本文關(guān)鍵詞： ICU患兒 營養(yǎng)風(fēng)險(xiǎn)篩查 營養(yǎng)風(fēng)險(xiǎn) 營養(yǎng)支持　出處：《南華大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的：ICU患兒病情較重,進(jìn)展迅速,因此恰當(dāng)?shù)臓I養(yǎng)支持對于ICU患兒病情恢復(fù)的作用不可低估。然而目前ICU患兒不恰當(dāng)營養(yǎng)支持治療現(xiàn)象較為普遍,影響預(yù)后,因此我們需要根據(jù)其本身的營養(yǎng)狀況以及潛在的營養(yǎng)風(fēng)險(xiǎn)而制定恰當(dāng)?shù)臓I養(yǎng)支持計(jì)劃。目前已經(jīng)陸續(xù)制定了各種各樣的營養(yǎng)風(fēng)險(xiǎn)篩查工具,但是專門針對兒童的并不多。NRS2002被歐洲腸外腸內(nèi)營養(yǎng)學(xué)會(huì)(European Society for Clinical Nutrition and Metabolism, ESPEN)推薦為住院患者營養(yǎng)風(fēng)險(xiǎn)評定的首選工具,NRS2002的優(yōu)點(diǎn)在于簡便易行、醫(yī)患有溝通,有臨床RCT的支持。此研究的目的是調(diào)查PICU患兒營養(yǎng)風(fēng)險(xiǎn)發(fā)生率；調(diào)查PICU營養(yǎng)支持治療現(xiàn)狀；探索PICU患兒營養(yǎng)風(fēng)險(xiǎn)以及營養(yǎng)支持治療與疾病轉(zhuǎn)歸的關(guān)系。 方法：本研究分為兩部分,第一部分為前瞻性研究,以2012年10月至2013年9月入住湖南省兒童醫(yī)院PICU的患兒為研究樣本,對符合入組條件的916名患兒及其家屬進(jìn)行調(diào)查研究,第一部分通過對PICU患兒入院時(shí)的各項(xiàng)營養(yǎng)相關(guān)指標(biāo)進(jìn)行監(jiān)測以及對相關(guān)病史的詢問采集,主要包括身高、體重的測量,飲食狀況以及疾病嚴(yán)重程度等相關(guān)病史,并通過營養(yǎng)風(fēng)險(xiǎn)篩查工具(NRS2002)篩查入住PICU患兒的營養(yǎng)風(fēng)險(xiǎn),從而調(diào)查PICU患兒營養(yǎng)風(fēng)險(xiǎn)的發(fā)生率,并對不同年齡段、不同性別、不同疾病的營養(yǎng)風(fēng)險(xiǎn)發(fā)生率進(jìn)行對比分析,并探索營養(yǎng)風(fēng)險(xiǎn)與疾病轉(zhuǎn)歸的關(guān)系；第二部分為回顧性研究,通過住院醫(yī)師工作站查詢并記錄患兒住院期間的營養(yǎng)支持治療情況,主要包括營養(yǎng)支持治療方式、持續(xù)的時(shí)間以及患兒的臟器功能損傷、疾病轉(zhuǎn)歸、住院時(shí)間、住院費(fèi)用等,了解PICU營養(yǎng)支持使用現(xiàn)狀,并探討恰當(dāng)?shù)臓I養(yǎng)支持治療對疾病轉(zhuǎn)歸的影響。 結(jié)果：對符合入組標(biāo)準(zhǔn)的916例患兒進(jìn)行營養(yǎng)風(fēng)險(xiǎn)篩查,發(fā)現(xiàn)有73.3%(671例)的患兒存在營養(yǎng)風(fēng)險(xiǎn)。不同疾病之間營養(yǎng)風(fēng)險(xiǎn)發(fā)生率具有統(tǒng)計(jì)學(xué)意義(x2=45.868,p0.001),營養(yǎng)風(fēng)險(xiǎn)發(fā)生率最高的是膿毒癥,為86.4%,發(fā)生率最低的是病毒性腦炎,為66.7%。