先天性心脏病患儿术后合并营养不良影响因素及其生存质量分析

Analysis on the influencing factors of postoperative malnutrition in children with congenital heart disease and the quality of life

目的评估先天性心脏病(CHD)患儿术后合并营养不良的发生率,分析其营养不良的影响因素及其对患儿术后生存质量的影响。方法选取2016年7月-2020年7月在北部战区总医院心外科、先心内科和儿科就诊且有既往心脏手术史的312例2~12岁患儿。评定研究对象是否合并营养不良,收集患儿一般资料分析其合并营养不良的影响因素。并采用中文版PedsQL^(TM)3.0心脏病模块量表和PedsQL4.0普适性核心量表评价CHD患儿术后的生存质量。结果1)CHD患儿术后合并营养不良发生率为17.9%。2)多因素Logistic回归分析结果显示年龄小、复杂型CHD、外科手术治疗、家庭经济收入低、家庭居住地为农村、父母学历为小学或初中为先天性心脏病患儿术后合并营养不良的独立危险因素(P<0.05)。3)营养不良组患儿心脏问题和症状、感知身体外貌、治疗焦虑和认知心理问题维度在PedsQL^(TM)3.0量表中的得分均低于无营养不良组(P<0.05)。2~4岁营养不良组患儿生理功能维度在PedsQL^(TM)4.0量表中的得分低于无营养不良组(P<0.05)。5~12岁营养不良组患儿PedsQL^(TM)4.0生存质量的4个亚量表及总分均低于无营养不良组(P<0.05)。结论CHD患儿术后发生营养不良的概率高,生存质量差,且受多种因素影响,应引起重视。

Objective To evaluate the incidence of postoperative malnutrition in children with congenital heart disease(CHD),and to analyze the influencing factors of malnutrition as well as its effect on postoperative quality of life.Methods From July 2016to July 2020,a total of 312children aged 2-12years with previous cardiac surgery were selected from the Department of Cardiac Surgery,Department of Primary Cardiology and Department of Pediatrics in the General Hospital of the Northern Theater Command.Whether the subjects had malnutrition or not was assessed,and the general data of the children were collected to analyze the influencing factors of malnutrition.The Chinese PedsQL^(TM)3.0Cardiology Module Scale and the PedsQL4.0Universal Core Scale were used to evaluate the postoperative quality of life of CHD children aged 2to 12years.Results 1)The incidence of postoperative malnutrition in CHD children was 17.9%.2)Multivariate Logistic regression analysis showed that the independent risk factors for postoperative malnutrition in CHD children included younger age,complex type of heart disease,surgical treatment,poor family economic status,family residence in rural areas,parents with primary or junior high school education(P<0.05).3)The scores of heart problems and symptoms,perceived physical appearance,treatment anxiety and cognitive psychological problems in the PedsQL^(TM)3.0 Scale in the malnutrition group were all lower than those in the non-malnutrition group(P<0.05).The score of physiological function of children aged 2to 4years in the PedsQL4.0Scale of malnutrition group was lower than that of the non-malnutrition group(P<0.05).The scores of four subscales and total scores of PedsQL4.0quality of life in children aged 5to 12years in the malnutrition group were lower than those in the non-malnutrition group(P<0.05).Conclusion Children with CHD have high probability of malnutrition and poor quality of life,which are affected by many factors,and should be paid more attention to.