先天性心脏病患儿术后1年的营养和健康状况变化调查

Analysis of nutritional status and quality of life in infants with congenital heart disease in 1 year after surgery

目的通过对先天性心脏病(简称先心病)术后患儿连续随访1年,了解婴儿期进行先心病手术患儿的生长轨迹及持续营养不良和临床事件的发生率。方法研究为前瞻性队列研究。纳入2018年1月至2019年1月广州医科大学附属妇女儿童医疗中心收治的年龄1岁以下、诊断为先心病且行手术治疗患儿为研究对象。分析患儿年龄、性别、出生体重及身长、父母身高及体重基本资料,并通过问卷调查的方式随访患儿术后1年的临床事件发生的情况以及家属对患儿健康的自评情况。术后1年的年龄别体重Z评分(weight for age Z score,WAZ)≤-2定义为营养不良,WAZ>-2定义为非营养不良。结果502例患儿中,男性301例、女性201例,入组年龄4.1(2.0,6.8)个月。简单先心病占64.7%,复杂先心病占35.3%。患儿术前普遍处于轻度营养不良状态(WAZ<-1和>-2),术后3个月、6个月时呈快速生长追赶状态,至术后1年趋于平缓,但均未能达到正常水平。患儿在术后1年各个随访时间点营养不良的发生率均呈逐渐下降趋势。术前营养不良发生率为47.0%,术后1个月时稍有下降,术后3个月、6个月时明显下降,术后1年时下降至17.9%。出院后患上呼吸道感染的患儿较多(74.5%),其次为肺炎和腹泻(分别为41.2%和36.7%),出现呕吐及便秘的患儿较少(22.1%)。家长自评孩子健康状况方面,术前约32.0%的家人认为孩子健康状况差,术后1年内,该比例逐渐下降至6.9%。结论先心病患儿术后1年呈持续生长追赶,营养状况逐渐改善,但术后1年时仍有部分患儿存在营养不良。

Objective To study the growth trajectory and the incidence of malnutrition and clinical events in infants with congenital heart disease in 1 year after surgery.Methods Children at the age of 1 year or younger who were diagnosed with congenital heart disease and underwent surgery at Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University from January 2018 to January 2019 were included.The age,gender,birth weight and length,and parental height and weight were collected,and the occurrence of clinical events of interest and the children's health as evaluated by caregiver within 1 year after surgery were followed up through questionnaire survey.Malnutrition was defined as a weight-for-age z-score(WAZ)≤-2 at 1 year after surgery and a WAZ>-2 was defined as non-malnourished.Results Among the 502 children,301 were boys and 201 were girls,aged 4.1(range:2.0 to 6.8)months,of whom 64.7%were with simple congenital heart disease and 35.3%complex congenital heart disease.The children were generally with mild malnutrition(WAZ<-1 and>-2)before surgery.At 3 months and 6 months after surgery,the children showed a rapid growth catch-up,although failing to reach the normal level,and the trend plateaued at 1 year after surgery.The proportion of children with malnutrition decreased gradually within 1 year after surgery.47.0%of included children had malnutrition before surgery,and the proportion decreased significantly at 3 months and 6 months,to 17.9%at 1 year after surgery.After discharge,these children suffered from upper respiratory infection most commonly(74.5%),followed by pneumonia(41.2%)and diarrhea(36.7%),and vomiting and constipation(22.1%).In terms of children's health status as evaluated by parents,about 32.0%of families considered their children in poor health before surgery,and the proportion decreased to 6.9%within 1 year after surgery.Conclusion Infants with congenital heart disease continued to grow and catch up within 1 year after surgery,showing significantly improved nutrition status,but some children still experienced malnutrition at 1 year after surgery.