本文選題：新生兒 + 危重癥��； 參考：《上海交通大學(xué)》2015年碩士論文

【摘要】：第一部分：早期EN支持對NICU新生兒臨床結(jié)局指標(biāo)影響目的 了解新生兒監(jiān)護室(neonatal intensive care unit, NICU)內(nèi)患兒營養(yǎng)攝入情況和早期腸內(nèi)營養(yǎng)(enteral nutrition, EN)開展的現(xiàn)狀,比較早期開始EN(入院后24h內(nèi))和延遲EN(24h)對患兒營養(yǎng)攝入情況和臨床結(jié)局指標(biāo)的影響。方法 本研究為觀察性隊列研究,觀察時間為2013年6月1日至2013年11月30日。記錄日齡1-28天的NICU患兒每天EN及腸外營養(yǎng)(parenteral nutrition, PN)醫(yī)囑配方量和實際攝入情況、體重變化和臨床結(jié)局相關(guān)指標(biāo)(住院總時間、住NICU時間、呼吸機及暖箱使用時間、肺炎罹患率、PN使用率等)。分析NICU新生兒生長遲緩和能量攝入不足現(xiàn)狀,評價早期EN(入監(jiān)護室24小時內(nèi))和延遲開始的EN(大于24小時)對患者臨床結(jié)局的不同影響。結(jié)果 研究期間我院新生兒監(jiān)護室共收治722例患兒,其中510例符合要求納入研究。結(jié)果發(fā)現(xiàn),多數(shù)患者(n=221;43.3%)平均每天攝入熱卡低于60 kcal/kg。生長遲緩在患兒住NICU期間普遍存在,其中早產(chǎn)兒的生長落后更為明顯：低于同胎齡體重第10百分位的患兒比例入院時為21.6%,出NICU時增加到67.6%。入院24h內(nèi)開始EN相比延遲開始EN,可以縮短入院后體重持續(xù)下降時間(0d vs.6d,p0.01),減少PN使用率(41.7%vs.95.0%,p0.01)和肺炎發(fā)生率(37.5% vs.54.4%,p0.05),縮短住NICU時間(8.2d vs.12.0d,p0.01),并且增加患兒住NICU期間平均每天能量攝入量(76.7kcal/kg/d vs. 63.3kcal/kg/d, p0.05)。結(jié)論 危重新生兒需盡早開始EN支持治療,推薦入NICU后24小時內(nèi)進行,可加快患兒體重增加速度、改善患兒臨床指標(biāo),促進預(yù)后。第二部分：危重新生兒營養(yǎng)中斷相關(guān)因素分析目的探究造成NICU新生兒EN中斷的相關(guān)因素,并觀察EN中斷對患兒臨床結(jié)局的影響。方法 本研究屬于觀察性隊列研究,研究時間為2013年6月1日至2013年11月30日共6個月。記錄年齡在1-28天的NICU患兒每天營養(yǎng)攝入(EN、PN)情況、造成EN中斷(喂養(yǎng)未按醫(yī)囑進行且中斷持續(xù)時間不少于30min)和PN棄用的原因,并分析持續(xù)時間較長的EN中斷對患兒營養(yǎng)攝入、臨床結(jié)局指標(biāo)的影響。結(jié)果共有491例患兒住NICU期間接受至少24h的EN支持治療,其中204例患兒EN支持期間發(fā)生過EN中斷(占使用EN患兒的41.5%),累計發(fā)生509次,共6951小時。EN中斷主要原因為胃腸道不耐受和相關(guān)床邊操作,兩者發(fā)生次數(shù)占全部EN中斷事件的70%(分別為222次,1962h和126次,468h)。其他原因包括：監(jiān)護室外相關(guān)檢查(37次),手術(shù)相關(guān)(25次),哭吵拒食(18次),相關(guān)操作禁食準(zhǔn)備(17次),搶救(13次)。手術(shù)相關(guān)原因造成EN中斷時間長達3444h,占EN中斷總時間的49.5%。有450位(占全部患兒88%)使用PN的患兒(PN使用中位時間為7天),住ICU期間共計發(fā)生971次PN棄用事件。造成PN棄用主要原因為：滴速或輸注時間受限(522次),血制品替代(269次),搶救(6()次),手術(shù)相關(guān)(54次)等。EN中斷與患兒入院后體重持續(xù)下降(7.5d vs.4.0d,p0.05)、住監(jiān)護室時間(16.9d vs.9.0d,p0.01)和住院總時間(18.2d vs.12.9d,p0.01)延長有關(guān),并降低新生兒平均每天能量攝入量(70.0kcal/kg/d vs.62.0kcal/kg/d, p0.05)和出NICU時經(jīng)EN能量攝入量(89.2kcal/kg vs.69.9kcal/kg, p0.01)。在全部存在EN中斷的患兒中,EN中斷時間12h的72例患兒較中斷時間12h的132例患兒,肺炎發(fā)病率高(75.0%vs.40.2%,p0.05)、體重持續(xù)下降時間(14.5d vs.6d,p0.01)以及住ICU時間(21.9d vs.13.5d,p0.05)均較長。結(jié)論 住NICU期間EN中斷總時間多于12h明顯延緩危重新生兒體重增加并影響臨床指標(biāo)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 闂存帴鍙楄嚦灝，

本文編號：1754080