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

Effect of energy-enriched formula for catch-up growth in malnourished infants after congenital heart disease surgery

目的 探讨高热量配方奶粉对先天性心脏病合并营养不良的婴儿术后生长追赶的有效性及耐受性.方法 纳入2014年12月1日至2015年5月30日在广州市妇女儿童医疗中心诊断为＆quot;先天性心脏病：室间隔缺损＆quot;并营养不良行外科手术治疗的6个月以下婴儿,按1：1比例随机分为高热量配方奶粉组（试验组）及普通热量配方奶粉组（对照组）,并对其进行肠内营养干预,连续观察3个月.观察指标包括术前、出ICU时、出院时、术后1个月、术后3个月5个时间点的体质量、身长、上臂围、血前白蛋白（PA）、视黄醇结合蛋白（RBP）、氨基端B型脑钠肽前体（NT-proBNP）,对比两组患儿各个时间点、各个指标间的差异.同时对比两组不同配方奶粉出现的不良反应.结果 试验组51例、对照组50例,两组术前体质量、身长、上臂围、PA、RBP、平均肠内营养开始时间、机械通气时间、ICU停留时间、住院时间、平均液体摄入量差异均无统计学意义（P均〉0.05）,但试验组的平均摄入热量显著高于对照组[（437.24±6.68）kJ比（312.43±86.22）kJ,P〈0.001],差异有统计学意义.两组患儿各不同时间点NT-proBNP、PA及RBP的变化差异无统计学意义（P均〉0.05）.试验组术后1个月营养改善比例（25.0％比4.9％,P=0.011）和3个月时营养改善的比例（64.1％比15.7％,P〈0.001）均明显高于对照组,差异有统计学意义.试验组出院时体质量较术前增长[（0.067±0.348）kg],而对照组体质量则较术前减少[（0.125±0.425）kg],两组比较差异有统计学意义（P=0.015）.术后1个月试验组体质量[（5.46±1.36）kg比（4.80±1.01）kg,P=0.008]、年龄别体质量Z值（WAZ）（-2.79±1.28比-3.75±1.27,P〈0.001）、身高别体质量Z值（WHZ）（-2.47±1.43比-3.62±1.77,P=0.001）均高于对照组.术后3个月时两组患儿体质量[（6.78±1.42）kg比（5.72±1.01）kg,P〈0.001]、上臂围[（12.80±1.17）cm比（12.00±0.90）cm,P〈0.001]、WAZ（-1.60±1.17比-3.10±1.40,P〈0.001）、年龄别身高Z值（HAZ）（-1.41±1.63比-2.10±1.41,P=0.034）、WHZ（-0.86±1.31比-2.59±2.13,P〈0.001）均较术前有增长,而试验组增长速率快于对照组.两组患儿均无明显不良反应.结论 高热量配方奶粉有助于先天性心脏病合并营养不良患儿术后生长追赶.

Objective To investigate the efficacy and safety of enriched-calorie formula in post-operative infants with congenital heart disease and malnutrition.Methods All malnourished infants less than 6 months diagnosed ＆quot;congenital heart disease： ventricular septal defect＆quot; and had undergone surgery in Guangzhou Women and Childrens Medical Center from December 1,2014 to May 30,2015 were included in this study.All cases were randomly divided into intervention group（energy-enriched formula,intervention group）and control group（standard formula,control group）for enteral nutrition intervention and observed for 3 months.Body mass,body length,upper arm circumference,blood prealbumin（PA）,retinol binding protein（RBP）,and B-terminal pro-brain natriuretic peptide（NT-proBNP）were measured before and after ICU,after discharge,and 1 month and 3 months after operation.Results Fifty-one cases were in intervention group and 50 cases in control group,respectively.There were no significant differences in body mass,body length,arm circumference,PA,RBP,mean enteral nutrition starting time,mechanical ventilation time,length of ICU stay,hospitalization time,and average fluid intake between the two groups（all P〉0.05）.The average caloric intake in intervention group was significantly higher than in control group [（437.24±6.68）kJ vs.（312.43±86.22）kJ,P=0.001].There was no significant difference in NT-proBNP,PA,and RBP at different time points between the two groups（all P〉0.05）.The improvement of nutrition in intervention group was significantly higher than that in control group at 1 month（25.0%vs.4.9%,P=0.011）and 3 months（64.1%vs.15.7%,P〈0.001）after operation.Body mass increased in intervention group [（0.067±0.348）kg] compared with that in control group,and decreased [（0.125±0.425）kg] in control group（P=0.015）.Body weight[（5.46±1.36）kg vs.（4.80±1.01）kg,P=0.008],weight for age Z score（WAZ）（-2.79±1.28 vs.-3.75±1.27,P〈0.001）,and height for weight Z score（WHZ）（-2.47±1.43 vs.-3.62±1.77,P=0.001）one month after surgery were significantly higher than those before operation.Body weight [（6.78±1.42）kg vs.（5.72±1.01）kg,P〈0.001] arm circumference [（12.80±1.17）cm vs.（12.00±0.90）cm,P〈0.001],WAZ（-1.60±1.17 vs.-3.10±1.40,P〈0.001）,height for age Z score（HAZ）（-1.41±1.63 vs.-2.10±1.41,P=0.034）,and WHZ（-0.86±1.31 vs.-2.59±2.13,P〈0.001）of the two groups at 3 months postoperative were significantly higher than those before operation,and the growth rate of intervention group was faster than control group.There were no significant adverse reactions in both groups.Conclusion Calorie-enriched formula powder can help malnourished infants to catch up after congenital heart disease surgery.