二期Fontan术患儿各手术阶段生长发育情况分析  

Analysis of somatic growth in each operative stage among children undergoing stage Ⅱ Fontan procedure

作　　者：孙崇蕊 张明杰 徐卓明[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2017年第12期912-915,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的调查行二期全腔静脉肺动脉连接术(Fontan术)患儿各手术阶段的生长发育情况。方法回顾性分析2012年1月至2015年12月我院行二期Fontan术152例患儿的临床资料,其中男84例、女68例,年龄4~16岁。评估患儿各手术阶段的身高、体重,并转换为WHO Z评分,描述患儿的生长发育模式。结果患儿各手术阶段年龄别体重Z评分(weight for age Z-score,WAZ)、年龄别身高Z评分(height for age Z-score,HAZ)出生时分别为–0.73和0.06,双向腔肺吻合术(Glenn术)前分别为–1.27±1.37和–1.27±1.72,Fontan术前分别为–0.47±1.08和–0.69±1.17,术后随访时分别为–0.42±1.18和–0.39±1.48。其中Glenn术前与出生时、二期Fontan术前的WAZ、HAZ差异有统计学意义(P<0.05),Fontan术前与随访时HAZ评分差异有统计学意义(P<0.05)。结论二期Fontan术患儿经过各手术阶段后其长发育模式发生变化。在Glenn术前出现生长低谷,术后患儿开始迅速追赶生长;至Fontan术前患儿身高、体重尚未达到正常水平,术后患儿追赶生长减慢;并且随访时仍然存在低体重和生长迟缓现象。未来需要采取有效措施如加强Glenn术前患儿的营养支持,以期待改善患儿的生长发育。Objective To investigate somatic growth of children undergoing stage II Fontan procedure.Methods Clinical data of 152 children who underwent stage II Fontan procedure in Shanghai Children＇s Medical Center, Shanghai Jiaotong University School of Medicine between January 2012 and December 2015 were reviewed. There were 84 males and 68 females at age of 4-16 years. The weight and height of those children in each operative stage were assessed, and WHO Z-score was obtained to describe the pattern of growth of the children. Results Mean weight for age Z-score （WAZ） and height for age Z-score （HAZ） were -0.73 and 0.06 at birth, -1.27±1.37 and -1.27±1.72 before Glenn procedure, -0.47±1.08 and -0.69±1.17 before Fontan procedure, -0.42±1.18 and -0.39±1.48 at follow-up, respectively. A significant decline （P〈0.05） in WAZ and HAZ was found before Glenn procedure. After the Glenn procedure, there was significant catch-up growth （P〈0.05）. The WAZ was stabilized after Fontan procedure, while the HAZ was reversed （P〈0.05） continually. Conclusion The somatic growth is impaired in children with stage Ⅱ Fontan procedure. There is a trough of growth before Glenn procedure. Although catch-up growth occurs after Glenn procedure, low body weight and growth retardation remain at follow-up. Effective interventions such as more intensive nutritional strategies before Glenn procedure should be targeted at those children in the future, so as to improve their growth.

关 键 词：单心室 全腔静脉肺动脉连接术 生长发育 

分 类 号：R726.5[医药卫生—儿科]