PICU危重病儿营养管理现状单中心调查

The nutritional management survey in critically ill children in PICU:a single center study

目的:全方位调查重症监护病房营养管理现状,以引起医护人员对营养治疗的重视。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儿科重症监护室的病儿,分析病儿营养风险和营养评估的结果及喂养情况。结果:研究共纳入471例病儿,70.7%(333例)的病儿具有营养风险,其中患有呼吸及心血管系统疾病的病儿营养风险发生率更高,具有营养风险的病儿住院时间更久(P=0.005),机械通气时间更长(P=0.016)。PICU病儿入院时营养不良发生率为32.3%,营养状态越差的病儿住院时间越久(P=0.002)、机械通气时间越长(P<0.001)、住院费用越多(P=0.023)。统计能够准确计算每日摄入能量及蛋白质水平的接受奶粉喂养的244例病儿,发现能量摄入比例越低的病儿住院时间越久,机械通气时间越长,住院费用越多(均P<0.001)。根据ASPEN危重儿童指南确定蛋白质需求量,蛋白质摄入不足病儿体质量下降更多(P=0.012),住院时间更久(P=0.017),住院费用更高(P=0.016)。结论:本研究结果表明危重病儿营养风险及营养不良发生率高,不合理的喂养会加剧营养不良的发生,营养风险及营养不良均导致病儿预后更差。

Objective:This study aimed to comprehensively investigate the current situation of nutrition management in pediatric intensive care unit.Methods:This was a retrospective study involving the consecutive children admitted to the pediatric intensive care unit of Shengjing Hospital of China Medical University from January to June 2019.The nutritional risk,nutritional assessment results and the nutritional practice of the included children were collected.Results:A total of 471 children were included in the study,and 70.7%(333 cases)of them had high nutritional risk.Among them,children with respiratory and cardiovascular diseases had increased incidence of high nutritional risk.Children with high nutritional risk had prolonged hospital stay(P=0.005)and longer duration of mechanical ventilation(P=0.016).The incidence of malnutrition in PICU children was 32.3%at admission,and children with malnutrition had longer length of hospitalization(P=0.002)and duration of mechanical ventilation(P<0.001),and higher hospital costs(P=0.023).In 244 children fed with milk powder,in whom the daily energy and protein intake could be accurately calculated,the lower energy intake was associated with worse clinical outcomes(all P<0.001).Children with insufficient protein intake had more weight loss(P=0.012),longer length of hospitalization(P=0.017),and higher hospital costs(P=0.016).Conclusion:The results of this study showed that the incidence of high nutritional risk and malnutrition in critically ill children was high.Inappropriate feeding would increase the incidence of malnutrition,and both high nutritional risk and malnutrition would lead to worse prognosis.