儿科重症监护室营养支持现状及其临床结局分析

Analysis of nutritional support status and clinical outcomes in pediatric intensive care unit

目的分析儿科重症监护室(PICU)患儿的营养支持现况及对临床结局的影响。方法选择2018年11月至2020年8月西安市儿童医院PICU住院>48 h的患儿为研究对象,采用STAMP量表进行营养风险筛查并统计分析患儿营养支持状况。结果纳入393例患儿(男219例,女174例),中位年龄2岁2个月。高度营养风险患儿285例(72.5%),中度营养风险患儿108例(27.5%)。接受肠内营养患儿280例(71.2%),271例患儿(69.0%)可在48 h内开始营养支持,营养延迟组患儿的住院费用、机械通气率及病死率增加。315例肠内及肠外营养的患儿中,41例(13.0%)能量摄入合理,240例(76.2%)能量不足,34例(10.8%)能量过度。PICU患儿蛋白质摄入量为(1.05±0.68)g/(kg·d),262例患儿(83.2%)蛋白质摄入不足,使用机械通气的患儿蛋白质不足者更多(P=0.004)。能量和蛋白质摄入不足的患儿住院费用增加。结论PICU存在高比例的营养风险,需要规范化营养管理,包括营养风险筛查、评估和治疗。

Objective To investigate the nutritional treatment in pediatric intensive care unit(PICU),and analyze the rationality and corresponding impact on clinical outcomes.Methods The children hospitalized in PICU of Xi'an Children's Hospital for more than 48 hours were enrolled from November 1,2018 to August 31,2020.The malnutrition risk of the children were assessed using Screening Tool for the Assessment of Malnutrition in Pediatrics(STAMP),the nutritional treatment during hospitalization and clinical outcomes were collected,and the rationality and impact on clinical outcomes of energy and protein intake were analyzed.Results A total of 393 children(219 boys and 174 girls)at the median age of two years and two months old were included.There were 285(72.5%)cases with high malnutrition risk and 108(27.5%)cases with moderate malnutrition risk.280(71.2%)cases received enteral nutrition(EN),and 271(69.0%)cases were able to start early nutritional treatment within 48 hours of hospitalization.Mechanical ventilation use,hospitalization cost,and mortality were increased in children with delayed nutritional treatment.Of the 315 children receiving nutritional treatment(enteral,parenteral or both in combination),only 41(13.0%)had reasonable energy intake,240(76.2%)insufficient,and 34(10.8%)excessive.The protein intake of patients in PICU was(1.05±0.68)g/(kg·d).262(83.2%)children had insufficient protein intake,and those on mechanical ventilation were more likely to experience insufficient protein intake(P=0.004).Hospitalization cost was increased for children with insufficient energy and protein intake.Conclusion Most of the critically ill children are at high risk of malnutrition and unreasonable energy and protein intake during hospitalization,warranting standardized nutrition management including risk screening,assessment and treatment.