Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperativ...Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperative feeding is comprised of three stages:feeding in the intensive care unit,feeding in the general ward and family feeding,in which the general ward is considered as the“transitional stage”.At present,there is little research on the optimal mode of feeding care for the transitional stage,and there is no universally recognized and accepted protocol.Methods:We retrospectively analyzed 114 CHD infants with PH who underwent family-centered(FC)feeding care from July 2017 to December 2018,and prospectively studied 122 CHD infants with the same baseline level who adopted the improved mode,nurse-parent-driven(NPD)feeding mode from January 2019 to June 2020.The feasibility and efficacy of NPD as a“transitional”feeding nursing mode in CHD infants with PH were compared with the FC cohort by observing and analyzing the stress of family caregivers,feedingrelated complications,the proportion of breastfeeding,improvement of nutritional status,acquisition of knowledge and skills of feeding care,inpatient’s satisfaction rating and prognosis.Results:When compared with the FC feeding care,the NPD mode significantly reduced the burden of family caregivers,improved the rate of feeding care knowledge and skills and inpatient’s satisfaction rating,reduced the incidence of improper feeding-related complications,and enhanced the proportion of breastfeeding and nutritional status of infants at the“transitional stage”(all P<0.05).The self-assessment score of care ability of family caregivers and weight gain of children in the NPD group were significantly higher than those in the FC group(all P<0.05)during the follow-up.Conclusions:As a transitional mode of feeding in CHD infants with PH,NPD feeding care is superior to the conventional FC mode,which therefore can be adopted as a standard protocol in clinical practice.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Respiratory syncytial virus (RSV) causes significant morbidit...<strong>Background:</strong><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Respiratory syncytial virus (RSV) causes significant morbidity and mortality in patients with a history of prematurity and congenital heart disease (CHD). In 2014, the guidelines for Palivizumab became more restrictive for this population. We hypothesized the percentage of RSV+ admissions would increase overall and in this target group (TG) specifically.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We conducted a retrospective review of patients under age 2 years admitted with bronchiolitis two seasons prior to the change (Pre) and two seasons after (Post). Our TG included patients who were eligible prior to the 2014 changes but currently no longer eligible. We used chi-square analysis to answer the two main hypotheses: 1</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> Percent RSV+/total bronchiolitis Pre vs Post and 2</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> Percent of TG/RSV+ Pre vs Post.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 1283 patients (546 pre, 737 post) were admitted with the diagnosis of RSV between 2012-2016, 866 actually tested positive for RSV (367 Pre, 499 Post). There was no significant difference in the number of total patients admitted with RSV (Pre = 67.2%, Post = 67.7%) or in our TG (Pre 7.1% vs Post 8.2%). TG overall had a more complicated course: longer length of stay, median 5 days, IQR 2</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">12 vs 3 days, IQR 1</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">5, (p < 0.001), intensive care unit admissions (36% vs 22.8%, p = 0.02), positive pressure ventilation (25.4% vs 15.4%, p = 0.03) and intubation (16.4% vs 6.8%, p = 0.004)</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">but there was no difference Pre vs Post.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The TG had an overall higher acuity</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">but there was no increase in the number of patients hospitalized with RSV or severity as a result of the Palivizumab guideline changes.</span>展开更多
Background Acute renal failure (ARF) is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk...Background Acute renal failure (ARF) is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% (n = 36). High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [(21.73 ± 7.28) days vs (7.41 ± 3.76) days], P 0. 001] and mortality (27.8% vs 7.5%, P 0. 001) between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.展开更多
