室间隔缺损患儿住院干预期间营养风险筛查及其临床结局的研究  

Nutrition risk screening and clinical outcomes of children with ventricular septal defect during hospitalization

作　　者：潘莉雅 宋思清 翁子寒[2] 付欢欢 贾雪琦 洪莉[1] Pan Liya;Song Siqing;Weng Zihan;Fu Huanhuan;Jia Xueqi;Hong Li(Department of Clinical Nutrition,Shanghai Children's Medical Center,Shanghai 200127,China;Department of Information,Shanghai Children's Medical Center,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心临床营养科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心信息科,上海200127

出　　处：《中华小儿外科杂志》2024年第9期783-787,共5页Chinese Journal of Pediatric Surgery

基　　金：国家重点研发计划(2023YFC2706505/2023YFF1104301);福建省卫生健康重大科研专项资助计划(2022ZD01007)。

摘　　要：目的:利用信息化工具分析室间隔缺损(ventricular septal defect,VSD)患儿的营养风险筛查评分及相关临床数据,为VSD患儿的营养成本效益分析提供循证基础。方法:收集2019年1月至2020年12月上海交通大学医学院附属上海儿童医学中心心脏科收治的3100例VSD患儿的临床资料,其中男1605例,女1495例;心内科收治455例,心外科收治2557例,重症监护室收治88例。以改良的儿科营养不良评估筛查工具对患儿进行营养风险筛查,<4分为低中营养风险,≥4分为高营养风险。收集患儿身高、体重资料,计算相关Z值并评估患儿为急慢性营养不良。分别比较不同营养风险和是否存在急慢性营养不良患儿的临床结局相关指标差异。组间比较采用χ2检验、配对t检验、Wilcoxon检验。结果:住院期间高营养风险患儿1430例,心内科32例,心外科1343例,重症监护室55例。与中低营养风险比较,VSD患儿在高营养风险时有更长的住院天数[(10.3±6.9)d比(8.3±3.5)d],其住院总费用[(74346.6±30347.0)元比(65916.1±36780.4)元]、抗菌药物费用[(1260.0±344.2)元比(612.8±154.7)元]以及日均抗菌药物费用[(92.1±86.5)元比(63.2±59.3)元]均提高,差异具有统计学意义(均P<0.001)。VSD患儿入院时即存在急慢性营养不良的患儿分别为496例和515例,但两者间住院天数、住院总费用、抗菌药物费用、日均总费用和日均抗菌药物费用差异均无统计学意义(均P>0.05)。结论:与入院时的身高、体重相比,营养风险筛查对住院天数与总费用、抗菌药物费用及日均费用等均具有更好的预测作用,住院期间应定期对VSD患儿进行营养风险筛查。Objective:To employ information technology tools to collect the nutritional risk screening scores and related clinical data of children with ventricular septal defect(VSD)and to provide evidence-based rationales for examining nutritional cost-effectiveness.Methods:From January 2019 to December 2020,the relevant clinical data were retrospectively reviewed for 3100 hospitalized VSD children.There were 1605 boys and 1495 girls.The admitted departments were cardiology(n=455),cardiac surgery(n=2557)and intensive care unit(n=88).Modified pediatric malnutrition assessment screening tool was utilized for screening the nutritional risk of<4 low-to-medium and≥4 high.The data of height and weight were recorded for calculating the related Z value.And the differences of clinical outcome related parameters in children with different nutritional risks were compared byχ2,paired t and Wilcoxon tests.Results:During hospitalization,there were 1430 cases of high nutrition risk.The admitted departments were cardiology(n=32),cardiac surgery(n=1343)and intensive care unit(n=55).As compared with those with low-to-moderate nutrition risk,VSD children with high nutrition risk had longer hospitalization stay[(10.3±6.9)d vs(8.3±3.5)d],significantly higher total hospitalization expense[(74,346.6±30,347.0)Yuan vs(65,916.1±36,780.4)Yuan],higher antibiotic expense[(1,260.0±344.2)Yuan vs(612.8±154.7)Yuan]and higher daily average antibiotic expense[(92.1±86.5)Yuan vs(63.2±59.3)Yuan](all P<0.001).At admission,496 and 515 cases of acute and chronic malnutrition were identified.However,no statistically significant inter-group differences existed in hospitalization stay,total hospitalization expense,antibiotic expense,daily average total expense or daily average antibiotic expense(all P>0.05).Conclusions:As compared with height/weight values at admission,nutrition risk screening has a better predictive effect on hospitalization stay,total expense,antibiotic expense and daily average expense.Therefore regular nutrition risk screening should

关 键 词：心室间隔缺损 营养风险筛查 住院天数 住院费用 

分 类 号：R725.4[医药卫生—儿科] R459.3[医药卫生—临床医学]