儿科重症监护病房患者肠内营养支持现况及其临床结局分析  

Analysis of the current status and clinical outcomes of enteral nutrition support in Pediatric Intensive Care Unit patients

作　　者：沈静丽 杨玉霞 顾莺 陆国平 陈伟明 胡静 沈伟杰 高萱[3] 朱婷 SHEN Jingli;YANG Yuxia;GU Ying;LU Guoping;CHEN Weiming;HU Jing;SHEN Weijie;GAO Xuan;ZHU Ting(Pediatric Intensive Care Unit,Children's Hospital of Fudan University,Shanghai,201102,China)

机构地区：[1]复旦大学附属儿科医院重症医学科,上海市201102 [2]复旦大学附属儿科医院护理部,上海市201102 [3]复旦大学附属儿科医院营养科,上海市201102

出　　处：《中国护理管理》2024年第8期1181-1186,共6页Chinese Nursing Management

基　　金：国家重点研发计划(2021YFC2701800,2021YFC2701805);2022年度上海市市级医院诊疗技术推广及优化管理项目(原临床科技创新项目)(SHDC22022221);上海市卫生健康系统重点扶持学科项目(2023ZDFC0103);2021年上海市“医苑新星”青年医学人才培养资助计划(沪卫人事[2022]65号)。

摘　　要：目的:调查儿科重症监护病房患者肠内营养支持的现况及其临床结局,为提高重症护理质量提供依据。方法:采用连续抽样法,选取2022年7月至2023年1月在上海某三级甲等儿童专科医院重症监护病房的330例患儿为研究对象,调查并分析早期肠内营养、能量及蛋白质摄入情况及患儿临床结局。结果:330例患儿中,实施早期肠内营养的有275例(83.3%),发生营养延迟的有55例(16.7%),能量摄入不合理的有125例(37.9%),蛋白质摄入不足的有155例(47.0%),幽门后喂养的有6例(1.8%),发生肠内营养中断的有210例(63.6%),发生肠内营养并发症的有77例(23.3%)。早期肠内营养组患儿体质量增加值、机械通气时间、多脏器功能不全发生率、PICU住院时间及住院费用与肠内营养延迟组比较差异具有统计学意义(P<0.05);能量摄入合理组患儿体质量增加值、多脏器功能不全发生率、PICU住院时间与能量摄入不合理组比较差异具有统计学意义(P<0.05);蛋白质摄入合理组患儿机械通气时间、PICU住院时间与蛋白质摄入不足组比较差异具有统计学意义(P<0.05)。结论:儿科重症监护病房患者营养中断及营养并发症发生率高、能量及蛋白质摄入不合理率高、幽门后喂养率低,早期开展肠内营养、能量及蛋白质摄入合理的患儿PICU住院时间等临床结局更佳。需要规范肠内营养支持管理,以提高PICU患儿护理质量。Objective:To investigate the current status and clinical outcomes of enteral nutrition support in Pediatric Intensive Care Unit(PICU)patients,in order to provide a basis for improving the quality of critical care.Methods:A total of 330 children admitted to the intensive care unit of a tertiary grade A children's hospital in Shanghai from July 2022 to January 2023 were recruited by continuous sampling method.The study investigated the intake of early enteral nutrition,energy,protein and the clinical outcome of the children.Results:Among the 330 cases,275 cases(83.3%)had early enteral nutrition and 55 cases(16.7%)had delayed nutrition.There were 125 cases(37.9%)with unreasonable energy intake.Protein intake was insufficient in 155 cases(47.0%).There were 6 cases(1.8%)of retropyloric feeding,210 cases(63.6%)of enteral nutrition interruption,and 77 cases(23.3%)of enteral nutrition complications.There were significant differences in weight gain,mechanical ventilation time,multiple organ dysfunction,PICU hospitalization time and hospitalization cost between early enteral nutrition group and delayed enteral nutrition group(P<0.05).There were significant differences in weight gain,multiple organ dysfunction and hospitalization time in PICU between rational energy intake group and irrational energy intake group(P<0.05).There were significant differences in mechanical ventilation time and hospitalization time of PICU between reasonable protein intake group and insufficient protein intake group(P<0.05).Conclusion:Patients in PICU have low retropyloric feeding rate,high incidence of nutritional disruption and nutritional complications,and high unreasonable rate of energy and protein intake.The early enteral nutrition,reasonable energy and protein intake of patients have better clinical outcomes such as hospitalization time in PICU.It is necessary to standardize the management of enteral nutrition support to improve the quality of care for PICU patients.

关 键 词：儿童 儿科重症监护病房 肠内营养 营养支持 临床结局 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]