutrition risk group had higher incidence of infectious complications,more days of hospitalization and higher hospital expenses than moderate or low nutrition risk group(P<0.05).Conclusion The nutrition risk is closely related to clinical outcome of children with severe pneumonia,so it is supposed to give rational nutrition intervention to the high-risk children.