儿科营养筛查-评估工具在消化科患儿中的应用

doi:10.12372/jcp.2022.21e1763

Abstract

Abstract:

Objectives To recognize the nutritional status of hospitalized children by the pediatric nutrition screening-assessment tool, to analyze the differences in clinical outcomes and biochemical indicators under different nutritional status, and to provide evidence for reasonable nutritional intervention. Methods A pediatric nutrition screening-assessment tool, named as Pediatric Nutrition Screening APP, developed by Working group of Pediatrics, Chinese Society of Parental and Enteral Nutrition was used to nutritional screening and assessment of children admitted to the Division of Gastroenterology and Nutrition Xinhua Hospital from March 2018 to October 2020, and to evaluate children at risk of malnutrition and analyze the difference in clinical outcomes and biochemical indicators under different nutritional status. Results A total of 624 children were enrolled, including 368 males and 256 females. There were 158 children in the 0-1 year old group, 95 children in the 1-3 years old group, and 371 children in elder than 3 years old group. Nutrition screening showed that the incidence of malnutrition risk was 56.25%, and the risk of malnutrition was 89.24%, the highest in the 0-1 year old group. Grouped by disease, children with short bowel syndrome have the highest risk of malnutrition at 90.05%, followed by acute pancreatitis at 88.89%, and chronic diarrhea at75.00%. Compared with the non-malnutrition risk group, the children in the malnutrition risk group had significantly longer duration of hospitalization, more hospitalization expenses, higher infection rates, and significantly reduced total protein, albumin, hemoglobin, and 25-(OH)-Vitamin D levels (all P<0.05). Nutrition assessment indicated that the incidence of moderate malnutrition and severe malnutrition were 35.89% and 16.37%, respectively. The incidence of moderate malnutrition and severe malnutrition in the 0-1 year old group were the highest, 34.61% and 36.54%, respectively (both P<0.05). In the normal group, moderate malnutrition group, and severe malnutrition group, the duration of hospitalization, hospitalization expenses, and infection rate stepped up, and the levels of total protein, albumin levels stepped down (all P<0.05). Conclusions The risk of malnutrition and the incidence of moderate and severe malnutrition were higher in children in gastroenterology ward. Children under small age had higher risk of malnutrition and incidence of moderate to severe malnutrition. Under malnutrition status, children had longer hospitalization, increased hospitalization expenses, and higher infection rate, and lower levels of total protein, albumin, and 25-hydroxyvitamin D.

Key words: nutritional screening, nutritional assessment, gastroenterology disease, child

WANG Zhixin, LU Lina, WANG Jinling, YAN Weihui, CAI Wei, WANG Ying. Clinical application of a pediatric nutrition screening-assessment tool in gastroenterology ward[J].Journal of Clinical Pediatrics, 2022, 40(5): 376-381.

Figures/Tables 5

References 29

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项目	0分	1分	2分	3分
疾病风险	无	有	—	—
饮食摄入	饮食无改变	近1个月以来进食较平时减少,但一半能完成	近1个月以来进食较平时减少一半以上	—
体格测量	任意Z值>–1（其中BMI部分的Z值未超过中国肥胖工作组标准P₈₅水平）	任意Z值介于–1和–2之间或BMI部分Z值在中国肥胖工作组标准P₈₅~P₉₅水平	任意Z值介于-2和-3之间或BMI部分Z值超中国肥胖工作组标准过P₉₅水平	Z值≤–3

项目		例数	无营养不良风险(n=273)	营养不良风险(n=351)	χ²值	P
性别	男	368	163（44.29）	205（55.71）	0.108	0.743
性别	女	256	110（42.97）	146（57.03）		0.743
年龄	0~1岁	158	17（10.76）	141（89.24）	99.147	<0.001
	1~3岁	95	42（44.21）	53（55.79）
	>3岁	371	214（57.68）	157（42.32）
病种	短肠综合征	221	22（9.95）	199（90.05）	200.864	<0.001
	急性胰腺炎	9	1（11.11）	8（88.89）
	慢性腹泻	36	9（25.00）	27（75.00）
	炎症性肠病	41	20（48.78）	21（51.22）
	急性消化道出血	52	37（71.15）	15（28.85）
	其他	265	184（69.43）	81（30.57）

