先天性心脏病患儿术前营养状况评价及对临床结局的影响

发布时间：2018-04-23 06:41

本文选题：先天性心脏病 + 儿童　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:前瞻性研究先天性心脏病患儿的术前营养状况,并对其术后临床结局进行分析,寻求手术前后营养水平的变化特点,以期提供患儿的营养支持依据,有的放矢地进行营养支持治疗,以改善患儿的临床结局。方法:1病例选择:2013年1月~2016年12月在邢台市人民医院、邢台市第三医院住院的0~6岁先天性心脏病且行手术治疗的患儿。2评价方法:根据年龄、身高、体重等指标,应用Z评分法对患儿进行术前营养评价,评价计算指标包括年龄别身长Z评分(Height for Age,HAZ)、年龄别体重Z评分(Weight for Age,WAZ)和身高别体重Z评分(Weight for Height,WHZ)。根据不同指标评价的营养不良定义:年龄别体重Z评分(WAZ)-2定义为低体重,身高别体重Z评分(WHZ)-2定义为消瘦,年龄别身高Z评分(HAZ)-2定义为生长迟缓。低体重或消瘦中的任一项判定为存在急性营养不良(Acute Malnutrition,AM),以生长迟缓判定为存在慢性营养不良(Chronic Malnutrition,CM)。3观察指标:3.1体格测量指标:身高、体重、头围。3.2血液指标测定:包括手术前后的血清白蛋白(Alb)、血红蛋白(Hb)、淋巴细胞总数(TLC)。3.3临床结局指标:住院时间、住院费用及并发症发生情况。结果:符合入组标准的病例共130例,其中男51例,女79例。年龄为5个月~6岁。(1)以WAZ评分进行营养状况评价:低体重组34例,占26.15%,正常体重组96例,占73.85%。两组患儿术前体重存在有显著性差异(P0.01),但年龄、身高、头围、血清白蛋白、血红蛋白、淋巴细胞总数则无明显差异(P0.05);两组患儿术后血清白蛋白、血红蛋白、淋巴细胞总数均无显著性差异(P0.05),住院时间和住院费用也无显著性差异(p0.05),而低体重组发生3例并发症,其中1例压疮,2例肺部感染,正常体重组未发生并发症,两组并发症发生率存在明显差异(p0.05)。(2)以whz评分进行营养状况评价:消瘦组32例,占24.62%,正常组98例,占75.38%。消瘦组患儿术前的年龄、身高、体重均明显低于正常组(p0.05),而头围、血清白蛋白、血红蛋白、淋巴细胞总数在两组间则无显著差别(p0.05);两组患儿术后的血清白蛋白、血红蛋白、淋巴细胞总数均无显著性差异(p0.05);两组患儿住院时间和住院费用均无显著性差异(p0.05),而消瘦组发生3例并发症,其中1例压疮,2例肺部感染,正常组未发生并发症,两组间并发症发生率存在显著性差异(p0.05)。(3)以haz评分进行营养状况评价:生长迟缓组29例,占22.31%,生长正常组101例,占77.69%。生长迟缓组患儿术前的年龄、身高、体重、头围明显低于生长正常组(p0.05),而血清白蛋白、血红蛋白、淋巴细胞总数在两组间则无显著性差异(p0.05);两组患儿术后血清白蛋白水平无显著性差异(p0.05),而生长迟缓组血红蛋白和淋巴细胞总数显著低于生长正常组(p0.05),两组患儿住院时间和住院费用均无显著性差异(p0.05),而生长迟缓组发生2例肺部感染,生长正常组发生1例压疮,两组间并发症发生率存在显著性差异(p0.05)。(4)不同类型营养不良在不同性别患儿发病情况比较:130例先天性心脏病患儿中32例存在急性营养不良,其中男孩12例,发病率为23.53%,女孩20例,发病率为25.32%,男孩和女孩急性营养不良的发病率无显著性差异(p0.05);130例先天性心脏病患儿中29例存在慢性营养不良,其中男孩17例,发病率为33.33%,女孩12例,发病率为15.19%,男孩慢性营养不良的发病率明显高于女孩(p0.01)。结论:1通过z评分对先天性心脏病患儿术前的营养状况进行评价,研究发现先心病患儿存在不同程度的营养不良,低体重、消瘦和生长迟缓的发生率分别为26.15%、24.62%和22.31%。2先心病主要影响了患儿的体格发育,而对内脏、肌肉以及免疫功能的发育没有显著影响。3急性营养不良患儿术后的血清白蛋白、血红蛋白和淋巴细胞总数均与正常患儿没有显著性差异,而慢性营养不良患儿术后的血红蛋白和淋巴细胞总数显著低于正常患儿。急、慢性营养不良患儿术后并发症发生率明显高于正常患儿,但住院时间和住院费用与正常患儿无显著性差异。
[Abstract]:Objective: To prospectively study the preoperative nutritional status of children with congenital heart disease (congenital heart disease), and to analyze the postoperative clinical outcome and to seek the characteristics of the changes of nutrition level before and after the operation in order to provide the basis of nutritional support for children and to improve the clinical outcome of the children with a definite target in order to improve the clinical outcome of the children. Method: 1 cases selection: ~2 in January 2013. In December, 016 years, the.2 evaluation method for children with 0~6 year old congenital heart disease and surgical treatment in Xingtai People's Hospital and Xingtai third hospital was evaluated according to age, height, weight and so on. The Z scoring method was used to evaluate the children's preoperative nutrition. The evaluation index included the age Z score (Height for Age, HAZ), and the age body. Weight Z score (Weight for Age, WAZ) and weight Z score (Weight for Height, WHZ). According to different indexes, the definition of poor body weight Z score (WAZ) is defined as low weight, tall body weight and weight score is defined as growth retardation, low weight or weight loss. Acute Malnutrition, AM, determined by growth retardation as the existence of Chronic Dystrophy (Chronic Malnutrition, CM).3 observation index: 3.1 physique measurements: height, weight, and head circumference.3.2 blood indexes: including serum albumin (Alb) before and after operation, hemoglobin (Hb), and total number of lymphocytes (TLC).3.3 Clinical outcome indexes: hospitalization time, hospitalization expenses and complications. Results: 130 cases were in accordance with the standard of admission, including 51 males and 79 females. The age was 5 months ~6 years old. (1) the nutritional status was evaluated with WAZ score: 34 cases of low body recombination, 26.15%, and 96 cases of normal weight group, and there were significant pre operation weight in group 73.85%. two. There was no