营养风险筛查对重症肺炎儿童不良临床结局的评估

目的采用儿科营养不良评估筛查工具(STAMP)调查重症肺炎儿童营养风险发生情况,分析营养风险与不良临床结局的关系。方法选择216例重症肺炎患儿为研究对象,根据STAMP评分分为高度营养风险组(HR组,n=98)、中度营养风险组(MR组,n=65)和低度营养风险组(LR组,n=53)。空腹抽血检测胰岛素样生长因子-1(IGF-1)、脂联素、瘦素、非酯化脂肪酸(NEFA)、白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白(RBP)水平,记录不良临床结局。结果 HR组的血清IGF-1、瘦素、脂联素、前白蛋白、RBP水平低于LR组和MR组(P0.05),而血清NEFA水平高于LR组和MR组(P0.05)。HR组中入住ICU患儿的比例高于LR组和MR组(P0.05);HR组机械通气时间长于LR组和MR组(P0.05);HR组住院时间长于LR组和MR组(P0.05),并发症发生率高于LR和MR组(P0.05)。结论营养风险筛查对评估重症肺炎儿童临床结局有重要价值,高度营养风险患儿有更多的不良临床结局,应尽早给予合理的营养支持。

Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia

Objective To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes.Methods According to the STAMP score,216 children with severe pneumonia were classified into high nutritional risk group (HR group;n=98),moderate nutritional risk group (MR group;n=65),and low nutritional risk group (LR group;n=53).Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1),adiponectin,leptin,non-esterified fatty acid (NEFA),albumin,transferrin,prealbumin,and retinol binding protein (RBP).The adverse clinical outcomes were recorded.Results Compared with the MR and LR groups,the HR group had significantly lower serum levels of IGF-1,leptin,adiponectin,prealbumin,and RBP,as well as a significantly higher serum level of NEFA (P＜0.05).Compared with the MR and LR groups,the HR group had a significantly higher proportion of children admitted to the intensive care unit and a significantly longer duration of mechanical ventilation (P＜0.05).The HR group had a significantly longer mean hospital stay and a significantly higher incidence rate of complications compared with the LR and MR groups (P＜0.05).Conclusions Nutritional risk screening has an important value in evaluating the clinical outcome of children with severe pneumonia,and children at a higher nutritional risk tend to have more adverse clinical outcomes.