CAJ | 학술논문

目的应用改良儿科营养不良评估筛查工具(screening tool for the assessment of malnutrition in paediatrics,STAMP)对外科住院患儿进行营养风险评估,并分析营养风险与临床结局的相关性.方法回顾性分析2010年8月至2011年6月入住上海儿童医学中心外科(包括新生儿外科,普外科,泌尿外科,心胸外科,骨科等)的住院1 201例患儿的临床数据,根据STAMP评分分为低营养风险组(LNR组,STAMP评分＜4分)900例及高营养风险组(HNR组,STAMP评分≥4分)301例,统计分析两组营养干预情况及临床结局数据.其中手术对营养风险的影响采用国家院内感染监控风险指数(national nosocomial infection surveillance risk index,NNIS)进行量化评分.结果 HNR组和LNR组的院内感染率分别为4.7％(14/301)和2.1％(19/900)、住院时间分别为(12.59±8.75)d和(10.55±7.69)d、ICU滞留时间分别为(6.59±7.58)d和(3.89±4.25)d、肠外营养使用率分别为17.3％(52/301)和3.1％(28/900)、肠内营养使用率分别为10.0％(30/301)和3.1％(28/900),HNR组均高于LNR组；而治愈率、住院费用两组之间没有显著统计学差异.结论改良STAMP评分可以有效评价住院外科患儿的营养风险,对指导围手术期合理营养干预有参考价值.应用NNIS评分可将手术风险进行量化评估.
목적 응용개량인과영양불량평고사사공구(screening tool for the assessment of malnutrition in paediatrics,STAMP)대외과주원환인진행영양풍험평고,병분석영양풍험여림상결국적상관성.방법 회고성분석2010년8월지2011년6월입주상해인동의학중심외과(포괄신생인외과,보외과,비뇨외과,심흉외과,골과등)적주원1 201례환인적림상수거,근거STAMP평분분위저영양풍험조(LNR조,STAMP평분＜4분)900례급고영양풍험조(HNR조,STAMP평분≥4분)301례,통계분석량조영양간예정황급림상결국수거.기중수술대영양풍험적영향채용국가원내감염감공풍험지수(national nosocomial infection surveillance risk index,NNIS)진행양화평분.결과 HNR조화LNR조적원내감염솔분별위4.7％(14/301)화2.1％(19/900)、주원시간분별위(12.59±8.75)d화(10.55±7.69)d、ICU체류시간분별위(6.59±7.58)d화(3.89±4.25)d、장외영양사용솔분별위17.3％(52/301)화3.1％(28/900)、장내영양사용솔분별위10.0％(30/301)화3.1％(28/900),HNR조균고우LNR조；이치유솔、주원비용량조지간몰유현저통계학차이.결론 개량STAMP평분가이유효평개주원외과환인적영양풍험,대지도위수술기합리영양간예유삼고개치.응용NNIS평분가장수술풍험진행양화평고.
Objective To evaluate the efficacy of modified screening tool for assessment of malnutrition in pediatric (STAMP) to evaluate nutritional status and clinical outcome in hospitalized children on a pediatric-surgical ward.Methods In this retrospective cohort study,1201 hospitalized surgical patients were recruited from August 2010 to June 2011 in a pediatric-surgical ward of Shanghai Children's Medical Center.The patients were grouped according to the STAMP Score at admission:low nutritional risk group (LNR,900 patients with a STAMP Score＜4),and high nutritional risk group (HNR,301 patients with a STAMP Score≥4).The parenteral nutrition (PN) and enteral nutrition (EN) support and clinical outcome were compared between these 2 groups,The impact of nutritional risk of operation was scored by calculating National Nosocomial Infection Surveillance risk index (NNIS).Results Compared with the LNR patients,the HNR patients had higher nosocomial infection rate (4.7％ vs 2.1％),longer length of hospital stay (12.59±8.75 d vs 10.55±7.69 d),longer length of ICU stay (6.59±7.58 d vs 3.89±4.25 d),more PN and EN application (PN,52/301 vs 28/900; EN,30/301 vs 28/900).No difference of cure rate and medical cost between these 2 groups was found.Conclusions The modified STAMP score is accurate to evaluate the nutritional risk of the hospitalized surgical children.Higher STAMP score is associated with poor clinical outcomes,and indicates nutritional support before or after surgery.