PDF(1455 KB)
高能量密度配方奶喂养室间隔缺损并重症肺炎患儿的有效性研究
黄娇甜, 卢秀兰, 肖政辉, 臧平, 龚玲, 周武, 黄鹏
中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (10) : 998-1004.
PDF(1455 KB)
PDF(1455 KB)
高能量密度配方奶喂养室间隔缺损并重症肺炎患儿的有效性研究
Clinical effect of feeding with calorie-enriched formula in children with ventricular septal defect and severe pneumonia
目的 通过评价不同能量喂养对先天性心脏病合并重症肺炎患儿的营养状态、临床经过及转归情况的影响，为制定先天性心脏病患儿的营养管理策略提供临床依据。方法 纳入2017年1月1日至12月30日诊断为"室间隔缺损合并重症肺炎"并行外科手术治疗，且术前合并营养不良的6个月以下婴儿43例为研究对象，随机分为观察组（n=21）和对照组（n=22），观察组术后以高能量密度配方奶（100 kcal/100 mL）进行喂养，对照组术后以普通热量配方奶（67 kcal/100 mL）进行喂养。通过连续观察两组患儿3个月，记录体格测量结果、实验室指标、营养风险筛查结果等，并对患儿进行营养状态评估，同时对两组的预后及不良反应进行比较分析。结果 两组患儿入院时体格测量结果、实验室指标、营养评估及营养风险筛查结果比较差异均无统计学意义（P > 0.05）。对照组出院时、术后1个月及术后3个月，营养不良程度及营养风险等级均高于观察组（P < 0.05）。重复测量方差分析结果显示体重、上臂围、年龄别体重Z值、年龄别身高Z值、身高别体重Z值及白蛋白水平均存在时间因素及分组因素差异，且分组因素与时间因素均有交互作用（P < 0.05）。观察组住院期间平均每日摄入液体量低于对照组，而平均每日摄入能量高于对照组，喂养不足发生率低于对照组（P < 0.05）。观察组住院时间、机械通气时间、术后发热时间及住院费用均较对照组明显减少（P < 0.05），两组患儿均无明显不良反应。结论 适当增加先天性心脏病患儿术后的热量供应可以改善患儿的营养不良状况及临床转归。
Objective To study the effect of different energy feeding patterns on the nutritional status, clinical course, and outcome of children with congenital heart disease (CHD) and severe pneumonia. Methods A total of 43 malnourished infants, aged <6 months, who were diagnosed with ventricular septal defect and severe pneumonia and underwent surgical operation from January 1 to December 30, 2017 were enrolled. They were randomly divided into an observation group with 21 infants and a control group with 22 infants. The infants in the observation group were given calorie-enriched formula milk powder (100 kcal/100 mL) after surgery, and those in the control group were given formula milk powder with normal calories (67 kcal/100 mL). The two groups were observed for 3 months to record physical measurements, laboratory markers and nutritional risk screening results. Nutritional status was evaluated for all infants. The two groups were compared in terms of prognosis and adverse events. Results There were no significant differences between the two groups in physical measurements, laboratory markers, nutritional assessment and nutritional risk screening results on admission (P > 0.05). At discharge and 1 and 3 months after surgery, the control group had significantly higher degree of malnutrition and level of nutritional risk than the observation group (P < 0.05). The analysis of variance with repeated measures showed significant differences in body weight, upper arm circumference, weight-forage Z-score, height-for-age Z-score, weight-for-height Z-score, and albumin level at different time points and between different groups, and there was an interaction between group factors and time factors (P < 0.05). Compared with the control group, the observation group had a significantly lower average daily intake of fluid, a significantly higher average daily intake of energy, and a significantly lower incidence rate of insufficient feeding during hospitalization (P < 0.05). Compared with the control group, the observation group had significantly shorter length of hospital stay, duration of mechanical ventilation, and duration of postoperative pyrexia, as well as significantly lower hospital costs (P < 0.05). No significant adverse reactions were observed in either group. Conclusions An appropriate increase in postoperative energy supply for children with CHD can improve the status of malnutrition and clinical outcome.
先天性心脏病 / 重症肺炎 / 营养不良 / 高能量密度配方奶 / 婴儿
Congenital heart disease / Severe pneumonia / Malnutrition / Calorie-enriched formula / Infant
[1] GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries:a systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet Infect Dis, 2017, 17(11):1133-1161.
[2] Arodiwen I, Chinawa J, Ujunwa F, et al. Nutritional status of congenital heart disease (CHD) patients:burden and determinant of malnutrition at university of Nigeria teaching hospital Ituku-Ozalla, Enugu[J]. Pak J Med Sci, 2015, 31(5):1140-1145.
