营养支持在先天性心脏病术后ECMO辅助中的差异分析  

Nutritional Support Differences in Postoperative ECMO Assistance for Congenital Heart Disease

作　　者：黄坚鹄 张悦玥 王伟[1] 张蔚[1] 郭铮 姜磊 于新迪[1] 杨寅愉 Huang Jianhu;Zhang Yueyue;Wang Wei;Zhang Wei;Guo Zheng;Jiang Lei;Yu Xindi;Yang Yinyu(Department of Cardiothoracic Surgery,Affiliated 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：《中华小儿外科杂志》2024年第9期802-805,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的:比较先天性心脏病(congenital heart disease,CHD)患儿术后行体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助期间营养支持的情况,为CHD患儿围手术期营养支持策略提供参考。方法:收集2019年1月至2021年12月期间在上海交通大学医学院附属上海儿童医学中心心胸外科手术治疗后行ECMO辅助的79例患儿,其中男36例,女43例;中位年龄4.43个月,中位身高61.00 cm,中位体重5.30 kg。收集患儿的一般资料、诊疗情况及实验室检查指标,根据是否在ECMO辅助期间开展肠内或全配方的肠外营养,将患儿分为营养支持组和非营养支持组,并按是否在ECMO辅助的48 h内开展营养支持将患儿分为早期营养支持和延迟营养支持。采用方差分析和χ^(2)检验比较不同营养支持策略对CHD患儿的影响。结果:79例CHD行ECMO辅助的患儿中,营养不良占55.70%(44/79),ECMO辅助期间开展营养支持的比例达83.54%(66/79)。营养支持组患儿在ECMO辅助期间的抗凝血酶Ⅲ的最高值(75.92±21.53)%、平均值(57.33±14.66)%以及白蛋白值(35.71±5.51)g/L均高于非营养支持组的(56.46±19.04)%、(48.15±15.36)%、(30.67±6.56)g/L,差异有统计学意义(均P<0.05),且早期营养支持的患儿ECMO辅助时间更短(P=0.043)。结论:CHD术后行ECMO辅助的患儿基础营养状况不佳,ECMO辅助期间开展营养支持有助于改善患儿预后。Objective:To compare the nutritional support of children with congenital heart disease(CHD)during auxiliary period of extra-corporeal membrane oxygenation(ECMO)post-operation and provide references for perioperative nutritional supports.Methods:From January 2019 to December 2021,79 children(36 boys and 43 girls)underwent ECMO-assisted cardiothoracic operation.Median age was 4.43 month,median height 61.00 cm and median weight 5.30 kg.Demographic profiles,diagnoses,treatments and laboratory examination parameters were recorded.According to whether or not on enteral nutrition or total parenteral nutrition during ECMO-assisted period,they were assigned into two groups of nutritional support and non-nutritional support.Based upon whether or not on nutritional support within 48h assisted by ECMO,they were divided into two groups of early and delayed nutritional supports.The effects of different nutritional supports were compared by variance analysis andχ^(2) test.Results:Among those on ECMO,malnutrition was present in 55.70%(44/79)and nutritional support was provided in 83.54%(66/79).Peak value(75.92±21.53)%and mean value(57.33±14.66)%of antithrombin III,as well as albumin level(35.71±5.51)g/L,were significantly higher in nutritional support group than non-nutritional support group(56.46±19.04)%,(48.15±15.36)%,and(30.67±6.56)g/L.There were statistically significant differences(all P<0.05).Also children on early nutritional support had a shorter duration of ECMO assisting(P=0.043).Conclusions:Basic nutritional status of CHD children assisted by ECMO is poor.Nutritional support during ECMO helps to improve the prognosis.

关 键 词：营养支持 先天性心脏病 体外膜肺氧合 

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