影响NICU新生儿营养摄入相关因素研究

发布时间：2018-04-15 12:19

  本文选题：新生儿 + 危重症　； 参考：《上海交通大学》2015年硕士论文

【摘要】：第一部分：早期EN支持对NICU新生儿临床结局指标影响目的 了解新生儿监护室(neonatal intensive care unit, NICU)内患儿营养摄入情况和早期肠内营养(enteral nutrition, EN)开展的现状,比较早期开始EN(入院后24h内)和延迟EN(24h)对患儿营养摄入情况和临床结局指标的影响。方法 本研究为观察性队列研究,观察时间为2013年6月1日至2013年11月30日。记录日龄1-28天的NICU患儿每天EN及肠外营养(parenteral nutrition, PN)医嘱配方量和实际摄入情况、体重变化和临床结局相关指标(住院总时间、住NICU时间、呼吸机及暖箱使用时间、肺炎罹患率、PN使用率等)。分析NICU新生儿生长迟缓和能量摄入不足现状,评价早期EN(入监护室24小时内)和延迟开始的EN(大于24小时)对患者临床结局的不同影响。结果 研究期间我院新生儿监护室共收治722例患儿,其中510例符合要求纳入研究。结果发现,多数患者(n=221;43.3%)平均每天摄入热卡低于60 kcal/kg。生长迟缓在患儿住NICU期间普遍存在,其中早产儿的生长落后更为明显：低于同胎龄体重第10百分位的患儿比例入院时为21.6%,出NICU时增加到67.6%。入院24h内开始EN相比延迟开始EN,可以缩短入院后体重持续下降时间(0d vs.6d,p0.01),减少PN使用率(41.7%vs.95.0%,p0.01)和肺炎发生率(37.5% vs.54.4%,p0.05),缩短住NICU时间(8.2d vs.12.0d,p0.01),并且增加患儿住NICU期间平均每天能量摄入量(76.7kcal/kg/d vs. 63.3kcal/kg/d, p0.05)。结论 危重新生儿需尽早开始EN支持治疗,推荐入NICU后24小时内进行,可加快患儿体重增加速度、改善患儿临床指标,促进预后。第二部分：危重新生儿营养中断相关因素分析目的探究造成NICU新生儿EN中断的相关因素,并观察EN中断对患儿临床结局的影响。方法 本研究属于观察性队列研究,研究时间为2013年6月1日至2013年11月30日共6个月。记录年龄在1-28天的NICU患儿每天营养摄入(EN、PN)情况、造成EN中断(喂养未按医嘱进行且中断持续时间不少于30min)和PN弃用的原因,并分析持续时间较长的EN中断对患儿营养摄入、临床结局指标的影响。结果共有491例患儿住NICU期间接受至少24h的EN支持治疗,其中204例患儿EN支持期间发生过EN中断(占使用EN患儿的41.5%),累计发生509次,共6951小时。EN中断主要原因为胃肠道不耐受和相关床边操作,两者发生次数占全部EN中断事件的70%(分别为222次,1962h和126次,468h)。其他原因包括：监护室外相关检查(37次),手术相关(25次),哭吵拒食(18次),相关操作禁食准备(17次),抢救(13次)。手术相关原因造成EN中断时间长达3444h,占EN中断总时间的49.5%。有450位(占全部患儿88%)使用PN的患儿(PN使用中位时间为7天),住ICU期间共计发生971次PN弃用事件。造成PN弃用主要原因为：滴速或输注时间受限(522次),血制品替代(269次),抢救(6()次),手术相关(54次)等。EN中断与患儿入院后体重持续下降(7.5d vs.4.0d,p0.05)、住监护室时间(16.9d vs.9.0d,p0.01)和住院总时间(18.2d vs.12.9d,p0.01)延长有关,并降低新生儿平均每天能量摄入量(70.0kcal/kg/d vs.62.0kcal/kg/d, p0.05)和出NICU时经EN能量摄入量(89.2kcal/kg vs.69.9kcal/kg, p0.01)。在全部存在EN中断的患儿中,EN中断时间12h的72例患儿较中断时间12h的132例患儿,肺炎发病率高(75.0%vs.40.2%,p0.05)、体重持续下降时间(14.5d vs.6d,p0.01)以及住ICU时间(21.9d vs.13.5d,p0.05)均较长。结论 住NICU期间EN中断总时间多于12h明显延缓危重新生儿体重增加并影响临床指标改善。
[Abstract]:The first part: early EN support of NICU objective to investigate the clinical outcomes of neonatal neonatal intensive care unit (neonatal intensive care unit, NICU) in children with nutritional intake and early enteral nutrition (enteral, nutrition, EN) to carry out the status quo, comparison of early EN (within 24h after admission) and EN (24h) on the impact of delay children with nutritional status and clinical outcome. Methods this study was an observational cohort study, the observation time is from June 1, 2013 to November 30, 2013. The record day old NICU children EN every day and 1-28 days of parenteral nutrition (parenteral, nutrition, PN) order formula and the actual amount intake, body weight changes and clinical outcome indicators (total hospitalization time, NICU stay, ventilator and incubator use time, incidence of pneumonia, etc.). The rate of use of PN NICU analysis of neonatal growth retardation and insufficient energy intake status, evaluation of early E N (into the ICU within 24 hours) and delayed the start of the EN (more than 24 hours) of different effects on clinical outcomes of patients. Results during the neonatal intensive care unit in our hospital were treated 722 patients, including 510 cases meet the requirements included in the study. The results showed that most of the patients (n=221; 43.3%) the average daily calorie intake below 60 kcal/kg. growth retardation in children living in common during the period of NICU, premature growth retardation is more obvious: the birth weight of tenth lower than the same percentile of the proportion of children on admission was 21.6%, NICU increased to 67.6%. within 24h after admission to EN compared to delay the start of EN, can shorten the time of admission after losing weight (0d vs.6d, P0.01, PN) to reduce the use rate (41.7%vs.95.0%, P0.01) and the incidence of pneumonia (37.5% vs.54.4%, P0.05), shorten NICU stay (8.2d vs.12.0d, P0.01), and the increase in the average daily energy intake during NICU stay (76 .7kcal/kg/d vs. 63.3kcal/kg/d, P0.05). Conclusion the critically ill neonates is needed as soon as possible to start the EN support treatment is recommended within 24 hours after admission to the NICU, children can accelerate the rate of increase in weight, improve the clinical indicators, with promoting the prognosis. The second part: the analysis to explore the causes of NICU related factors of neonatal EN interruption factors related to neonatal nutrition and interrupt critical observation EN interrupt effects on clinical outcomes in children. Methods this study is an observational cohort study, the research time is from June 1, 2013 to November 2013 30, 6 months. Recorded at 1-28 days of age NICU children daily intake of nutrients (EN, PN), EN (interrupt caused by doctor's advice for feeding and the interruption duration of not less than 30min PN) reasons and abandoned, and the analysis of longer duration of interruption of EN intake on children nutrition, affect clinical outcome. Results a total of 491 patients in NICU stage 闂存帴鍙楄嚦灏，

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