Background: Congenital heart disease (CHD) is the most common congenital malformations with high mortality and morbidity. The prevalence of CHD reported previously ranged from 4 per 1000 live births to 50 per 1000 ...Background: Congenital heart disease (CHD) is the most common congenital malformations with high mortality and morbidity. The prevalence of CHD reported previously ranged from 4 per 1000 live births to 50 per 1000 live births. In this cross-sectional study, we aimed to document the prevalence of CHD in Langfang district of Hebei Province, China by analyzing data collected by hospitals located in 11 the counties of the district, as supported by a public health campaign. Methods: A total of 67,718 consecutive 3-month-old infants were included from July 19,2012 to July 18, 2014. Structural abnormalities were diagnosed based on echocardiography findings, including two-dimensional and color Doppler echocardiography results. Results: Of the 67,718 infants, 1554 were found to have cardiac structural abnormalities. The total prevalence of CHD was 22.9 per 1000 live births, a value significantly higher than the previously reported prevalence of 8 cases per 1000 live births. The top five most common cardiac abnormalities were as follows: atrial septal defect (ASD, 605 cases, 8.93‰); ventricular septal defect (550 cases, 8.12‰); patent ductus arteriosus (228 cases, 3.37‰); pulmonary stenosis (66 cases, 0.97‰); and tetralogy of Fallot (32 cases, 0.47‰). The CHD prevalence differed by gender in this study (x^2 = 23.498, P 〈 0.001), and the majority of ASD cases were females. Regional differences in prevalence were also found (x^2 = 24.602, P 〈 0.001); a higher prevalence was found in urban areas (32.2 cases per 1000 live births) than in rural areas (21. 1 cases per 1000 live births). There was a significant difference in the prevalence of CHD in preterm versus full-term infants (x^2 - 133.443, P 〈 0.001 ). Prevalence of CHD in infants of maternal aged 35 years or over was significantly higher (x^2 86.917, P 〈 0.001). Conclusions: The prevalence of CHD in Langfang district was within the range reported using echocardiography. Echocardiography can be used to early diagnose the CHD.展开更多
Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestation...Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.展开更多
Background The survival rate of preterm infants with critical congenital heart disease (P-CCHD) has been improved by medicine advances. The aims of this study were to investigate the contemporary treatments for shor...Background The survival rate of preterm infants with critical congenital heart disease (P-CCHD) has been improved by medicine advances. The aims of this study were to investigate the contemporary treatments for short-term outcomes of P-CCHD and to evaluate risk factors associated with the outcomes. Methods Sixty-four P-CCHD patients admitted to Guangdong General Hospital between 2011 and 2015 were included in this study. De-mographic characteristics and patient records were reviewed. Logistic regression was used to analyze the risk fac-tors of P-CCHD outcome. Results Thirty-six patients underwent surgical treatments for cardiac anomalies. Moreover, 31.25% of the P-CCHD infants did not receive surgery because these parents refused further treat-ment. The in-hospital mortality rate was 8.3% for the patients who underwent surgeries. During a median follow-up of 1.2 years, the survivors were basically healthy. However, mental and physical growth retardation remained. Conclusions Compared to infants in developed Western countries, the treatments and short-term outcomes of P-CCHD infants were satisfactory. However, the long-term outcomes remain to be determined.展开更多
Background Currently it remains controversial whether intensive control of glucose is required for pediatric hyperglycemia. Few studies are available on the blood glucose control for the infants receiving congenital h...Background Currently it remains controversial whether intensive control of glucose is required for pediatric hyperglycemia. Few studies are available on the blood glucose control for the infants receiving congenital heart disease operation. However, there are no uniform standards to control hyperglycemmia after congenital heart disease operation. In this study, we determined the ranges and methods of postoperative blood glycemic control in infants with congenital heart disease. Methods Eighty-two infants younger than 6 months of age, who underwent correction of congenital heart disease in our hospital from 06/01/2014 to 06/01/2015, participated in this study. All patients were randomly divided into two groups: group A (insulin control group) and groupB (non-insulin control group). Each group was randomly divided into three subgroups (A1-A3.B1-B3). Children in group A were treated using the glycemic control therapy with insulin. Children in group B received a glycemic control therapy without insulin. Femoral vein blood was drew in 72 hours after the operation to check WBC, CRP, lactate, ALT and Cr. The duration of ICU, incidence of lung infection, hypoglycemia and mortality were recorded. Results The differences of Cr ALT, WBC and CRP indexes were statistically significant (P 〈 0.05) in A and B subgroups, but not between the A and B groups (P 〉 0.05). The ICU stay time of group A2 and B2 was less than that of other groups, but the difference was not statistically significant (P 〉 0.05). The incidence of pulmonary infection and hypoglycemia in 2 groups was lower than that in A1 and A3 group. The incidence of complications in group B2 was lower than that in B1 group and B3 group, but there was no significant difference (P 〉 0.05). There was no significant difference between the A and B groups (P 〉 0.05). Conclusions Hyperglycemia can increase postoperative pulmonary infection. Aggressive control of blood glucose does not improve patient outcomes, but increases the incidence of hypoglycemia.展开更多