项目	无营养不良风险组（n=273）	营养不良风险组（n=351）	统计量	P
前白蛋白(x±s)/ g·L^–1	181.81±43.73	176.11±49.29	t=1.060	0.290
总蛋白(x±s)/ g·L^–1	72.04±35.02	65.42±9.79	t=3.183	0.004
白蛋白(x±s) / g·L^–1	44.41±4.26	41.67±5.79	t=6.465	<0.001
血红蛋白(x±s) / g·L^–1	124.31±15.73	115.73±20.69	t=5.718	<0.001
维生素D[M（P₂₅~P₇₅）]/nmol·L^–1	68.99(44.21~96.99)	48.82(34.08~73.06)	Z=4.197	<0.001
维生素A[M（P₂₅~P₇₅）] /μmol·L^–1	0.80(0.58~1.09)	0.86(0.59~1.09)	Z=0.163	0.948
住院天数[M（P₂₅~P₇₅）]/s	5.0(3.0~8.0)	13.0(5.0~28.0)	Z=11.323	<0.001
住院费用[M（P₂₅~P₇₅）]/元	6892.61（5251.65~10335.05）	16477.56（6763.51~43222.53）	Z=9.020	<0.001
感染[n(%）]	33(12.09)	171(48.72)	χ²=93.637	<0.001

项目		例数	SGNA正常(n=137)	SGNA中度(n=103)	SGNA重度(n=47)	χ²值	P
性别	男	179	91（50.84）	59（32.96）	29（16.20）	2.104	0.349
	女	108	46（42.59）	44（40.74）	18（16.67）
年龄	0~1岁	104	30（28.85）	36（34.61）	38（36.54）	55.734	<0.001
	1~3岁	40	19（47.50）	19（47.50）	2（5.00）
	>3岁	143	88（61.53）	48（33.57）	7（4.90）

项目	正常（n=137）	中度营养不良（n=103）	重度营养不良（n=47）	统计量	P
前白蛋白(x±s)/ g·L^–1	176.80±48.24	182.44±51.19	164.91±52.74	F=0.975	0.380
总蛋白(x±s)/ g·L^–1	66.11±9.52	65.48±9.89	61.01±8.44	F=4.787	0.009
白蛋白[M（P₂₅~P₇₅）]/g·L^–1	42.80(40.30~45.10)	44.00(38.00~45.55)	41.25(37.96~45.20)	H=7.697	0.021
血红蛋白(x±s) / g·L^–1	117.42±21.04	115.94±20.07	113.00±20.15	F=0.787	0.456
维生素D[M（P₂₅~P₇₅）]/nmol·L^–1	51.15 (37.89~102.20)	55.18(36.42~73.34)	42.33 (22.22~73.90)	H=4.557	0.102
维生素A (x±s) /μmol·L^–1	0.91±0.30	0.81±0.27	0.76±0.23	F=3.033	0.052
住院天数[M（P₂₅~P₇₅）]/d	8.0(4.0~22.0）	14.0(9.0~28.0）	30.0(15.0~44.0）	H=37.081	<0.001
住院费用[M（P₂₅~P₇₅）]/元	12 055.33 （6 270.17~32 747.39）	21 723.88 （9 380.87~42 129.81）	36 892.59 （16 211.15~69 638.22）	H=23.612	<0.001
感染[n(%）]	53（38.69）	52（50.49）	39（82.98）	χ²=27.468	<0.001

Clinical application of a pediatric nutrition screening-assessment tool in gastroenterology ward

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