重症脑炎病儿营养状况及其与临床结局的关系

Relationship between nutritional status and clinical outcomes in children with severe encephalitis

目的:调查重症脑炎病儿营养状况、营养风险现状,探讨不同营养风险与临床结局的相关性,为临床开展营养支持提供依据。方法:选择2017年7月至2019年6月南京医科大学附属儿童医院入住PICU的127名诊断重症脑炎病儿,根据WHO 2006儿童生长标准评定营养状况、采用STRONGkids进行营养风险筛查,比较不同营养风险病儿的临床结局差异。结果:127例中枢神经系统感染病儿中,7例(5.5%)存在低度营养风险,66例(52%)存在中度营养风险,54例(42.5%)存在高度营养风险,≤3岁病儿高度营养风险发生率显著高于其他年龄组的儿童(χ^2=5.741,P<0.05);入PICU时,35例病儿(27.5%)存在营养不良,其中轻度营养不良21例(16.5%),中度营养不良6例(4.7%),重度营养不良8例(6.3%),营养不良组高营养风险发生率显著高于无营养不良组,随着营养不良程度的增加,高度营养风险的发生率显著增加(P<0.01)。高度营养风险组ICU住院时间,住院费用,机械通气率,机械通气时间及不良预后的发生率均显著高于低营养风险组(P<0.05)。结论:重症脑炎病儿大部分存在中、高度营养风险,≤3岁婴幼儿高度营养风险发生率显著高于>3岁年龄组,并且高度营养风险病儿临床结局预后较差,可使用STRONGkids对病儿进行营养风险筛查,尽早予以合理营养支持。

Objective:To investigate the nutritional status and nutritional risks of children with severe encephalitis,and to explore the correlation between different nutritional risks and clinical outcomes,so as to provide basis for clinical nutrition support.Methods:We enrolled 127 children with severe encephalitis received inpatient treatment at pediatric intensive care unit(PICU)in Nanjing Medical University Affiliated Children's Hospital between July 2017 and June 2019.Nutritional status was assessed according to WHO 2006 child growth standards and STRONGkids was used for nutritional risk screening to compare the clinical outcomes of children with different nutritional risks.Results:Of the 127 cases,7(5.5%)were at low nutritional risk,66(52%)were at moderate nutritional risk,and 54(42.5%)were at high nutritional risk.The incidence of high nutritional risk was significantly higher in≤3 years old group than the other age group(χ^2=5.741,P<0.05).The prevalence of malnutrition was 35 cases(27.5%)when admitted to PICU,of which mild malnutrition,moderate malnutrition and severe malnutrition was 16.5%,4.7%,6.3%respectively.The malnutrition group had a higher incidence of high nutritional risk than children at normal nutritional status(P<0.01).As the level of malnutrition increased,the incidence of high nutritional risk increased significantly(P<0.01).Patients in high nutritional risk group had higher longer duration of ICU stay,total medical cost,the rate of mechanical ventilation,longer duration of mechanical ventilation and the rate of poor prognosis than those in mild nutritional risk group(P<0.05)Conclusion:High nutritional risk is common among children with severe encephalitis,especially in≤3 years old children.High nutritional risk has an adverse influence on clinical outcomes.STRONGkids is a valid tool for nutritional risk screening in hospitalized children,and early nutrition support is recommended.