能量代谢车在术后早期合并严重左心功能不全患儿中的应用探索

Application of metabolic carts in early postoperative children with severe left heart failure

目的:探究严重左心功能不全患儿术后早期能量代谢特点及营养支持策略。方法:2022年1月至2024年1月中国医学科学院阜外医院小儿心脏中心PICU收治53例先天性冠状动脉畸形合并左心功能不全(射血分数<40%)手术患儿,其中男33例,女20例;年龄(61.54±58.37)个月;体重(22.70±19.58)kg;身高(105.89±41.27)cm;体重指数为13.93 kg/m^(2)。于术后4 h、第1天分别测定静息能量消耗(resting energy expenditure,REE),了解患儿术后REE变化规律。按是否根据REE给予营养支持分为REE组和常规营养支持组,比较两组患儿术后能量需求的异同及不同营养支持策略下的临床预后。使用配对t检验和秩和检验进行数据统计分析。结果:REE组患儿24例,常规营养组患儿29例,两组术前年龄、身高、体重、性别、营养状态评分差异无统计学意义;两组术前左室舒张末径及左室射血分数差异无统计学意义(P=0.088,P=0.935),两组术后均应用能量代谢车对REE进行监测,术后4 h及术后1 d的REE差异无明显统计学意义(P=0.510,P=0.212);术后机械通气时间常规营养组为(86.52±139.95)h,相较于REE组的(44.75±47.10)h,机械通气时间延长(P=0.041),ICU住院时间差异无统计学意义(P=0.852);术后并发症对比,常规营养支持组(6例)相较于REE组(0例)二次插管率高,差异具有统计学意义(P=0.021)。结论:严重左心功能不全患儿术后早期能量代谢较低,基于REE的营养支持策略可以减少机械通气时间,减少二次插管率。

Objective:To explore the characteristics of early postoperative energy metabolism and nutritional support strategies in children with severe left ventricular dysfunction.Methods:From January 2022 to January 2024,53 surgical children with congenital coronary artery malformation complicated with left ventricular dysfunction(ejection fraction<40%)were admitted into Pediatric Intensive Care Unit(PICU)of our Pediatric Heart Center.There were 33 boys and 20 girls with an average age of(61.54±58.37)months,an average weight of(22.70±19.58)kg,an average height of(105.89±41.27)cm and a body mass index(BMI)of 13.93 kg/m^(2).Resting energy expenditure(REE)was measured at 4h post-operation and Day 1 post-operation to record the postoperative changes in REE.They were divided into two groups of REE(n=24)and routine nutritional support(n=29)based upon whether or not nutritional support was provided according to REE measurements.The similarities and differences in postoperative energy requirements between two groups and clinical outcomes under different nutritional support strategies were compared.Statistical analysis of the data was performed by paired t and rank-sum tests.Results:No statistically significant inter-group differences existed in preoperative age,height,weight,gender or nutritional status scores.Additionally,there were no significant inter-group differences in preoperative left ventricular end-diastolic diameter or left ventricular ejection fraction(P=0.088,P=0.935).Both groups underwent postoperative REE monitoring with metabolic carts,and no statistically significant inter-group differences existed in REE at 4h and Day 1 post-operation(P=0.510,P=0.212).Duration of postoperative mechanical ventilation was significantly longer in routine nutrition group than that compared to REE group[(86.52±139.95)vs(44.75±47.10)h,P=0.041].However,no statistically significant inter-group difference existed in intensive care unit(ICU)length of stay(P=0.852).Regarding postoperative complications,routine nutrition support group had a higher rate of reintubation than REE group(n=6 vs n=0)and this difference was statistically significant(P=0.021).Conclusions:Energy metabolism of children with severe left ventricular dysfunction is low in an early postoperative stage.Nutritional support strategy based upon REE may shorten mechanical ventilation time and lower the rate of re-intubation.