儿童先天性心脏病术后静脉-动脉体外膜肺氧合治疗期间营养干预策略探讨

Nutritional intervention strategies during veno-arterial extracorporeal membrane oxygenation therapy for children with congenital heart disease after surgery

目的探讨不同营养干预策略对先天性心脏病术后行静脉-动脉体外膜肺氧合(VA-ECMO)治疗患儿临床结局的影响。方法回顾性分析2015年1月至2021年1月在广东省人民医院行先天性心脏病手术并接受VA-ECMO治疗的58例患儿的临床资料。根据营养干预策略将患儿分为肠内营养(EN)组15例,肠外营养(PN)组33例和混合营养(EN+PN)组10例;根据EN干预时机分为早期EN组9例和晚期EN组16例。主要结局为住院死亡率,次要结局为住ICU时间、总住院时间、新发感染及消化道并发症发生率。比较不同营养干预策略及EN干预时机的临床结局。结果EN组、EN+PN组和PN组的住院死亡率、住ICU时间、总住院时间、新发感染率比较差异均无统计学意义(P>0.05),三组消化道并发症发生率比较差异有统计学意义(P<0.05)。早期EN组和晚期EN组的住院死亡率、住ICU时间、总住院时间、新发感染率以及消化道并发症发生率比较差异均无统计学意义(P>0.05)。结论EN或EN+PN增加消化道并发症,不增加住院死亡率、住ICU时间、总住院时间及新发感染率。EN启动时机对临床结局无影响。

Objective To explore the effects of different nutritional intervention strategies on the clinical outcomes of pediatric patients treated with veno-arterial extracorporeal membrane oxygenation(VA-ECMO)after surgery for congenital heart disease.Methods The clinical data of pediatric patients who underwent surgery for congenital heart disease and received VA-ECMO treatment in Guangdong Provincial People′s Hospital from January 2015 to January 2021 were retrospectively analyzed.According to different nutritional intervention strategies,the pediatric patients were divided into enteral nutrition(EN)group(15 cases),parenteral nutrition(PN)group(33 cases)and mixed nutrition(EN+PN)group(10 cases),and were divided into early EN group(9 cases)and late EN group(16 cases)according to the timing of EN.The primary outcome was in-hospital mortality,while the secondary outcomes were the length of stay in intensive care unit(ICU),total length of stay in hospital,incidence rates of new infections and gastrointestinal complications.The clinical outcomes of the pediatric patients with different nutritional intervention strategies and different timing of EN were compared.Results There were no significant differences in the in-hospital mortality,length of stay in ICU,total length of stay in hospital and incidence rate of new infections among the EN group,the EN+PN group and the PN group(P>0.05),while there were significant differences in the incidence rates of gastrointestinal complications among the three groups(P<0.05).There were no significant differences in the in-hospital mortality,length of stay in ICU,total length of stay in hospital and incidence rates of new infections and gastrointestinal complications between the early EN group and the late EN group(P>0.05).Conclusion EN or EN+PN increases gastrointestinal complications,but does not increase in-hospital mortality,length of stay in ICU,total length of stay in hospital and incidence rate of new infections.The timing of EN initiation has no effect on clinical outcomes.