摘要
目的 采用儿科营养不良筛查工具（STAMP）对危重症患儿进行营养风险筛查,调查其营养风险与营养不良发生率,分析营养风险与临床结局相关性.方法 以2013年2至1 1月入住上海交通大学医学院附属上海儿童医学中心儿童重症监护室（PICU）共506例患儿为研究对象.按STAMP评分分为低度营养风险（0～1分）、中度营养风险（2～3分）和高度营养风险（4～9分）.以WHO正常儿童生长曲线为标准,采用标准差单位法（Z-score）评定营养状况.统计比较患儿医院感染发生率、机械通气率、器官功能障碍数目、多器官功能障碍综合征（MODS）发生率、PICU住院天数、总住院天数、住院费用、出PICU后28 d病死率等临床结局.结果 根据STAMP评分,79例（15.6％）患儿存在低营养风险,167例（33.0％）存在中度营养风险,260例（51.4％）存在高度营养风险.营养不良发生率为50.0％ （253/506）,包括营养不足（225/506,44.5％）和超重（28/506,5.5％）,其中低体重、生长迟缓和消瘦发生率分别为31.0％ （157/506）、29.4％ （149/506）和14.4％ （73/506）.高度营养风险患儿的机械通气率、器官功能障碍数目、MODS发生率、PICU住院天数、总住院天数、住院费用和出PICU后28 d病死率显著高于中度营养风险[45.8％比31.7％,P=0.004;1（1,2）比1（0,2）,P=0.000; 45.8％比26.3％,P=0.000;8（3,15）d比5（2,9）d,P =0.000;17 （9,29）d比12 （6,21）d,P=0.001;3.81 （1.67,8.53）万元比2.09（1.13,4.85）万元,P=0.000; 26.9％比18.6％,P=0.047]和低营养风险患儿[45.8％比22.8％,P=0.000;1（1,2）比1（0,1）,P=0.000; 45.8％比15.2％,P=0.000;8（3,15）d比6（3,9）d,P=0.008;17（9,29）d比11（6,20）d,P=0.001;3.81 （1.67,8.53）万元比1.57 （0.96,3.37）万元,P=0.000;26.9％比7.6％,P=0.000].营养不良患儿的MODS和医院感染发生率均显著高于营养正常患儿（39.9％比29.2％,x2=6.368,P=0.012; 8.3％比4.0％,x2=4.158,P=0.041）.结论 大部分危重症儿童存在高度营养风险和营养不良,且高营养风险预示临床结局不良.可采用STAMP评分对危重症患儿进行营养风险筛查,尽早予以合理营养支持.
Objective To evaluate the incidences of nutritional risk and malnutrition of critically ill children using Screening Tool for the Assessment of Malnutrition in Pediatrics （STAMP）,and to investigate the correlation between nutritional risk and clinical outcomes.Methods Altogether 506 children admitted to pediatric intensive care unit （PICU） of Shanghai Children＇s Medical Center from February to November 2013 were enrolled.The patients were divided into 3 groups based on STAMP scores,namely low risk group （score 0-1）,medium risk group （score 2-3）,and high risk group （score 4-9）.Nutritional status was determined using Z-scores based on the World Health Organization child growth standards.Clinical outcomes were recorded and analyzed,including nosocomial infection,mechanical ventilation,number of dysfunction organs,incidence of multiple organ dysfunction syndrome （MODS）,PICU stay,hospital stay,hospital fee,and 28-day mortality after discharge from PICU.Results According to STAMP scores,79 children （15.6%） were at low nutritional risk,167 （33.0%） at medium nutritional risk,and 260 （51.4%） at high nutritional risk.Upon admission,253 children （50.0%） were malnourished,including 225 （44.5%） with undernutrition and 28 （5.5%） with overweight.The prevalence of underweight,stunting,and wasting was 31.0% （157/506）,29.4% （149/506）,and 14.4% （73/506）,respectively.Children at high nutritional risk had higher incidence of mechanical ventilation,more organ dysfunction,higher incidence of MODS,longer length of PICU stay and length of hospital stay,higher hospital fee,and higher 28-day mortality than those at medium risk [45.8% vs.31.7%,P=0.004; 1 （1,2） vs.1 （0,2）,P=0.000; 45.8% vs.26.3%,P=0.000; 8 （3,15） days vs.5 （2,9） days,P=0.000; 17 （9,29） days vs.12 （6,21） days,P=0.001; 3.81 （1.67,8.53） ×104 yuan vs.2.09 （1.13,4.85） ×l04 yuan,P=0.000; 26.9% vs.18.6%,P=0.047] and those at low risk [45.8% vs.22.8%,P=0.000; 1 （1,2） vs.1 （0,1）,P=0.000;45.8%vs.15.2%,P=0.000;8 （3,15） daysvs.6 （3,9） days,P=0.008; 17 （9,29） daysvs.11 （6,20） days,P=0.001; 3.81 （1.67,8.53） ×104yuanvs.1.57 （0.96,3.37） ×104yuan,P=0.000; 26.9% vs.7.6%,P =0.000].Malnourished children had higher incidence of MODS and nosocomial infection compared with children at normal nutritional status （39.9% vs.29.2%,x2 =6.368,P =0.012; 8.3% vs.4.0%,x2 =4.158,P =0.041）.Conclusions High nutritional risk and malnutrition are common among critically ill children.Patients at high nutritional risk are more likely to have worse clinical outcomes.STAMP is a valid tool for nutritional risk screening in critically ill children and early nutrition support is recommended.
出处
《中华临床营养杂志》
CAS
CSCD
2014年第6期323-328,共6页
Chinese Journal of Clinical Nutrition
基金
上海儿童医学中心.雅培/世界健康基金会临床营养发展中心（AFINS）项目（AFINS-HOPE-2012-06-A）
关键词
危重症儿童
营养风险筛查
营养不良
Critically ill children
Nutritional risk screening
Malnutrition
