ICU患儿营养风险筛查以及营养支持治疗分析

发布时间：2018-02-25 23:08

  本文关键词： ICU患儿 营养风险筛查 营养风险 营养支持　出处：《南华大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景和目的：ICU患儿病情较重,进展迅速,因此恰当的营养支持对于ICU患儿病情恢复的作用不可低估。然而目前ICU患儿不恰当营养支持治疗现象较为普遍,影响预后,因此我们需要根据其本身的营养状况以及潜在的营养风险而制定恰当的营养支持计划。目前已经陆续制定了各种各样的营养风险筛查工具,但是专门针对儿童的并不多。NRS2002被欧洲肠外肠内营养学会(European Society for Clinical Nutrition and Metabolism, ESPEN)推荐为住院患者营养风险评定的首选工具,NRS2002的优点在于简便易行、医患有沟通,有临床RCT的支持。此研究的目的是调查PICU患儿营养风险发生率；调查PICU营养支持治疗现状；探索PICU患儿营养风险以及营养支持治疗与疾病转归的关系。 方法：本研究分为两部分,第一部分为前瞻性研究,以2012年10月至2013年9月入住湖南省儿童医院PICU的患儿为研究样本,对符合入组条件的916名患儿及其家属进行调查研究,第一部分通过对PICU患儿入院时的各项营养相关指标进行监测以及对相关病史的询问采集,主要包括身高、体重的测量,饮食状况以及疾病严重程度等相关病史,并通过营养风险筛查工具(NRS2002)筛查入住PICU患儿的营养风险,从而调查PICU患儿营养风险的发生率,并对不同年龄段、不同性别、不同疾病的营养风险发生率进行对比分析,并探索营养风险与疾病转归的关系；第二部分为回顾性研究,通过住院医师工作站查询并记录患儿住院期间的营养支持治疗情况,主要包括营养支持治疗方式、持续的时间以及患儿的脏器功能损伤、疾病转归、住院时间、住院费用等,了解PICU营养支持使用现状,并探讨恰当的营养支持治疗对疾病转归的影响。 结果：对符合入组标准的916例患儿进行营养风险筛查,发现有73.3%(671例)的患儿存在营养风险。不同疾病之间营养风险发生率具有统计学意义(x2=45.868,p0.001),营养风险发生率最高的是脓毒症,为86.4%,发生率最低的是病毒性脑炎,为66.7%。男性患儿营养风险发生率为73.3%,女性患儿营养风险发生率为73.1%,无统计学意义(x2=0.004,p=0.951)。根据儿童年龄分期将916例患儿分为4组,1月～1岁为婴儿组,1岁～3岁为幼儿组,3岁～6岁为学龄前组,6岁以上为学龄组。各年龄组患儿营养风险发生率分别为72.2%,78.2%,68.4%,68.6%,无统计学意义(x2=4.389,p=0.222) 通过秩相关性分析发现营养风险与疾病严重程度、脏器功能损伤、总住院时间、总住院费用呈正相关,与疾病转归呈负相关,有统计学意义。 调查发现有76.1%(697例)的患儿在住院期间使用了营养支持,63.5%(582例)的患儿单独使用了肠内营养,1.3%(12例)患儿单独使用肠外营养,11.2%(103例)的患儿联合使用了肠内、肠外营养,23.9%(219例)患儿未使用临床营养支持,有统计学意义(x2=12.204,p0.001) 根据NRS2002评分进行分组,≥3分为有风险组,3分为无风险组,有风险组患儿共671例,有风险组90.0%(604例)的患儿使用了营养支持治疗,10.0%(67例)的患儿未使用营养支持治疗；无风险组患儿共245例,其中有38.0%(93例)的患儿使用了营养支持治疗,62.0%(152例)的患儿未使用营养支持治疗,有风险组和无风险组率的比较行卡方检验,均有统计学意义(x2=267.036,p0.001) 在PICU患儿中,先天性心脏病患儿的临床营养支持使用率最高,为95.3%,其次为小儿腹泻的患儿,为91.7%；药物中毒患儿的临床营养支持使用率最低,为57.1%,有统计学意义(x2=52.245,p0.001) 未干预组较干预组总住院时间更长,总住院费用更高,脏器功能损伤更严重,疾病转归更差,有统计学意义。 结论：PICU患儿营养风险发生率较高。具有营养风险的患儿较无风险的患儿总住院时间更长,总住院费用更高,疾病预后更差。通过调查发现临床上存在营养支持使用不规范现象。恰当的营养支持能改善疾病的预后,缩短病程,减少医疗支出。
[Abstract]:BACKGROUND & OBJECTIVE : The condition of children in ICU is more serious and rapid , so the proper nutrition support is not to be underestimated in ICU children . However , there are many nutrition risk screening tools in ICU . The aim of this study is to investigate the nutritional risk rate of children in ICU . The aim of this study is to investigate the nutritional risk rate of children with PICU . The research aim is to investigate the nutritional risk rate of PICU children and to investigate the nutritional risk of PICU and the relationship between nutrition support and disease outcome . Methods : This study was divided into two parts , the first part divided into two parts , the first part was a prospective study , and the first part investigated the nutritional risk of children with PICU from October 2012 to September 2013 . The first part analyzed the nutritional risk of children in PICU by the nutrition risk screening tool ( NRS2002 ) . Results : A total of 916 children who met the criteria of enrollment were screened for nutritional risk . There were 73 . 3 % ( 671 patients ) with nutritional risk . The incidence of nutritional risk among different diseases was statistically significant ( x2 = 45.868 , p0.001 ) . The highest incidence of nutritional risk was sepsis , 66.4 % , and the lowest incidence was viral encephalitis ( 66.7 % ) . The incidence of nutritional risk was 73.1 % in male children and 73.1 % in female children ( x2 = 0.004 , p = 0.951 ) . According to the age of the child , 916 children were divided into 4 groups , 1 month to 1 year old group , 1 year to 3 year old as infant group , 3 to 6 years old as preschool group and 6 years old as school age group . The incidence of nutrition risk in each age group was 72.2 % , 78.2 % , 68.4 % and 68.6 % , respectively . There was no significant difference ( x2 = 4.389 , p = 0.222 ) . Through the rank correlation analysis , it was found that the nutrition risk was positively correlated with the severity of disease , organ function injury , total hospitalization time and total hospitalization expense . It was found that 76.1 % ( 697 cases ) of children used nutrition support during hospitalization , 63.5 % ( 582 ) children used enteral nutrition alone , 1.3 % ( 12 ) children used enteral nutrition alone , 11.2 % ( 103 ) children used enteral , parenteral nutrition , 23 . 9 % ( 219 ) had no clinical nutrition support , with statistical significance ( x2 = 12.204 , p0.001 ) According to the NRS2002 score , 鈮，

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