[3] Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease:a challenge in children[J]. Curr Opin Cardiol, 2013, 28(2):122-129.
[4] 中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(2013修订)[J].中华儿科杂志, 2013, 51(10):745-752.
[5] de Onis M, Onyango A, Borghi E, et al. Worldwide implementation of the WHO Child Growth Standards[J]. Public Health Nutr, 2012, 15(9):1603-1610.
[6] 乔俊英,郭菲菲,李凡,等.危重患儿营养评估及营养风险筛查工具的临床应用[J].中国当代儿科杂志, 2019, 21(6):528-533.
[7] Hulst JM, Zwart H, Hop WC, et al. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children[J]. Clin Nutr, 2010, 29(1):106-111.
[8] 陈昌辉,李茂军,张熔,等.婴幼儿腹泻病的诊断和治疗[J].现代临床医学, 2011, 37(5):35-38.
[9] 张良娟,王宝西.儿童功能性便秘相关检查的研究进展[J].临床儿科杂志, 2014, 32(6):587-590.
[10] Kuzma-O'Reilly B, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition[J]. Pediatrics, 2003, 111(4 Pt 2):e461-e470.
[11] 钱素云,纪健,祝益民.静息能量测定在儿童危重患者中的应用[J].中国小儿急救医学, 2015, 22(2):73-76.
[12] De Wit B, Meyer R, Desai A, et al. Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease[J]. Pediatr Crit Care Med, 2010, 11(4):496-501.
[13] Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition:a paradigm shift toward etiology-related definitions[J]. JPEN J Parenter Enterai Nutr, 2013, 37(4):460-481.
[14] Nicholson GT, Clabby ML, Kanter KR, et al. Caloric intake during the perioperative period and growth failure in infants with congenital heart disease[J]. Pediatr Cardiol, 2013, 34(2):316-321.
[15] Radman M, Mack R, Barnoya J, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR)[J]. J Thorac Cardiovasc Surg, 2014, 147(1):442-450.
[16] Fitria L, Caesa P, Joe J, et al. Did malnutrition affect postoperative somatic growth in pediatric patients undergoing surgical procedures for congenital heart disease?[J]. Pediatr Cardiol, 2019, 40(2):431-436.
[17] Toole BJ, Toole LE, Kyle UG, et al. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease[J]. Congenit Heart Dis, 2014, 9(1):15-25.
[18] Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease:a challenge in children[J]. Curr Opin Cardiol, 2013, 28(2):122-129.
[19] Hulst JM, Zwart H, Hop WC, et al. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children[J]. Clin Nutr, 2010, 29(1):106-111.
[20] Blasquez A, Clouzeau H, Fayon M, et al. Evaluation of nutritional status and support in children with congenital heart disease[J]. Eur J Clin Nutr, 2016, 70(4):528-531.
[21] Medoff-Copper B, Ravishankar C. Nutrition and growth in congenital heart disease:a challenge in children[J]. Curr Opin Cardiol, 2013, 28(2):122-129.
[22] Monteiro FP, de Araujo TL, Lopes MV, et al. Nutritional status of children with congenital heart disease[J]. Rev Lat Am Enfermagem, 2012, 20(6):1024-1032.
[23] 彭颖妮.营养护理应用于先天性心脏病患儿围手术期的效果分析[J].临床医学工程, 2014, 21(11):1483-1484.
[24] El-Koofy N, Mahmoud AM, Fattouh AM. Nutritional rehabilitation for children with congenital heart disease with left to right shunt[J]. Turk J Pediatr, 2017, 59(4):442-451.
[25] 张晓伟,李增宁,赵丽华,等.营养支持小组对先天性心脏病手术患儿临床结局的影响[J].中华临床营养杂志, 2014, 22(4):231-233.
[26] Newcombe J, Fry-Bowers E. a post-operative feeding protocol to improve outcomes for neonates with critical congenital heart disease[J]. J Pediatr Nurs, 2017, 35:139-143.
[27] 邹红梅,吴玫瑰,赵晖,等.两种早产儿配方奶对早产儿营养发育的影响及安全性评估[J].中国妇幼保健, 2015, 30(18):2954-2957.
[28] 李彩梅,丁晓春.个体化喂养在极低/超低出生体重儿中的应用观察[J].中华临床医师杂志(电子版), 2015, 9(11):2243-2246.
[29] 崔彦芹,李莉娟,周娜,等.高热量配方奶粉对先天性心脏病合并营养不良婴儿术后生长追赶的影响[J].中华临床营养杂志, 2017, 3(25):176-182.
湖南省卫生计生委科研计划课题项目（C2017051）；儿童急救医学湖南省重点实验室（2018TP1028）；湖南省儿童医院“1233”人才工程培养项目。