significant difference in age, height, head circumference, serum albumin, hemoglobin and total lymphocyte total (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte count (P0.05) in the two groups (P0.05), and there was no significant difference in hospitalization time and hospitalization expenses (P0.05), while 3 cases had complications in low body recombination. There were 1 cases of pressure sore, 2 cases of pulmonary infection, normal weight group had no complications, the incidence of complications in the two groups was significantly different (P0.05). (2) the nutritional status was evaluated by whz score: 32 cases, 24.62% and 98 cases in the normal group. The age, height and weight of the 75.38%. emaciation group were significantly lower than those of the normal group (P0.05), and the head circumference and blood were significantly lower than that of the normal group (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte total in the two groups (P0.05). There was no significant difference between the two groups of hospitalized time and hospitalization expenses (P0.05), and 3 cases in the emaciation group, including 1 cases of pressure sores, 2 There were no complications in the normal group. There was a significant difference in the incidence of complications between the two groups (P0.05). (3) the nutritional status was evaluated by HAZ score: 29 cases of growth retardation group, 22.31% and 101 cases of normal growth group, and the age, height, weight, and head circumference of the 77.69%. growth retardation group were significantly lower than that of the normal growth group (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte count between the two groups (P0.05). There was no significant difference in serum albumin level in the two groups (P0.05), but the total number of hemoglobin and lymphocyte in the growth retardation group was significantly lower than that of the normal growth group (P0.05). There was no significant difference in the hospitalization time and hospitalization expenses between the two groups. (P0.05), there were 2 cases of pulmonary infection in the growth retardation group and 1 cases of pressure ulcers in the normal growth group. There was a significant difference in the incidence of complications between the two groups (P0.05). (4) the incidence of different types of malnutrition in children with different sex was compared: 32 of the 130 children with congenital heart disease had acute malnutrition, of which 12 cases were boys and the incidence was 23. .53%, 20 girls, the incidence was 25.32%, there was no significant difference in the incidence of acute dystrophy between boys and girls (P0.05). 130 children with congenital heart disease had chronic malnutrition, including 17 boys, 33.33% and 12 girls, the incidence was 15.19%, and the incidence of chronic malnutrition in boys was significantly higher than that of girls (P0.01). Conclusions: 1 the nutritional status of children with congenital heart disease was evaluated by Z score. The study found that children with congenital heart disease had different degrees of malnutrition, low weight, emaciation and growth retardation rate of 26.15%, 24.62% and 22.31%.2, which mainly affected the physical development of the children, and the viscera, muscle and immunity. The development of the function did not significantly affect the serum albumin after the operation of.3 children with acute dystrophy. The hemoglobin and the total number of lymphocytes were not significantly different from those of the normal children, while the postoperative hemoglobin and the total number of lymphocytes in the children with chronic malnutrition were significantly lower than those of the normal children. The rate of birth was significantly higher than that of normal children, but there was no significant difference between hospitalization time and hospitalization expenses.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5;R459.3

【参考文献】