全腔静脉——肺动脉连接术后单心室患儿营养状况及其危险因素分析  

Nutritional status and risk factors for malnutrition in children with single ventricle physiology after total cavopulmonary connection

作　　者：孙崇蕊 张明杰 徐卓明[1] SUN Chong-rui;ZHANG Ming-jie;XU Zhuo-ming(Department of Cardiac and Thoracic Surgery,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

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：《上海交通大学学报（医学版）》2018年第10期1233-1241,共9页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·评估全腔静脉-肺动脉连接术(total cavopulmonary connection,TCPC)(又称Fontan术)后患儿的营养状况并分析该类患儿营养不良(低体质量、生长迟缓、消瘦)的临床危险因素。方法·回顾性分析2012年1月—2015年12月于上海交通大学医学院附属上海儿童医学中心行Fontan术的314例单心室患儿的临床资料。采用WHO Z评分评估Fontan术后患儿远期随访时的营养状况,并将患儿分为低体质量组和非低体质量组、生长迟缓组和非生长迟缓组、消瘦组和非消瘦组。通过单因素和多因素Logistic回归分析,研究患儿Fontan术后远期营养不良的危险因素。结果·Fontan术后远期随访时,低体质量患儿占11.9%,生长迟缓占17.8%,消瘦占16.9%。多因素Logistic回归分析显示,Fontan术前营养不良、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是Fontan术后患儿低体质量的危险因素(P=0.008,P=0.000,P=0.025,P=0.001);Fontan术前营养不良、平均肺动脉压力高、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是Fontan术后患儿生长迟缓的危险因素(P=0.001,P=0.046,P=0.000,P=0.019,P=0.004);Fontan术前营养不良、平均肺动脉压力高、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是Fontan术后患儿消瘦的危险因素(P=0.019,P=0.018,P=0.015,P=0.026,P=0.000)。结论·单心室患儿Fontan术后远期随访时营养不良的比例较高。患儿Fontan术前营养不良、心功能分级高、肺动脉压力高、利尿剂应用时间长和中度或重度房室瓣反流可能与Fontan术后营养不良相关。Objective·To analyse nutritional status of children underwent total cavopulmonary connection(TCPC)also called Fontan procedure,furthermore to investigate risk factors related to malnutrition including underweight,stunting,and thinness.Methods·Clinical data of 314 children underwent Fontan procedure in Shanghai Children′s Medical Center from Jan.2012 to Dec.2015 were reviewed.WHO Z score was used to evaluate nutritional status of the children underwent Fontan procedure at the time of long-term follow-up.According to the nutritional status,children were divided into underweight and no-underweight groups,stunting and no-stunting groups,thinness and no-thinness groups.Univariate and multivariate Logistic regression analysis were used to detect risk factors for malnutrition in the children after Fontan procedure.Results·In the follow-up survey after Fontan procedure,the proportion of underweight,stunted and thin children were 11.9%,17.8%,and 16.9%,respectively.Multivariate Logistic regression analysis showed that preoperative malnutrition,worse cardiac function,moderate or severe atrioventricular valve regurgitation and long time use of diuretics were the risk factors for underweight in the children after Fontan procedure(P=0.008,P=0.000,P=0.025,P=0.001);preoperative malnutrition,elevated mean pulmonary artery pressure,worse cardiac function,moderate or severe atrioventricular valve regurgitation and long time use of diuretics were the risk factors for stunting in the children after Fontan procedure(P=0.001,P=0.046,P=0.000,P=0.019,P=0.004);preoperative malnutrition,elevated mean pulmonary artery pressure,worse cardiac function,moderate or severe atrioventricular valve regurgitation and long time use of diuretics were the risk factors for thinness in the children after Fontan procedure(P=0.019,P=0.018,P=0.015,P=0.026,P=0.000).Conclusion·Malnutrition is still remained during follow-up period in the children with single ventricle physiology after Fontan procedure.Preoperative malnutrition,worse cardiac function,ele

关 键 词：单心室 全腔静脉-肺动脉连接术 营养不良 危险因素 

分 类 号：R725.4[医药卫生—儿科]