全腔静脉—肺动脉连接术后单心室患儿营养状况及其危险因素分析

doi:10.3969/j.issn.1674-8115.2018.10.018

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (10): 1233-.doi: 10.3969/j.issn.1674-8115.2018.10.018

全腔静脉—肺动脉连接术后单心室患儿营养状况及其危险因素分析

孙崇蕊，张明杰，徐卓明

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

出版日期:2018-10-28 发布日期:2018-11-18
通讯作者: 徐卓明，电子信箱：zmxyfb@163.com。
作者简介:孙崇蕊（1989—），女，硕士生；电子信箱： sunchongrui09@163.com。

Nutritional status and risk factors for malnutrition in children with single ventricle physiology after total cavopulmonary connection

SUN Chong-rui, ZHANG Ming-jie, XU Zhuo-ming

Department of Cardiac and Thoracic Surgery, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Online:2018-10-28 Published:2018-11-18

摘要/Abstract

摘要： 目的 ·评估全腔静脉 -肺动脉连接术（ total cavopulmonary connection，TCPC）（又称 Fontan术）后患儿的营养状况并分析该类患儿营养不良（低体质量、生长迟缓、消瘦）的临床危险因素。方法 ·回顾性分析 2012年 1月—2015年 12月于上海交通大学医学院附属上海儿童医学中心行 Fontan术的 314例单心室患儿的临床资料。采用 WHO Z评分评估 Fontan术后患儿远期随访时的营养状况，并将患儿分为低体质量组和非低体质量组、生长迟缓组和非生长迟缓组、消瘦组和非消瘦组。通过单因素和多因素 Logistic回归分析，研究患儿 Fontan术后远期营养不良的危险因素。结果 · Fontan术后远期随访时，低体质量患儿占 11.9%，生长迟缓占 17.8%，消瘦占 16.9%。多因素 Logistic 回归分析显示， Fontan 术前营养不良、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是 Fontan 术后患儿低体质量的危险因素（ P0.008，P0.000，P0.025，P0.001）；Fontan 术前营养不良、平均肺动脉压力高、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是 Fontan 术后患儿生长迟缓的危险因素（ P0.001，P0.046，P0.000，P0.019， P0.004）；Fontan 术前营养不良、平均肺动脉压力高、心功能分级高、中度或重度房室瓣反流、利尿剂应用时间长是 Fontan 术后患儿消瘦的危险因素（ P0.019，P0.018，P0.015，P0.026，P0.000）。结论 ·单心室患儿 Fontan术后远期随访时营养不良的比例较高。患儿 Fontan术前营养不良、心功能分级高、肺动脉压力高、利尿剂应用时间长和中度或重度房室瓣反流可能与 Fontan术后营养不良相关。

关键词: 单心室, 全腔静脉 -肺动脉连接术, 营养不良, 危险因素

Abstract:

Objective · To analyse nutritional status of children underwent total cavopulmonary connection (TCPC) also called Fontan procedure, furthermore to investigate risk factors related to malnutrition including underweight, stunting, and thinness. Methods · Clinical data of 314 children underwent Fontan procedure in Shanghai Children′s Medical Center Jan. 2012 to Dec. 2015 were reviewed. WHO Z score was used to evaluate nutritional status of the children underwent Fontan procedure at the time of long-term follow-up. According to the nutritional status, children were divided into underweight and no-underweight groups, stunting and no-stunting groups, thinness and no-thinness groups. Univariate and multivariate Logistic regression analysis were used to detect risk factors for malnutrition in the children after Fontan procedure. Results · In the follow-up survey after Fontan procedure, the proportion of underweight, stunted and thin children were 11.9%, 17.8%, and 16.9%, respectively. Multivariate Logistic regression analysis showed that preoperative malnutrition, worse cardiac function, moderate or severe atrioventricular valve regurgitation and long time of diuretics were the risk factors for underweight in the children after Fontan procedure (P0.008, P0.000, P0.025, P0.001); preoperative malnutrition, elevated mean pulmonary artery pressure, worse cardiac function, moderate or severe atrioventricular valve regurgitation and long time of diuretics were the risk factors for stunting in the children after Fontan procedure (P0.001, P0.046, P0.000, P0.019, P0.004); preoperative malnutrition, elevated mean pulmonary artery pressure, worse cardiac function, moderate or severe atrioventricular valve regurgitation and long time of diuretics were the risk factors for thinness in the children after Fontan procedure (P0.019, P0.018, P0.015, P0.026, P0.000). Conclusion · Malnutrition is still remained during follow-up period in the children with single ventricle physiology after Fontan procedure. Preoperative malnutrition, worse cardiac function, elevated pulmonary artery pressure, long time of diuretics and moderate or severe atrioventricular valve regurgitation may be associated with malnutrition after Fontan procedure.

Key words: single-ventricle, total cavopulmonary connection (TCPC), malnutrition, risk factor

中图分类号:

R725.4

孙崇蕊，张明杰，徐卓明. 全腔静脉—肺动脉连接术后单心室患儿营养状况及其危险因素分析[J]. 上海交通大学学报（医学版）, 2018, 38(10): 1233-.

SUN Chong-rui, ZHANG Ming-jie, XU Zhuo-ming. Nutritional status and risk factors for malnutrition in children with single ventricle physiology after total cavopulmonary connection[J]. , 2018, 38(10): 1233-.

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全腔静脉—肺动脉连接术后单心室患儿营养状况及其危险因素分析

Nutritional status and risk factors for malnutrition in children with single ventricle physiology after total cavopulmonary connection

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