法洛四联症患儿神经心理发育及营养状况的研究

发布时间：2018-11-06 15:07

【摘要】：目的：评估法洛四联症(TOF)患儿的神经心理发育及营养状况水平,研究影响法洛四联症患儿神经心理发育及营养状况的相关因素,并探讨法洛四联症根治术对法洛四联症患儿营养状况的影响。方法：第一部分：运用贝利婴幼儿发展量(BSID)表对我科法洛四联症患儿进行神经心理发育评估,根据评分结果将患儿分为正常和异常两组。比较各拟相关因素在正常和异常组之间的差异,将有统计学意义的研究因素进行单因素线性回归分析,再将单因素线性回归分析有意义的变量纳入多元线性回归模型进行分析,筛选出影响婴幼法洛四联症患儿神经心理发育的相关因素。第二部分：测量我科法洛四联症患儿的身高、体重,同时收集患儿人口学及临床资料,采用Z评分法综合评估患儿营养状况,根据评估结果分为营养不良组及非营养不良组,并对两组患儿的特征进行单因素分析,再将单因素分析有意义的因素,纳入多因素回归分析,筛出法洛四联症患儿营养不良的危险因素。第三部分：随访法洛四联症根治术后1月、3月、6月和1年时患儿的身高、体重,对比患儿手术前后营养状况变化。结果：第一部分：83例TOF患儿平均智力发展指数(MDI)为98.07±16.83,平均精神运动发展指数(PDI)为26.62±11.31。智力量表和运动量表评估都无非常优秀者,智力量表优秀者3例(3.6%),中上14例(16%),中等33例(39.8%),中下17例(20.5%),临界状态11例(13.3%),发育迟滞5例(6.0%),运动量表优秀者0、中上4例(4.8%)、中等37例(44.6%)、中下20例(24.1%)、临界状态16例(19.3%)、发育迟滞6例(7.2%)。多元线性回归分析结果显示,MaGoon指数、左心室舒张末容量指数(LVEDI)和手术时年龄与患儿神经心理-智力发育具有相关性,而MaGoon指数、LVEDI与患儿神经心理-运动发育存在相关性。第二部分：142例患儿,营养正常81例(57%),营养不良58例(47%),其中低体重36例(25.4%),的消瘦31例(21.8%),生长迟缓21人(14.8%)。回归分析结果显示低出生体重、早产是患儿低体重的主要影响因素,低出生体重、早产、紫绀、是患儿消瘦的主要影响因素,早产、母亲BMI18.5、LVEDI20ml/m2是患儿生长迟缓的主要影响因素。第三部分：根治术后1年平均体重别年龄Z评分(ZWA)(0.64±0.86vs-1.12±1.23)、平均体重别身高Z评分(ZWH)(0.56±1.02vs-1.03±1.05)、平均身高别年龄Z评分(ZHA)(0.51±0.18vs-1.06±1.75),术后1低体重、消瘦和发育迟滞发生率分别为11.5%、8.7%和10.1%。结论： 1.法洛四联症患儿存在一定程度的神经心理发育落后,一定范围内随MaGoon指数、LVEDI的增加,患儿的神经心理发育落后的风险会随之降低,随着手术年龄的减小患儿神经发育落后的风险降低。 2.婴幼法洛四联症患儿普遍存在营养不良,与低出生体重、早产、紫绀、LVEDI20ml/m2等因素有关。 3.法洛四联症根治术后患儿营养状况较术前好转,法洛四联症根治术有助于患儿改善营养状况。
[Abstract]:Objective: to evaluate the neuropsychological development and nutritional status in children with tetralogy of Fallot (TOF), and to study the related factors affecting neuropsychological development and nutritional status in children with tetralogy of Fallot. To investigate the effect of radical operation of tetralogy of Fallot on nutritional status of children with tetralogy of Fallot. Methods: the first part was to evaluate the neuropsychological development of tetralogy of Cofaclor by using (BSID) table of Bailey's infant development. According to the score, the children were divided into two groups: normal group and abnormal group. To compare the differences between normal and abnormal groups, single factor linear regression analysis was carried out, and the significant variables of single factor linear regression analysis were incorporated into multivariate linear regression model to analyze the difference between normal and abnormal groups. The factors related to neuropsychological development of infants with tetralogy of Fallot were screened. The second part: measuring the height and weight of the children with tetralogy of Cofaclor, collecting the demographic and clinical data of the children, and synthetically evaluating the nutritional status of the children by using Z score method. According to the evaluation results, the children were divided into two groups: malnutrition group and non-malnutrition group. The characteristics of the two groups were analyzed by univariate analysis, and then the significant factors were analyzed, and the risk factors of malnutrition in tetralogy of Fallot were screened out by multivariate regression analysis in order to identify the risk factors of malnutrition in children with tetralogy of Fallot. Part three: the height, weight and nutritional status of the children at 1 month, 3 months, 6 months and 1 year after radical operation of tetralogy of Fallot were followed up. Results: in the first part, the average intelligence development index (MDI) was 98.07 卤16.83 and the average psychomotor development index (PDI) was 26.62 卤11.31 in 83 children with TOF. There were 3 cases (3.6%), 14 cases (16%), 33 cases (39.8%) and 17 cases (20.5%) of intelligence scale and motor scale. Critical state 11 cases (13.3%), developmental retardation 5 cases (6.0%), excellent motor scale 0, middle and upper 4 cases (4.8%), middle 37 cases (44.6%), middle and lower 20 cases (24.1%), critical state 11 cases (13.3%), development retardation 5 cases (6.0%), motor scale excellent 4 cases (4.8%), middle and lower 20 cases (24.1%). Critical state 16 cases (19.3%), development retardation 6 cases (7.2%). Multiple linear regression analysis showed that MaGoon index, left ventricular end-diastolic volume index (LVEDI) and age at the time of operation were correlated with neuropsychological and intellectual development, while MaGoon index. There was a correlation between LVEDI and neuropsychological-motor development in children. The second part: among 142 children, 81 (57%) had normal nutrition, 58 (47%) were malnourished, 36 (25.4%) were low weight, 31 (21.8%) were wasting, 21 (14.8%) were stunted. The results of regression analysis showed that low birth weight and premature delivery were the main influencing factors of low birth weight. Low birth weight, premature delivery and cyanosis were the main factors influencing the weight loss of children, preterm birth and mother BMI18.5,. LVEDI20ml/m2 is the main factor affecting growth retardation in children. The third part: the average age of body weight (ZWA) () was 0.64 卤0.86vs-1.12 卤1.23 (1 year after radical mastectomy), and the average weight and height (Z) score was 0.56 卤1.02vs-1.03 卤1.05 (ZWH) (0.56 卤1.05). The average height age Z score (ZHA) () was 0.51 卤0.18vs-1.06 卤1.75). The incidence of low body weight, wasting and stunting was 11.5% and 10.1% respectively. Conclusion: 1. Children with tetralogy of Fallot had a certain degree of neuropsychological backwardness, and the risk of neuropsychological retardation decreased with the increase of MaGoon index and LVEDI in a certain range. The risk of neurodevelopmental retardation decreases with the age of surgery. 2. Malnutrition is common in infants with tetralogy of Fallot, which is associated with low birth weight, premature delivery, cyanosis and LVEDI20ml/m2. 3. The nutritional status of children with tetralogy of Fallot was improved after radical operation.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4

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