Background It remains controversial whether intensive control of glucose is required for pediatric hyperglycemia and no consensus has been reached on the threshold for blood glucose control for perioperative pediatric...Background It remains controversial whether intensive control of glucose is required for pediatric hyperglycemia and no consensus has been reached on the threshold for blood glucose control for perioperative pediatric patients. Few studies have been available on the blood glucose control for the infants receiving congenital heart disease operation. So far, there are no uniform standards to control hyperglycemmia after congenital heart disease operation. In this paper, we determined the ranges and methods of postoperative blood glycemic control in infants with congenital heart disease. Methods Eighty-two infants under 6 months of age, who underwent correction of congenital heart disease in our hospital from 06/01/2014 to 06/01/2015, participated in this study. All patients were randomly divided into two groups according to random number table method: group A (insulin control group) and group B (non-insulin control group). Each group was furhter divided into three subgroups (A1-A3, B1- B3). Children in group A were treated using the glycemic control therapy with insulin. Children in group B received a glycemic control therapy without insulin. Femoral vein blood was drew in 72 hours after the operation to check WBC, CRP, lactate, ALT and Cr. The duration of ICU, incidence of lung infection, incidence of hypogly- cemia, and mortality were measured and computed. Results The differences of Cr, ALT, WBC and CRP index between A and B subgroups were statistically significant (P 〈 0.05). There were no significant differences in ALT, Cr, WBC and CRP levels between the A and B groups (P 〉 0.05). The stay time of ICU in group A2 was significantly less than that in A1 or A3 group. ICU stay time was significantly less in group B2 than in B1 or B3 group. The incidence of pulmonary infection and hypoglycemia in 2 groups were lower than those in A1 and A3 group. There was no significant difference (P 〉 0.05) in the incidence of complications in B subgroups and between the two groups. Conclusions High blood sugar can increase postoperative pulmonary infection. Aggressive control of blood sugar does not improve patient outcomes, but increases the incidence of hypoglycemia.展开更多
基金This work was supported by the Science and Technology Project of Science and Technology Bureau of Wenzhou(Y20170467)the Science and Technology Project of Medical and Health of Zhejiang Province(2017RC021)+1 种基金Key Discipline Program of Pediatric Surgery of Health Bureau of Zhejiang Province(No.11-ZC27)Research Center for diagnosis and treatment of cardiac and vascular disease of Zhejiang,China(JBZX-202001).
文摘Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperative feeding is comprised of three stages:feeding in the intensive care unit,feeding in the general ward and family feeding,in which the general ward is considered as the“transitional stage”.At present,there is little research on the optimal mode of feeding care for the transitional stage,and there is no universally recognized and accepted protocol.Methods:We retrospectively analyzed 114 CHD infants with PH who underwent family-centered(FC)feeding care from July 2017 to December 2018,and prospectively studied 122 CHD infants with the same baseline level who adopted the improved mode,nurse-parent-driven(NPD)feeding mode from January 2019 to June 2020.The feasibility and efficacy of NPD as a“transitional”feeding nursing mode in CHD infants with PH were compared with the FC cohort by observing and analyzing the stress of family caregivers,feedingrelated complications,the proportion of breastfeeding,improvement of nutritional status,acquisition of knowledge and skills of feeding care,inpatient’s satisfaction rating and prognosis.Results:When compared with the FC feeding care,the NPD mode significantly reduced the burden of family caregivers,improved the rate of feeding care knowledge and skills and inpatient’s satisfaction rating,reduced the incidence of improper feeding-related complications,and enhanced the proportion of breastfeeding and nutritional status of infants at the“transitional stage”(all P<0.05).The self-assessment score of care ability of family caregivers and weight gain of children in the NPD group were significantly higher than those in the FC group(all P<0.05)during the follow-up.Conclusions:As a transitional mode of feeding in CHD infants with PH,NPD feeding care is superior to the conventional FC mode,which therefore can be adopted as a standard protocol in clinical practice.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Respiratory syncytial virus (RSV) causes significant morbidity and mortality in patients with a history of prematurity and congenital heart disease (CHD). In 2014, the guidelines for Palivizumab became more restrictive for this population. We hypothesized the percentage of RSV+ admissions would increase overall and in this target group (TG) specifically.