危重患儿肠内营养中断的临床研究

Clinical research on enteral nutritional interruption in critically ill children

目的了解PICU患儿肠内营养中断原因及其与预后的关系。方法回顾性研究2019年1月至6月所有入住中国医科大学附属盛京医院PICU的患儿,分析患儿基本喂养情况及肠内营养中断的频次、时间、原因,统计分析营养中断对患儿预后的影响。结果共纳入471例患儿,入住PICU时中度营养不良发生率20.0%(94例),重度营养不良发生率12.3%(58例),住院期间营养恶化率为3.8%(18例);平均住院期间体重变化-0.14 kg。181例(38.4%)患儿发生肠内营养中断,住院期间共发生362次中断,平均每例患儿住院期间发生过2次中断,中断时间总计5386 h,平均每次营养中断时间14.89 h。喂养中断最常见原因为喂养不耐受(158次,43.6%)。喂养方式为奶粉喂养者共发生270次中断,平均每次中断造成能量减少56.53 kcal/kg。不同病种、不同年龄、不同危重评分患儿肠内营养中断时间差异无统计学意义。发生营养中断患儿住院时间更长、住院费用更高、机械通气时间更长、体重下降更多(P均<0.05)。结论营养中断在PICU十分常见,肠内营养的中断会造成能量摄入减少,主要原因为喂养不耐受,营养中断的发生使患儿住院时间及机械通气延长,住院费用增多,体重下降幅度加大。

Objective To investigate the causes of enteral nutrition interruption in pediatric intensive care unit and its relationship with prognosis.Methods In this retrospective study,471 critically ill children admitted to PICU of Shengjing Hospital of China Medical University from January to June 2019 were enrolled.Data were collected to describe the patient cohort(anthropometrics and diagnostic category)and nutrition practices(feeding mode,frequency,duration,and causes of feeding interruptions).The effect of nutritional interruption on the prognosis of children was statistically analyzed.Results Ninety-four patients(20.0%)had moderate malnutrition at PICU admission,fifty-eight patients(12.3%)had severe malnutrition.The nutritional deterioration rate was 3.8%(18 cases).The average weight loss during hospitalization was-0.14 kg.A total of 181(38.4%)patients had feeding interruption(FI)during hospitalization.There were 362 episodes of FI in total,with a median of two episodes per patient.Median duration of each episode was 14.89 h.The most common cause of FI was feeding intolerance(n=158,43.6%).There were 270 episodes of FI in children feeded with milk powder.Median energy deficits per episode was-56.53 kcal/kg.There was no significant difference regarding the duration of FI among children with different diseases,different ages and different critical scores.Children with FI had significantly longer length of hospitalization,more hospitalization costs,greater length of mechanical ventilation and greater loss of weight(P<0.05,respectively).Conclusion Enteral nutrition interruption is very common in PICU,and FI is the main reason.Nutrition interruption will reduce energy intake,which can prolong the period of hospitalization and mechanical ventilation,increase the hospitalization cost and the weight loss.