不同年龄段重症患儿营养风险及不同时机启动肠内营养后血生化指标对照研究

A Comparative Study of Nutritional Risk and Blood Biochemical Indices After the Timing of Enteral Nutrition Initiation in Children with Severe Diseases at Different Ages

目的:探究重症监护病房(PICU)不同年龄段儿科患儿营养风险及启动肠内营养时机的选择。方法:收集80例PICU患儿纳入患者临床资料,根据肠内营养时机随机分为早期肠内营养组42例和晚期肠内营养组38例,两组均按≤1岁,1~5岁和≥5岁分为三个年龄段,患儿均接受营养风险筛查。分别于入院时、治疗后15 d监测两组患儿营养指标。比较两组患儿PICU入住时间、住院总时长、住院费用,热卡达标时间、机械通气例数,观察并记录营养风险发生率及不良反应发生情况。结果:两组PICU患儿肠内营养干预前TP、ALB、PA比较差异无统计学意义(均P>0.05),肠内营养实施后,早期肠内营养组TP、ALB、PA高于晚期肠内营养组(均P<0.05),>5岁年龄段的TP、ALB、PA水平同组间比较差异具有统计学意义(均P<0.05),两组肠内营养实施前后FN水平差异无统计学意义(均P>0.05);早期肠内营养组入住PICU时间、住院总时长短于晚期肠内营养组,热卡达标时间、机械通气例数少于晚期肠内营养组,差异均具有统计学意义(P<0.05);早期肠内营养组营养风险发生率少于晚期肠内营养组,差异具有统计学意义(P<0.05);各个年龄段患儿不良反应发生率差异无统计学意义(P>0.05)。结论:PICU重症患儿实施早期肠内营养能够改善5岁以上患儿营养状态,可有效降低PICU住院期间营养不良发生率。

Objective:To investigate the nutritional risk and timing of enteral nutrition for children in pediatric intensive care unit(PICU)at different ages.Methods:80 children with PICU were enrolled and their clinical data were collected.They were randomly di-vided into early enteral nutrition group(n=42)and late enteral nutrition group(n=38)according to the timing of enteral nutrition.The two groups were divided into three age groups according to≤1 years old,1-5 years old and≥5 years old.Children are screened for nu-tritional risk.The nutritional indexes of the two groups were monitored on admission and 15 days after treatment.PICU admission time,total length of hospitalization,hospitalization cost,thermal card standard time and mechanical ventilation cases were compared be-tween the two groups,and the incidence of nutritional risk and adverse reactions were observed and recorded.Results:There were no significant differences in TP,ALB and PA between the two groups before enteral nutrition intervention(all P>0.05).After enteral nu-trition was implemented,TP,ALB and PA in the early enteral nutrition group were higher than those in the late enteral nutrition group(all P<0.05).There were statistically significant differences in TP,ALB and PA levels in the>5 years old group(all P<0.05),but there was no statistically significant difference in FN levels before and after enteral nutrition implementation between the 2 groups(all P>0.05).The duration of PICU admission and total length of hospital stay in early enteral nutrition group were shorter than those in late enteral nutrition group,and the number of cases of thermal calorie standard and mechanical ventilation were lower than those in late enteral nutrition group,with statistical significance(P<0.05).The incidence of nutritional risk in early enteral nutrition group was lower than that in late enteral nutrition group,and the difference was statistically significant(P<0.05).There was no significant differ-ence in the incidence of adverse reactions in children of all ages(P>0.05).Conclusion:Early enteral nutrition in children with severe PICU can improve the nutritional status of children over 5 years old,and effectively reduce the incidence of malnutrition during PICU hospitalization.