先天性心脏病患儿术前营养不良对术后住院预后的影响

Effect of preoperative malnutrition on prognosis of postoperative hospitalization in children with congenital heart disease

目的旨在探索先天性心脏病外科手术患儿术前营养状况与术后预后之间的关系。方法回顾性分析2019年1-4月,在该院接受先天性心脏病外科手术的0~5岁患儿的临床资料。营养状态是根据世界卫生组织(WHO)儿童生长标准,使用年龄别体重z值(WAZ)来确定的。WAZ≤-2的儿童定义为营养不良。预后指标包括住院死亡率、医院感染、机械通气时间、重症监护时间、术后住院时间和术后需要联合使用血管活性药物。对两组有差异的术前自变量,进行倾向性评分匹配(PSM)。进行多因素logistic回归分析,调整年龄、体外循环时间、主动脉阻断时间和先天性心脏病手术风险调整评分(RACHS-1)等危险因素,验证术前营养不良对术后住院时间的影响。结果共有430例先天性心脏病患儿纳入本研究。最常见的心脏畸形是室间隔缺损(54.4%)、房间隔缺损(8.1%)和法洛四联症(7.4%)。155例患儿(36.0%)存在术前营养不良。PSM前,营养不良组患儿术后机械通气时间、重症监护时间、住院时间明显较非营养不良组延长,术后24 h联用血管活性药物的占比更高,差异有统计学意义(P<0.05),但死亡率和医院感染率两组差异无统计学意义(P>0.05)。PSM后,营养不良组术后重症监护时间和术后住院时间较非营养不良组延长,差异有统计学意义(P<0.05)。在多因素logistic回归分析中,营养不良组患儿术后住院时间延长的风险明显增加(校正OR=2.18,95%CI:1.08~4.42,P=0.03)。结论先天性心脏病外科手术患儿术前营养不良与术后重症监护时间和术后住院时间延长有关,是术后住院时间延长的独立危险因素。

Objective To explore the association between preoperative nutritional status and postoperative prognosis in children with congenital heart disease.Methods The clinical data of children aged 0-5 years old who underwent congenital heart surgery at the hospital from 2019 January to April were retrospective analyzed.Nutritional status was determined using z-score of weight-for-age(WAZ),based on the World Health Organization(WHO)child growth standards.Children with weight for age z score(WAZ)≤2 were considered malnourished.Outcome measures included in-hospital mortality,hospital infection,duration of mechanical ventilation,duration of intensive care unit(ICU),length of hospital stay(LOS),and the combination of vasoactive agents post-operatively.Propensity Score Matching(PSM)was performed for preoperative covariates with different data between the two groups.Multivariable logistic regression analysis was performed to examine the impact of malnutrition on postoperative LOS,adjusting for age,cardiopulmonary bypass time,aortic cross-clamp time,and risk adjustment for congenital heart surgery(RACHS-1)score.Results A total of 430 children with congenital heart disease were included in the study.The most common cardiac lesions were ventricular septal defect(54.4%),atrial septal defect(8.1%),and tetralogy of Fallot(7.4%).A total of 155 pa-tients(36%)were malnourished on admission.Before PSM,the duration of mechanical ventilation,ICU LOS,hospital LOS in the malnutrition group were significantly longer than those in the non-malnutrition group,and the rate of combined use of vasoactive drugs after surgery was higher,with statistically significant differences(P<0.05),but there were no statistically significant differences in mortality and hospital infection rate between the two groups.After PSM,the ICU LOS and hospital LOS in the malnutrition group were longer than those in the non-malnutrition group,and the difference was statistically significant(P<0.05).In multivariable analysis,the risk of prolonged postoperative hospital stay was significantly increased in the malnutrition group[adjusted odds ratio(OR)=2.18,95%CI:1.08-4.42,P=0.03].Conclusion Preoperative WAZ≤-2 is associated with prolonged postoperative ICU LOS and hospital LOS,and is an independent risk factor of prolonged hospital LOS.