男性患兒營養(yǎng)風(fēng)險(xiǎn)發(fā)生率為73.3%,女性患兒營養(yǎng)風(fēng)險(xiǎn)發(fā)生率為73.1%,無統(tǒng)計(jì)學(xué)意義(x2=0.004,p=0.951)。根據(jù)兒童年齡分期將916例患兒分為4組,1月～1歲為嬰兒組,1歲～3歲為幼兒組,3歲～6歲為學(xué)齡前組,6歲以上為學(xué)齡組。各年齡組患兒營養(yǎng)風(fēng)險(xiǎn)發(fā)生率分別為72.2%,78.2%,68.4%,68.6%,無統(tǒng)計(jì)學(xué)意義(x2=4.389,p=0.222) 通過秩相關(guān)性分析發(fā)現(xiàn)營養(yǎng)風(fēng)險(xiǎn)與疾病嚴(yán)重程度、臟器功能損傷、總住院時(shí)間、總住院費(fèi)用呈正相關(guān),與疾病轉(zhuǎn)歸呈負(fù)相關(guān),有統(tǒng)計(jì)學(xué)意義。 調(diào)查發(fā)現(xiàn)有76.1%(697例)的患兒在住院期間使用了營養(yǎng)支持,63.5%(582例)的患兒單獨(dú)使用了腸內(nèi)營養(yǎng),1.3%(12例)患兒單獨(dú)使用腸外營養(yǎng),11.2%(103例)的患兒聯(lián)合使用了腸內(nèi)、腸外營養(yǎng),23.9%(219例)患兒未使用臨床營養(yǎng)支持,有統(tǒng)計(jì)學(xué)意義(x2=12.204,p0.001) 根據(jù)NRS2002評分進(jìn)行分組,≥3分為有風(fēng)險(xiǎn)組,3分為無風(fēng)險(xiǎn)組,有風(fēng)險(xiǎn)組患兒共671例,有風(fēng)險(xiǎn)組90.0%(604例)的患兒使用了營養(yǎng)支持治療,10.0%(67例)的患兒未使用營養(yǎng)支持治療；無風(fēng)險(xiǎn)組患兒共245例,其中有38.0%(93例)的患兒使用了營養(yǎng)支持治療,62.0%(152例)的患兒未使用營養(yǎng)支持治療,有風(fēng)險(xiǎn)組和無風(fēng)險(xiǎn)組率的比較行卡方檢驗(yàn),均有統(tǒng)計(jì)學(xué)意義(x2=267.036,p0.001) 在PICU患兒中,先天性心臟病患兒的臨床營養(yǎng)支持使用率最高,為95.3%,其次為小兒腹瀉的患兒,為91.7%；藥物中毒患兒的臨床營養(yǎng)支持使用率最低,為57.1%,有統(tǒng)計(jì)學(xué)意義(x2=52.245,p0.001) 未干預(yù)組較干預(yù)組總住院時(shí)間更長,總住院費(fèi)用更高,臟器功能損傷更嚴(yán)重,疾病轉(zhuǎn)歸更差,有統(tǒng)計(jì)學(xué)意義。 結(jié)論：PICU患兒營養(yǎng)風(fēng)險(xiǎn)發(fā)生率較高。具有營養(yǎng)風(fēng)險(xiǎn)的患兒較無風(fēng)險(xiǎn)的患兒總住院時(shí)間更長,總住院費(fèi)用更高,疾病預(yù)后更差。通過調(diào)查發(fā)現(xiàn)臨床上存在營養(yǎng)支持使用不規(guī)范現(xiàn)象。恰當(dāng)?shù)臓I養(yǎng)支持能改善疾病的預(yù)后,縮短病程,減少醫(yī)療支出。
[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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