婴儿先天性心脏病患儿术后肠内营养支持的回顾性分析

Retrospective analysis of postoperative enteral nutrition support in infants with congenital heart disease

目的描述婴儿先天性心脏病患者术后能量摄入及喂养现状。方法回顾性队列研究,研究对象为2014年1-12月在复旦大学附属儿科医院心血管中心接受治疗且满足纳入标准的婴儿先天性心脏病患儿。研究工具为研究人员基于文献资料与专家意见自主设计的"先天性心脏病患儿术后营养支持调查表"。结果本研究共纳入149例患儿,患儿平均月龄为2.0(0.9~4.0)月,出生平均体质量为3 700.0(3 000.0~4 875.0)g,术前平均体质量为4 400.0(3 470.0~5 500.0)g。先心术后患儿启动肠内营养时间为72.0(48.0~95.3)h。患儿术后1~7d能量摄入分别为192.5(150.3~252.4)kJ/(kg·d)、169.5(141.5~204.3)kJ/(kg·d)、177.9(147.3~204.7)kJ/(kg·d)、191.7(156.1~231.9kJ/(kg·d)、200.5(170.4~251.6)kJ/(kg·d)、230.2(189.2~284.6)kJ/(kg·d)和237.8(194.6~293.0)kJ/(kg·d)。术后肠内营养支持期间,共45名患儿发生喂养中断,喂养过程中9名患儿发生胃肠道不良反应。监护室滞留期间,仅有28.9%患儿体质量增长,40.3%患儿体质量下降,30.8%患儿体质量无改变。结论婴儿先天性心脏病患者术后较少出现喂养不耐受现象,能量摄入逐步增加,但术后早期能量摄入仍旧偏低且患儿体重不增,患儿肠内营养启动时间较晚,因此医护人员仍需积极探索合理的营养支持方式改善患儿营养状态。

Objective To describe the status of nutrition support in children with congenital heart disease.Methods Children with congenital heart disease in a cardiac intensive care unit from January to December 2014 were selected.The research tool was the "postoperative nutritional support questionnaire for children with congenital heart disease",which was designed independently by the researchers based on the literature and expert opinion.Results 149 children were admitted in this study.The average age of children was 2.0(0.9~4.0)m,the average birth weight was 3700.0(3000.0~4875.0)g,the average preoperative weight was 4400.0(3470.0~5500.0)g.Time starting enteral nutrition was 72.0(48.0~95.3)h.The 1st-7th energy intake of children after operation were 192.6(150.3~252.4)kJ/(kg·d)、169.5(141.5~204.3)kJ/(kg·d)、177.9(147.3~204.7)kJ/(kg·d)、191.7(156.1~231.9kJ/(kg·d)、200.4(170.4~251.6)kJ/(kg·d)、230.2(189.2~284.6)kJ/(kg·d)和237.8(194.6~293.0)kJ/(kg·d).45 of children had interruption of feeding and 9of them had feeding intolerance.40.3% of the children had weight loss,and 30.8% of the children had no weight change.Only 28.9%children gained weight during guardianship period.Conclusions Few children with congenital heart disease had feeding intolerance.Children had low energy intake after operation and cannot gain weight.In addition,Time starting enteral nutrition was late compared to other studies.So we need to find a better protocol for these children.