PICU患儿营养风险筛查及高风险对临床结局的影响

Nutritional risk screening of children in PICU and its effects on clinical outcomes

目的对儿童重症监护病房(PICU)患儿进行营养风险筛查,统计不同营养风险检出率,分析高风险对临床结局的影响,为临床营养治疗提供依据。方法选择2018年11月至2019年8月于西安市儿童医院PICU住院时间大于48h的345例患儿为研究对象,采用儿科营养不良评估筛查工具(STAMP)于患儿入PICU时进行营养风险筛查,统计分析不同营养风险的检出率及高风险对临床结局的影响。结果345例患儿中高营养风险240例(69.6%),中营养风险105例(30.4%),无低营养风险;不同疾病类型的高营养风险检出率与中营养风险检出率组间差异有统计学意义,且两两比较发现,呼吸系统、神经系统疾病在高营养风险组占比较高,消化系统、外科疾病占比较低(χ^2=30.937,P<0.05);与中营养风险组比较,高营养风险组患儿的PICU住院时间延长、总住院费用增加、机械通气率增加(Z/χ^2值分别为-3.004、-2.299、10.438,均P<0.05)。结论PICU危重患儿入院时多存在高营养风险,高营养风险的患儿临床结局不良。

Objective Nutritional risk screening was conducted for children in the pediatric intensive care unit(PICU),the detection rates of different nutritional risks were calculated,and the influence of high risk on clinical outcomes was analyzed,so as to provide basis for clinical nutritional treatment.Methods Children with PICU hospitalization of more than 48 hours in Xi’an Children’s Hospital from November 2018 to August 2019 were selected as subjects.Screening Tool for the Assessment of Malnutrition in Pediatrics(STAMP)was used to screen nutritional risk when children entered PICU,and the detection rate of different nutritional risk and the influence of high risk on clinical outcome were statistically analyzed.Results Among 345 children,240 children with high nutritional risk(69.6%)and 105 children with moderate nutritional risk(30.4%),without low nutritional risk.There was a statistically significant difference in the detection rate of high nutritional risk and moderate nutritional risk for different disease types.And a pairwise comparison found that respiratory and nervous system diseases accounted for a higher proportion in the high nutritional risk group,while digestive and surgical diseases accounted for a lower proportion(χ^2=30.937,P<0.05).The mechanical ventilation rate,the length of stay in PICU and the hospital expenses were higher in the high nutritional risk group compared with the moderate nutritional risk group(Z/χ^2 values were-3.004,-2.299 and 10.438,respectively,all P<0.05).Conclusion Most critically ill children in PICU were at high nutritional risk when admitted to hospital,and the children with high nutritional risk had poor clinical outcomes.