儿科重症监护病房患儿存在高营养风险的影响因素及对临床结局的影响

Influencing factors for high nutritional risk in children of pediatric intensive care unit and its effect on clinical outcome

目的探讨儿科重症监护病房(PICU)患儿存在高营养风险的影响因素及对临床结局的影响。方法纳入249例PICU患儿,收集临床资料,应用儿科营养不良筛查工具(STAMP)评估营养风险及营养状态,并采用小儿危重评分、第三代小儿死亡危险评分(PRISMⅢ)分别评估病情严重程度及死亡风险。比较不同营养风险的PICU患儿(其中中低营养风险127例,高营养风险122例)之间临床资料、病情严重程度、死亡风险及临床结局。采用多因素Logistic回归模型分析PICU患儿高营养风险的影响因素。结果共122例(49.0%)患儿存在营养高风险。高营养风险患儿的体重、体质指数低于中低营养风险患儿,身高矮于中低营养风险患儿,营养不良率、PRISMⅢ及机械通气率高于中低营养风险患儿,病情重于中低营养风险患儿(均P<0.05),但两者PICU住院时间及28 d病死率差异无统计学意义(均P>0.05)。Logistic回归分析结果显示,营养不良、病情重是发生高营养风险的危险因素(均P<0.05)。结论 PICU患儿营养风险发生率较高,其中营养不良、病情重的患儿存在营养风险更高。存在高营养风险患儿的临床预后可能更差。

Objective To investigate the influencing factors for high nutritional risk in children of pediatric intensive care unit(PICU) and its effect on clinical outcome.Methods A total of 249 children from PICU were enrolled,and their clinical data were collected.The nutritional risk and status were evaluated by Screening Tool for the Assessment of Malnutrition in Pediatrics(STAMP),and moreover Pediatric Critical Illness Score and the Pediatric Risk of Mortality Ⅲ(PRISM Ⅲ) were employed respectively to evaluate the severity of disease and the risk of mortality.The clinical data,the severity of disease,the risk of mortality and clinical outcome were compared between PICU children(including 127 children at moderate or low nutritional risk and 122 children at high nutritional risk) at various nutritional risks.Multivariate Logistic regression model was performed to analyze the influencing factors for high nutritional risk in PICU children.Results High nutritional risk was found in 122(49%) children.Compared to the children at moderate or low nutritional risk,the children at high nutritional risk had lower weight and body mass index,shorter height,higher malnutrition rate,higher PRISM Ⅲ and mechanical ventilation rate,and greater severity of disease(all P<0.05);however,there were no statistically significant differences in the PICU stay and the 28-day mortality rate between the two groups(all P>0.05).Logistic regression analysis results revealed that malnutrition and high severity of disease were the influencing factors for high nutritional risk(all P<0.05).Conclusion PCIU children exhibit relatively higher incidence of nutritional risk,among which the children with malnutrition or severer disease have a higher nutritional risk.The children at high nutritional risk may have poorer clinical prognosis.