婴幼儿先天性心脏病营养状况评估及其与术后预后的关系  

The Evaluation of Nutritional Status in Infants and Young Children with Congenital Heart Disease and Its Relationship with Prognosis of Postoperative

作　　者：郑林[1] 王旭[1] 潘沱 李丹[1] 王巍[2] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院小儿心脏外科PICU,北京市100037 [2]北京协和医学院中国医学科学院国家心血管病中心阜外医院心脏外科,北京市100037

出　　处：《中国分子心脏病学杂志》2016年第6期1896-1900,共5页Molecular Cardiology of China

摘　　要：目的通过对阜外医院PICU先天性心脏病婴幼儿营养状况的评估以及分析其与术后临床预后的关系,探讨先天心脏病婴幼儿营养不良发生率与临床结局的关系,为先天性心脏病规范化营养风险评估及营养支持治疗提供理论依据。方法选取2015年1月-2016年1月于我院小儿外科中心先天性心脏病2岁以下手术患儿,选取患儿均给予先心病手术风险RACHS-1分级。设定了入选标准及排除标准,收集患儿术前、术中及术后临床资料,了解先心病患儿营养状况,对比营养不良患儿与非营养不良患儿在临床指标上的差异,分析影响先心病营养不良患儿的危险因素,明确先心病营养不良与临床预后的关联性。结果入选患儿共532例,男性306例,女性226例,手术年龄(中位数)9月,手术时体重(中位数)7.8kg,出生体重(中位数)3.2kg,机械通气时间(中位数)11小时,ICU滞留时间2天,出现并发症情况94例,占总数17%,其中死亡16例,占总数3%。营养不良患儿309例,非营养不良患儿223例,两组间比较术前、术中及术后数据,术前RACHS-1分级无明显差异,体重、身高,出生体重存在统计学差异。术前血红蛋白(Hgb),血清白蛋白无统计学差异。营养不良组术后机械通气时间明显延长,存在统计学差异,而ICU滞留时间不存在统计学差异,P值为0.059,接近存在统计学意义P值。术后并发症,营养不良组60例,占组内病例总数19.4%,非营养不良组出现并发症34例,占组内病例总数15.2%,总体并发症两组比较发生率无明显差异。营养不良组患儿二次插管率及死亡率明显多于非营养不良患儿,且具有统计学意义,其它并发症两组间比较差异不大。多因素分析,发现先心病患儿营养不良的群体中,年龄、低出生体重可以加剧营养不良程度。结论先天性心脏病婴幼儿中营养不良患儿比例偏高,营养不良严重程度与手术年龄,低出生体重有关,营养不良患儿先Objective Through the assessment of the infants＇ nutritional status with congenital heart disease in PICU fuwai hospital and to discuss the incidence of malnutrition in infants and young children with congenital heart disease, to analyze its relationship with clinical outcomes, provide theoretical basis for the regular nutrition risk assessment for congenital heart disease and nutritional support treatment. Methods From January 2015 to January 2016 children with congenital heart disease surgery under the age of 2 were selected for congenital heart disease surgery risk grading RACHS- 1. We set the inclusion criteria and exclusion criteria, collect children with preoperative, intraoperative and postoperative clinical data, value the nutritional status of children with congenital heart disease, compare the differences in the clinical indicators of malnutrition children and normal nutrition children, analysis the risk factors of children with malnutrition in congenital heart disease, the relevance of malnutrition in congenital heart disease and clinical outcomes. Results In children with a total of 532 cases, 306 cases of male, female 226, age（median） 9months, weight when the operation（median） 7.8 kg, birth weight（median） 3.2 kg, mechanical ventilation（median） 11 hours time, ICU stay time 2 days, complications 94 cases, 17% of the total, including 16 cases of death, accounting for 3%. Malnutrition children in 309 and non malnourished children in 223 cases, comparison between the two groups preoperative, intraoperative and postoperative data, RACHS-1 grade had no significant difference. But weight,height before operation, birth weight between the two groups, there were significant differences. Preoperative Hgb, serum albumin was not statistically different. Postoperative mechanical ventilation time in malnutrition group was significantly prolonged, and there were statistical differences, and ICU retention time was not statistically significant, P value was 0.059, close to the statistical significance

关 键 词：先天性心脏病 营养状况 临床预后 并发症 

分 类 号：R726.5[医药卫生—儿科]