先天性心脏病患儿术前营养状况与术后短期临床结局研究  

Preoperative nutritional status and short-term clinical outcomes in children with congenital heart disease

作　　者：许莹[1] 唐旭威 郭敏之 王亦萍[1] 沈颜明 黄鸿淼 胡志坚[2] 廖东山[3] Xu Ying;Tang Xuwei;Guo Minzhi;Wang Yiping;Shen Yanming;Huang Hongmiao;Hu Zhijian;Liao Dongshan(Department of Nutrition,Affiliated Union Hospital,Fujian Medical University,Fuzhou 350001,China;Department of Epidemiology&Statistics,School of Public Health,Fujian Medical University,Fuzhou 350122,China;Department of Cardiac Surgery,Affiliated Union Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院营养科,福州350001 [2]福建医科大学公共卫生学院流行病与统计学系,福州350122 [3]福建医科大学附属协和医院心脏外科,福州350001

出　　处：《中华小儿外科杂志》2024年第9期794-801,共8页Chinese Journal of Pediatric Surgery

基　　金：福建省科技厅引导性项目(2023Y0023)。

摘　　要：目的:评估先天性心脏病(congenital heart disease,CHD)患儿术前营养状况、术后血液指标和短期预后的相关性,为改善术后结局的营养干预策略提供证据。方法:收集2018年1月至2022年12月福建医科大学附属协和医院心脏外科行手术治疗的3532例CHD患儿的临床资料。应用《中国儿童生长标准》和《中国儿童体格发育评价标准》的3个指标,即年龄别体重Z值(weight-for-age Z score,WAZ)、年龄别身高Z值(height-for-age Z score,HAZ)、年龄别体重指数Z值(body mass index-for-age Z score,BAZ)进行营养评价。采用Spearman相关性分析探索术前营养指标和术后血液指标(白细胞、C反应蛋白、降钙素原等)之间的相关性。通过logistics回归分析探讨术前营养指标对CHD手术短期预后(住院时间是否>14 d、ICU停留时间是否>3 d、死亡)的关联。并进一步根据手术年龄进行分层分析。结果:根据手术年龄将所有CHD患儿分为0~<1岁组(1245例)、1~<3岁组(1041例)和3~<18岁组(1246例)。营养不良在0~<1岁婴儿中最常见。降钙素原在3~<18岁组、N末端前体B型钠尿肽在1~<3岁组和3~<18岁组、白蛋白在0~<1岁组的数值与WAZ、HAZ和BAZ均呈负相关,均P<0.05。在采用体外循环的患儿中,降钙素原和N末端前体B型钠尿肽与WAZ、HAZ和BAZ呈负相关,均P<0.01。营养不良及其严重程度与短期预后有关,尤其是手术年龄在1~<3岁的患儿。WAZ和BAZ在术后血液指标变化及短期结局方面的影响更显著。结论:对不同年龄段CHD患儿综合使用WAZ和BAZ作为术前营养状况的评价工具进行个体化的干预,可能对改善患儿术前营养状况以及术后血液指标和短期结局具有积极作用。Objective:To evaluate the correlation between preoperative nutritional status,postoperative blood parameters and short-term prognosis in children with congenital heart disease(CHD)and to provide rationales for developing nutritional intervention strategies for optimal postoperative outcomes.Methods:From January 2018 to December 2022,the relevant clinical data were retrospectively reviewed for 3532 CHD children undergoing cardiac operation at Affiliated Union Hospital.Nutrition evaluations were performed by age-specific weight z score(WAZ),age-specific height z score(HAZ)and age-specific body mass index z score(BAZ)of China Pediatric Growth Standard and China Pediatric Physical Development Evaluation Standard.Spearman's correlation analysis was utilized for exploring the correlation between preoperative nutritional parameters and postoperative blood parameters(leucocyte,C-reactive protein&procalcitonin).Logistic regression analysis was utilized for exploring the relationship between preoperative nutritional parameters and short-term prognosis of CHD operation(whether or not hospitalization time>14 day,ICU stay time>3 day or death).Further stratified analysis was performed.Results:According to operative age,they were divided into three groups of 0-<1 year(n=1245),1-<3 year(n=1041)and 3-<18 year(n=1246).Malnutrition was the most common among infants aged 0-<1 year.The values of procalcitonin in 3-<18 year group,N-terminal precursor B-type natriuretic peptide(NT-proBNP)in 1-<3 year and 3-<18 year groups and albumin in 0-<1 year group were correlated negatively with WAZ,HAZ and BAZ(all P<0.05).Procalcitonin and NT-proBNP were correlated negatively with WAZ,HAZ and BAZ in children undergoing cardiopulmonary bypass(all P<0.01).Malnutrition and its severity were correlated with short-term prognosis,especially for children aged 1-<3 year post-operation.WAZ and BAZ had more significant effects on the changes of blood parameters and short-term outcomes post-operation.Conclusions:Individualized intervention with WAZ and BAZ

关 键 词：心脏病 先天畸形 儿童 营养不良 预后 

分 类 号：R726.5[医药卫生—儿科] R459.3[医药卫生—临床医学]