CAJ | 학술논문

目的了解危重患儿在小儿重症监护室(PICU)住院期间的营养状况、营养摄入情况,并对导致营养支持不足的相关因素进行分析.方法观察2012年6月至10月期间入住上海儿童医学中心PICU、符合PICU入室标准、住院时间＞72 h的127例危重症患儿.记录患儿相关人体测量指标、入室1～10d的营养摄入情况等.结果 59例(46.5％)患儿在入HCU时即存在营养不良,其中重度营养不良占49.2％；65例(51.2％)患儿在出HCU时存在营养不良,其中重度营养不良占63.1％.美国肠外肠内营养学会(ASPEN)推荐热量中位数为376.7 kJ/(kg·d)[四分位数间距,IQR:314.0～376.7 kJ/ (kg·d)],入室1～10 d平均医嘱供给量为237.8 kJ/ (kg·d)[IQR:159.5～291.8 kJ/(kg·d)],平均实际摄入量为220.2 kJ/ (kg·d)[IQR:132.3 ～279.2 kJ/ (kg·d)],三者之间的差异有统计学意义(P =0.000).在总1021个记录天数内,实际摄入热量低于90％推荐量的天数有824 d(80.7％),医嘱供给热量低于90％推荐量的天数有759 d(74.3％).入室1～10 d平均累积热量缺乏量为(933.5±745.5) kJ/(kg·人),平均累积蛋白缺乏量为(4.0±5.0)g/(kg·人).83/127例患儿(65.4％)在入室1～10 d内发生了至少1次喂养中断,共中断170次,其中117次(68.8％)是因为检查操作.结论危重患儿入PICU时营养不良发生率极高,PICU住院期间其营养状况会发生进一步恶化.医嘱供给不足是导致实际摄入量未能达到ASPEN推荐量的首要原因,喂养中断是导致实际热量摄入量未能达到医嘱供给量的首要原因.需及早对患儿进行营养风险筛查,给予合理营养干预,避免营养支持不足的发生.
목적 료해위중환인재소인중증감호실(PICU)주원기간적영양상황、영양섭입정황,병대도치영양지지불족적상관인소진행분석.방법 관찰2012년6월지10월기간입주상해인동의학중심PICU、부합PICU입실표준、주원시간＞72 h적127례위중증환인.기록환인상관인체측량지표、입실1～10d적영양섭입정황등.결과 59례(46.5％)환인재입HCU시즉존재영양불량,기중중도영양불량점49.2％；65례(51.2％)환인재출HCU시존재영양불량,기중중도영양불량점63.1％.미국장외장내영양학회(ASPEN)추천열량중위수위376.7 kJ/(kg·d)[사분위수간거,IQR:314.0～376.7 kJ/ (kg·d)],입실1～10 d평균의촉공급량위237.8 kJ/ (kg·d)[IQR:159.5～291.8 kJ/(kg·d)],평균실제섭입량위220.2 kJ/ (kg·d)[IQR:132.3 ～279.2 kJ/ (kg·d)],삼자지간적차이유통계학의의(P =0.000).재총1021개기록천수내,실제섭입열량저우90％추천량적천수유824 d(80.7％),의촉공급열량저우90％추천량적천수유759 d(74.3％).입실1～10 d평균루적열량결핍량위(933.5±745.5) kJ/(kg·인),평균루적단백결핍량위(4.0±5.0)g/(kg·인).83/127례환인(65.4％)재입실1～10 d내발생료지소1차위양중단,공중단170차,기중117차(68.8％)시인위검사조작.결론 위중환인입PICU시영양불량발생솔겁고,PICU주원기간기영양상황회발생진일보악화.의촉공급불족시도치실제섭입량미능체도ASPEN추천량적수요원인,위양중단시도치실제열량섭입량미능체도의촉공급량적수요원인.수급조대환인진행영양풍험사사,급여합리영양간예,피면영양지지불족적발생.
Objective To assess the nutritional status of critically ill children and the nutritional intake during their stay in pediatric intensive care unit (PICU),and analyze the correlation factors of nutritional deftciencies.Methods One hundred and twenty-seven patients who met the PICU admission standards with a PICU stay of ＞72 h were recruited from June to October 2012 in Shanghai Children's Medical Center.Anthropometric measurements and all nutrition-related indicators of those patients were recorded from day 1 to day 10.Results 59 of the 127 patients (46.5％) showed malnutrition at admission,in which 49.2％ had severe malnutrition.65 of the 127 patients (51.2％) showed malnutrition at discharge,in which 63.1％ were severely malnourished.Median estimated energy requirements (EER) by American Society for Parenteral and Enteral Nutrition was 376.7 kJ/ (kg · d) [interquartile range,IQR:314.0～376.7 kJ/ (kg · d)],prescribed calories were 237.8 kJ/ (kg· d) [IQR:159.5 ～291.8 kJ/ (ks· d)],and delivered calories were 220.2 kJ/ (kg· d)[IQR:132.3 ～ 279.2 k J/ (kg · d)],showing significant difference (P =0.000).The delivered energy was ＜90％ of EER in 80.7％ of the 1021 recorded days and the prescribed energy was ＜90％ of EER in 74.3％of the 1021 recorded days.The cumulative calory deficiency from day 1 to day 10 in PICU was (933.5 ±745.5) kJ/ (kg · person),and the cumulative protein deficiency was (4.0 ±5.0) g/ (kg · person).83 patients (65.4％) experienced at least one feeding interruption.Altogether 170 times of feeding interruption were recorded,of which 117 (68.8％) could be explained by examination procedures.Conclusions There is a high prevalence of malnutrition in critically ill children at admission into PICU,and their nutritional status deteriorates during hospital stay.Discrepancies between required and delivered energy were mainly attributed to under-prescription,while discrepancies between prescribed and delivered energy were mainly attributed to feeding interruptions.Appropriate care for these children entails early nutritional risk screening and correct nutrition support to avoid nutritional deficiencies.