PDF(1485 KB)
PDF(1485 KB)
PDF(1485 KB)
改良儿科营养风险筛查工具的临床应用
Clinical application of the modified pediatric nutritional risk screening tool
目的 探讨改良儿科营养风险筛查工具及营养评估在临床中的应用，为建立儿科规范化营养管理流程提供理论依据。方法 回顾性分析16 249例住院患儿的入院营养风险筛查和营养评估资料，将患儿按营养风险程度分为高营养风险组（588例）、中营养风险组（4 330例）、无营养风险组（11 331例），对比各营养风险组患儿的营养评估情况，分析营养风险筛查的评分构成，以及营养风险筛查的开展对营养支持治疗率的影响。结果 营养风险发生率为30.27%（4 918/16 249），营养不良发生率为27.37%（4 448/16 249），营养过剩发生率为11.29%（1 834/16 249）。营养评估结果与营养风险程度均存在显著相关性（5岁及以上：rs=0.313，P < 0.05；5岁以下：rs=-0.304，P < 0.05）。不同营养风险组间，各评分项目的构成差异均有统计学意义（P < 0.05）。随着营养风险筛查的开展，患儿接受营养支持治疗率逐年上升（P < 0.05）。结论 住院患儿营养风险发生率较高，使用改良儿科营养风险筛查工具可促进规范化营养管理工作的开展。
Objective To study the clinical application of the modified nutritional risk screening tool and nutrition assessment in pediatric patients in China, and to provide a theoretical basis for establishing a standardized nutritional management process for pediatric patients. Methods A retrospective analysis was performed for the nutritional risk screening and nutrition assessment data of 16 249 hospitalized children. According to the degree of nutritional risk, the children were divided into a high nutritional risk group with 588 children, a moderate nutritional risk group with 4 330 children, and a non-nutritional risk group with 11 331 children. Nutrition assessment results were compared between groups. The composition of nutritional risk screening scores and the impact of nutritional risk screening on the rate of nutrition support therapy were analyzed. Results The incidence rate of nutritional risk was 30.27% (4 918/16 249), and the incidence rates of malnutrition and overnutrition were 27.37% (4 448/16 249) and 11.29% (1 834/16 249), respectively. Nutrition assessment results were significantly correlated with nutritional risk (≥ 5 years old:rs=0.313, P < 0.05; < 5 years old:rs=-0.304, P < 0.05). There was a significant difference in the composition of scoring items between the groups with different nutritional risks (P < 0.05). With the implementation of nutritional risk screening, there was a gradual increase in the rate of nutrition support therapy year by year (P < 0.05). Conclusions There is a high incidence rate of nutritional risk in hospitalized children. The use of the modified pediatric nutritional risk screening tool can promote the implementation of standardized nutritional management.
改良儿科营养风险筛查工具 / 营养评估 / 儿童
Modified pediatric nutritional risk screening tool / Nutrition assessment / Child
[1] 彭璐婷, 李晓南. 关注疾病状态下儿童营养风险评估及临床营养支持[J]. 发育医学电子杂志, 2019, 7(1):8-12.
[2] 中华医学会肠外肠内营养学分会儿科协作组. 中国儿科肠内肠外营养支持临床应用指南[J]. 中华儿科杂志, 2010, 48(6):436-441.
[3] Mueller C, Compher C, Ellen DM, et al. A.S.P.E.N. clinical guidelines:nutrition screening, assessment, and intervention in adults[J]. JPEN J Parenter Enteral Nutr, 2011, 35(1):16-24.
[4] 胡丽娣. 住院患儿营养风险筛查及营养评价模式的应用效果评估[J]. 世界最新医学信息文摘, 2018, 18(99):57.
[5] 李心仪, 黄晟, 何苗, 等. 5236例住院患儿营养风险筛查及营养状况评价[J].四川大学学报(医学版), 2019, 50(5):779-782.
[6] 史雯嘉, 黄燕, 李素云. 住院患儿营养风险筛查及营养护理现状调查[J]. 护理学杂志, 2017, 32(9):15-17.
[7] 成琦. 1176例住院患儿的营养风险筛查及其临床指导意义[D]. 杭州:浙江大学, 2016.
[8] Lu L, Mao X, Sheng J, et al. Development and validation of a Pediatric Nutritional Screening Score (PNSS) for hospitalized children[J]. Asia Pac J Clin Nutr, 2018, 27(1):65-71.
[9] 盛金叶, 茅晓蒙, 陆丽娜, 等. 住院儿童应用改良儿科营养不良风险筛查工具的临床评价[J]. 中国实用儿科杂志, 2018, 33(4):281-285.
[10] Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient:Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J]. JPEN J Parenter Enteral Nutr, 2017, 41(5):706-742.
[11] Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition:indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition)[J]. Nutr Clin Pract, 2015, 30(1):147-161.
[12] Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity:summary report[J]. Pediatrics, 2007, 120(Suppl 4):S164-S192.
[13] World Health Organization. WHO child growth standards:length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age:methods and development[EB/OL]. (2006)[2020-09-20]. https://apps.who.int/iris/handle/10665/43413.
[14] World Health Organization. BMI-for-age (5-19 years)[EB/OL]. (2007)[2020-09-20]. https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age.
[15] 石汉平, 许红霞, 李苏宜, 等. 营养不良的五阶梯治疗[J]. 肿瘤代谢与营养电子杂志, 2015, 2(1):29-33.
[16] Cramér H. Mathematical Methods of Statistics[M]. Princeton:Princeton University Press, 1946:282.
[17] White M, Lawson K, Ramsey R, et al. Simple nutrition screening tool for pediatric inpatients[J]. JPEN J Parenter Enteral Nutr, 2016, 40(3):392-398.
[18] Wong Vega M, Beer S, Juarez M, et al. Malnutrition risk in hospitalized children:a descriptive study of malnutrition-related characteristics and development of a pilot pediatric risk-assessment tool[J]. Nutr Clin Pract, 2019, 34(3):406-413.
[19] Patel V, Romano M, Corkins MR, et al. Nutrition screening and assessment in hospitalized patients:a survey of current practice in the United States[J]. Nutr Clin Pract, 2014, 29(4):483-490.
[20] 于圣娟. 住院患儿营养风险筛查及影响因素分析[D]. 重庆:重庆医科大学, 2013.
[21] 何冰洁. 住院患儿营养风险筛查及营养评估的临床应用研究[D]. 广州:南方医科大学, 2015.
[22] 冯一, 傅景, 汪正园, 等. 住院儿童膳食营养素摄入情况调查[J]. 中国食物与营养, 2013, 19(3):84-87.
[23] Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk:a randomised clinical trial[J]. Lancet, 2019, 393(10188):2312-2321.
[24] 孔粼, 吕麟亚, 于爽. 儿科慢性病营养管理体系的构建及效益分析[J]. 中国慢性病预防与控制, 2020, 28(8):636-640.
[25] 蒋朱明, 陈伟, 朱赛楠, 等. 中国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查[J]. 中国临床营养杂志, 2008, 16(6):335-337.
[26] 常颖, 张晴, 范锐心, 等. 恶性肿瘤住院病人营养风险和营养支持与临床转归的研究[J]. 肠外与肠内营养, 2016, 23(2):71-73.
[27] 魏天桐, 王卉, 高媛, 等. 北京大学第一医院消化内科2015年住院患者营养风险筛查和营养支持调查[J]. 实用预防医学, 2017, 24(4):419-422.
[28] Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis[J]. Gastroenterology, 2018, 154(4):1096-1101.
四川省卫健委课题项目（18PJ583）。
