| Background and purpose:It’s known that ICU patients is in critical condition and might deteriorate rapidly, so it’s important for them to get appropriate nutritional support in order to recover.However, it’s common in clinical work that most physicians are using inappropriate nutrition evaluation methods and support treatment, which might affect the prognosis of diseases, so we must make proper nutrition treatment plan for patients according to their different nutritional condition and potential risk.UP to no, a variety of nutritional risk screening tool has been formulated, but not much for children specifically. The European Society for Clinical Nutrition and Metabolism(ESPEN) recommended NRS2002as the best choice of hospitalized patients at nutritional risk assessment tool, because NRS2002is simple, has doctor-patient communication and has RCT clinical support. The purpose of this study was to investigate the nutritional risk of PICU patients; Survey the present situation of PICU nutrition support therapy; Explore the relationship between nutritional risk and nutritional support treatment with disease outcome of PICU patients.Methods:The study was divided into two parts, the first part is a prospective study. This survey included916patients who admitted to Hunan Province Children’s Hospital PICU(critical care medicine) from October2012to September2013, to meet their families to provide informed consent. The first part was to monitor various nutrition-related indicators and collect medical history inquiry through the PICU admission patients, including height, weight and BMI, severe of illness and so on, and using nutrition risk screening tool (NRS2002) to screening the nutritional risk of PICU patients, in order to investigate the incidence nutritional risks of PICU patients, and comparative and analysis the incidence of nutritional risk of different ages different genders, different diseases, and exploring the relationship between nutritional risk and disease outcome. The second part was to recording detailed records of the nutritional support, including nutritional support treatment modalities, duration and complications, the disease outcome, length of stay, hospital costs etc. to get the nutritional supports status of PICU and explore the influence of proper nutritional support therapy on disease outcome.Results:Of the916cases,73.3%(671) of the children with nutritional risk. The incidence of nutritional risk among different diseases with a significant difference (χ2=45.868, p<0.001), the highest incidence of nutritional risk is sepsis,86.4%, the lowest incidence of viral encephalitis,66.7%. The male was73.3%, female was73.1%, there was no significant difference (χ2=0.004, p=0.951). Divided those patients into four groups according to the age,1month to1year old baby groupl,1year old to3years old group2,3years old to6years old group3, over6years groups4. The nutritional risk in each group was72.2%,78.2%,68.4%,68.6%, no significant difference (x2=4.389,p=0.222).By rank correlation analysis found the nutritional risk is positively correlated with severity of disease,organs injury, the total length of stay, total hospital costs, negatively correlated with disease outcome, there is a significant correlation.We found that76.1%(697) of the patients used nutritional support during hospitalization,63.5%(582) patients used of enteral nutrition alone,1.3%(12) of children used intestinal nutrition alone,11.2%(103) used enteral and parenteral nutrition,23.9%(219) of children did not use the clinical nutrition support, have significant difference (χ2=12.204,p<0.001).Grouped according NRS2002score,≥3was risk group,<3was no-risk-group. The risk group included671patients,90.0%(604) of the children using nutritional support, but also10.0%(67) did not use the nutrition support therapy; patients without risk group of245, of which38.0%(93) of the children used nutrition support therapy,62.0%(152) of the children did not use nutrition support therapy, J^tests prompt significantly difference (χ2=267.036,p<0.001).The patients in PICU, the highest utilization rate of clinical nutrition support was the congenital heart disease of95.3%, followed was diarrhea,91.7%; the lowest was usage poisoning,57.1%, have significant difference (χ2=52.245, p<0.001).Compared with the intervention group,the no-intervention group has longer hospital stay and higher total hospital costs, more severe organ damage, disease prognosis is worse, there is significant differences.Conclusion:The nutritional risk of PICU patients was high. The children who has nutritional risk have a longer total length of hospital stay, a higher total cost of hospitalization, worse illness prognosis. According this study found that there is exists on the phenomenon of inappropriate use of clinical nutrition support. And appropriate nutritional support can improve the prognosis of the disease, shorten the course of disease and reduce medical expenses. |
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