婴幼儿重症肺炎营养风险筛查及其临床意义  

Nutritional risk screening and its clinical significance of infants with severe pneumonia

作　　者：万园园 缪红军[2] 潘键 王静文 刘长伟[1] 夏晓娜 王小红 Wan Yuanyuan;Miao Hongjun;Pan Jian;Wang Jingwen;Liu Changwei;Xia Xiaona;Wang Xiaohong(Department of Clinical Nutrition,Children's Hospital of Nanjing Medical University,Nanjing 210000,China;Emergency Department,Children's Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院临床营养科,210000 [2]南京医科大学附属儿童医院急诊科,210000

出　　处：《中国实用护理杂志》2019年第1期42-46,共5页Chinese Journal of Practical Nursing

摘　　要：目的调查28 d至3岁重症肺炎患儿的营养风险,分析其与临床结局的相关性,为临床营养支持提供依据。方法应用STRONGkids营养风险筛查工具对我院PICU的113例28 d至3岁重症肺炎患儿进行营养风险筛查,根据WHO 2006儿童生长标准评定营养状况,统计比较不同营养风险患儿重症监护期间机械通气率、机械通气时间、重症监护时间、住院费用、不良预后以及实验室指标的差异性。结果113例重症肺炎患儿入PICU时,44例占38.9%存在高度营养风险,49例占43.4%存在中度营养风险,20例占17.7%存在低度营养风险。入PICU时,113例患儿中59例(52.2%)存在营养不良,营养风险评分与营养不良程度有显著的相关性(r=0.574,P<0.01),随着营养不良程度的增加高度营养风险发生率明显增加。28 d至1岁年龄组患儿高度营养风险发生率较1~3岁组高(χ^2=20.46,P<0.01)。42.5%(48/113)的患儿有先天性疾病,患有先天性疾病的患儿高度营养风险(χ^2=11.375,P=0.003)及营养不良发生率(χ^2=10.083,P=0.001)显著高于无先天性疾病组。高度营养风险组机械通气率(P=0.028)、机械通气时间(P<0.01)、住院费用(P=0.002)及不良预后发生情况(P=0.014)均显著高于低度营养风险组。高度营养风险组视黄醇结合蛋白明显低于低度营养风险组(χ^2=6.333,P=0.021)。结论大部分28 d至3岁重症肺炎患儿存在高度营养风险和营养不良,尤其是年龄<1岁和患有先天性疾病者,且高度营养风险预示临床结局不佳。可以采用STRONGkids营养风险筛查工具对住院患儿进行营养风险筛查,尽早给予合理的营养支持。Objective To investigate the nutritional risk of hospitalized infants with severe pneumonia and its relationship with clinical outcome.Methods Totally 113 infants with severe pneumonia admitted to pediatric intensive care unit (PICU)were enrolled in the study. Nutritional risks were screened by STRONGkids, and the nutritional were assessment with WHO Anthro. Clinical outcomes were recorded and analyzed, including mechanical ventilation, length of PICU stay, total hospital expenses, prognosis, and biochemical test index.Results A total of 44 infants (38.9%) had high nutritional risk, 49 (43.4%) had medium nutritional risk, 20 (17.7%) had low nutritional risk when they admitted to PICU. A total of 59 (52.2%) infants were malnourished when they admitted to PICU. There was a significant correlation between the degree of malnutrition and nutritional risk (r=0.574, P<0.01).The incidence of high nutritional risk was significantly higher in 28d^1year-old group than in 1~3 year-old group (χ^2=20.46, P<0.01). Nearly 42.5% (48/113) of the children had congenital disease and had higher incidence of high nutritional risk (χ^2=11.375, P=0.003) and higher incidence of malnutrition (χ^2=10.083, P=0.001) than those without congenital disease. The rate of mechanical ventilation (P=0.028), the duration of mechanical ventilation (P<0.01), total hospital expenses (P=0.002) and the incidence of poor prognosis(P=0.014) were significantly higher in high nutritional risk group than the low nutritional risk group. The retinol binding protein in the high nutrition risk group was significantly lower than the low nutrition risk group (χ^2=6.333, P=0.021).Conclusion s High nutritional risk and malnutrition are common in infants with severe pneumonia. Malnutrition and nutritional risk are increased in patients less than 1 year old or suffering from congenital disease. Patients with high nutritional risk are more likely to have worse clinical outcomes. STRONGkids is a valid tool for nutritional risk screening in hospitalized children, and e

关 键 词：重症肺炎 婴幼儿 营养风险筛查 营养不良 

分 类 号：R473.72[医药卫生—护理学]