PICU脓毒症及严重脓毒症患儿肠内营养摄入能量及蛋白质充分性及其与预后的关系

doi:10.3969/j.issn.1006-7795.2016.02.004

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (2): 125-129.doi: 10.3969/j.issn.1006-7795.2016.02.004

PICU脓毒症及严重脓毒症患儿肠内营养摄入能量及蛋白质充分性及其与预后的关系

方伯梁, 钱素云

首都医科大学附属北京儿童医院重症医学科, 北京 100045

收稿日期:2016-03-01 出版日期:2016-04-21 发布日期:2016-04-14
通讯作者: 钱素云 E-mail:fangba6321@sina.com
基金资助:
北京市科委首都临床特色应用研究(Z141107002514144)

Prognostic significance of energy and protein adequacy provided by enteral nutrition in children with sepsis or severe sepsis in pediatric intensive care unit

Fang Boliang, Qian Suyun

Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China

Received:2016-03-01 Online:2016-04-21 Published:2016-04-14
Supported by:
This study was supported by Beijing Science and Technology Commission Foundation for Capital Characteristic Clinical Application (Z141107002514144).

摘要/Abstract

摘要： 目的了解儿童重症监护病房(pediatric intensive care unit,PICU)内脓毒症及严重脓毒症患儿经肠内营养(enteral nutrition,EN)途径摄入能量及蛋白质的充分性以及其与预后的关系。方法前瞻性观察记录2012年11月至2013年4月间首都医科大学附属北京儿童医院PICU收治的脓毒症及严重脓毒症患儿每日经EN途径摄入的能量及蛋白质,分别以64 kcal·kg^-1·d^-1及1.5 g·kg^-1·d^-1作为能量及蛋白摄入标准计算充分性。按肠内摄入能量及蛋白质是否充分分组并比较其预后差异。结果共入组患儿62例,平均年龄9.37个月。经肠内途径摄入能量充分性0.84±0.38,蛋白充分性0.94±0.46,观察期内达到能量及蛋白充分摄入者分别为25例(40.32%)及29例(46.8%)。与对照组相比,肠内能量不充分组患儿年龄较大(P=0.02)、儿童危重病例评分(pediatric critical illness score, PCIS)较低(77.12±10.21 vs 82.88±7.03),而有创机械通气天数较长(P=0.03);而肠内蛋白不充分组患儿体质量较大(P=0.00),严重脓毒症比例较高(42.4% vs 17.2%,P=0.03),器官功能障碍数目(P=0.01)亦较多。肠内能量(16.2% vs 4.0%)及蛋白(15.2% vs 6.9%)摄入不充分组住院28 d病死率高于充分组。结论 PICU脓毒症及严重脓毒症患儿中经肠内途径摄入能量及蛋白质不足者比例较高,且年龄及体质量偏大。肠内摄入能量不充分可能增加有创机械通气时间及住院费用,而蛋白摄入不充分可能增加脏器功能不全风险。肠内摄入能量或蛋白充分性不足可能导致PICU内脓毒症及严重脓毒症患儿病死率升高。

关键词: 儿童重症监护病房, 脓毒症, 肠内营养充分性

Abstract: Objective To examine the prognostic implications of the adequacy of energy and protein intake provided by enteral nutrition (EN) in children with sepsis or severe sepsis in pediatric intensive care unit (PICU). Methods We conducted a prospective observational study of consecutive children with sepsis or severe sepsis in PICU of Beijing Children's Hospital from Nov. 2012 to April 2013. Children's energy and protein intake by EN were daily recorded and their adequacy was calculated according to 64 kcal·kg^-1·d^-1 and 1.5 g·kg^-1·d^-1 respectively. The prognosis variables were compared between children with adequate EN and inadequate EN. Results Totally 62 children aged 9.37 months were included. The adequacy of energy by EN was 0.84±0.38, while the adequacy of protein was 0.94±0.46. Children reached adequate energy and protein intake by EN during observational periods were 25 (40.32%) and 29 (46.8%) cases, respectively. Children with inadequate energy intake by EN were older (P=0.02), with lower pediatric critical illness score (PCIS) (77.12±10.21 vs 82.88±7.03, P=0.02) and longer invasive mechanical ventilation duration (P=0.03). Children with inadequate protein intake by EN had higher weight (P=0.00), higher percent of children with severe sepsis (42.4% vs 17.2%, P=0.03) and more dysfunctional organs (P=0.01). Children with inadequate energy (16.2% vs 4.0%) and protein (15.2% vs 6.9%) intake by EN also had higher mortality at 28th hospital day. Conclusion Majority of children with sepsis or severe sepsis in PICU suffered from inadequate energy and protein intake by EN, and most with older age and higher weight. Inadequate energy intake by EN may associate with longer invasive mechanical ventilation and higher hospital fees, while inadequate protein intake by EN may be associated with increased risk of organ dysfunction. Inadequate energy or protein intake by EN may increase mortality of children with sepsis or severe sepsis in PICU.

Key words: pediatric intensive care unit, sepsis, adequacy of enteral nutrition

中图分类号:

R723.1

方伯梁, 钱素云. PICU脓毒症及严重脓毒症患儿肠内营养摄入能量及蛋白质充分性及其与预后的关系[J]. 首都医科大学学报, 2016, 37(2): 125-129.

Fang Boliang, Qian Suyun. Prognostic significance of energy and protein adequacy provided by enteral nutrition in children with sepsis or severe sepsis in pediatric intensive care unit[J]. Journal of Capital Medical University, 2016, 37(2): 125-129.

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PICU脓毒症及严重脓毒症患儿肠内营养摄入能量及蛋白质充分性及其与预后的关系

Prognostic significance of energy and protein adequacy provided by enteral nutrition in children with sepsis or severe sepsis in pediatric intensive care unit

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