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We conducted a retrospective review of patients under age 2 years admitted with bronchiolitis two seasons prior to the change (Pre) and two seasons after (Post). Our TG included patients who were eligible prior to the 2014 changes but currently no longer eligible. We used chi-square analysis to answer the two main hypotheses: 1</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> Percent RSV+/total bronchiolitis Pre vs Post and 2</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> Percent of TG/RSV+ Pre vs Post.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 1283 patients (546 pre, 737 post) were admitted with the diagnosis of RSV between 2012-2016, 866 actually tested positive for RSV (367 Pre, 499 Post). There was no significant difference in the number of total patients admitted with RSV (Pre = 67.2%, Post = 67.7%) or in our TG (Pre 7.1% vs Post 8.2%). TG overall had a more complicated course: longer length of stay, median 5 days, IQR 2</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">12 vs 3 days, IQR 1</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">5, (p < 0.001), intensive care unit admissions (36% vs 22.8%, p = 0.02), positive pressure ventilation (25.4% vs 15.4%, p = 0.03) and intubation (16.4% vs 6.8%, p = 0.004)</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">but there was no difference Pre vs Post.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The TG had an overall higher acuity</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">but there was no increase in the number of patients hospitalized with RSV or severity as a result of the Palivizumab guideline changes.</span>
基金supported by Key Projects in the National Science & Technology Pillar Program in the Eleventh Five-year Plan Period, China, (2006BA101A08)
文摘Background Acute renal failure (ARF) is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% (n = 36). High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [(21.73 ± 7.28) days vs (7.41 ± 3.76) days], P 0. 001] and mortality (27.8% vs 7.5%, P 0. 001) between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.
文摘Background: Congenital heart disease (CHD) is the most common congenital malformations with high mortality and morbidity. The prevalence of CHD reported previously ranged from 4 per 1000 live births to 50 per 1000 live births. In this cross-sectional study, we aimed to document the prevalence of CHD in Langfang district of Hebei Province, China by analyzing data collected by hospitals located in 11 the counties of the district, as supported by a public health campaign. Methods: A total of 67,718 consecutive 3-month-old infants were included from July 19,2012 to July 18, 2014. Structural abnormalities were diagnosed based on echocardiography findings, including two-dimensional and color Doppler echocardiography results. Results: Of the 67,718 infants, 1554 were found to have cardiac structural abnormalities. The total prevalence of CHD was 22.9 per 1000 live births, a value significantly higher than the previously reported prevalence of 8 cases per 1000 live births. The top five most common cardiac abnormalities were as follows: atrial septal defect (ASD, 605 cases, 8.93‰); ventricular septal defect (550 cases, 8.12‰); patent ductus arteriosus (228 cases, 3.37‰); pulmonary stenosis (66 cases, 0.97‰); and tetralogy of Fallot (32 cases, 0.47‰). The CHD prevalence differed by gender in this study (x^2 = 23.498, P 〈 0.001), and the majority of ASD cases were females. Regional differences in prevalence were also found (x^2 = 24.602, P 〈 0.001); a higher prevalence was found in urban areas (32.2 cases per 1000 live births) than in rural areas (21. 1 cases per 1000 live births). There was a significant difference in the prevalence of CHD in preterm versus full-term infants (x^2 - 133.443, P 〈 0.001 ). Prevalence of CHD in infants of maternal aged 35 years or over was significantly higher (x^2 86.917, P 〈 0.001). Conclusions: The prevalence of CHD in Langfang district was within the range reported using echocardiography. Echocardiography can be used to early diagnose the CHD.
文摘Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.
基金supported by the National Natural Science Foundation of China(No.8167060825)
文摘Background The survival rate of preterm infants with critical congenital heart disease (P-CCHD) has been improved by medicine advances. The aims of this study were to investigate the contemporary treatments for short-term outcomes of P-CCHD and to evaluate risk factors associated with the outcomes. Methods Sixty-four P-CCHD patients admitted to Guangdong General Hospital between 2011 and 2015 were included in this study. De-mographic characteristics and patient records were reviewed. Logistic regression was used to analyze the risk fac-tors of P-CCHD outcome. Results Thirty-six patients underwent surgical treatments for cardiac anomalies. Moreover, 31.25% of the P-CCHD infants did not receive surgery because these parents refused further treat-ment. The in-hospital mortality rate was 8.3% for the patients who underwent surgeries. During a median follow-up of 1.2 years, the survivors were basically healthy. However, mental and physical growth retardation remained. Conclusions Compared to infants in developed Western countries, the treatments and short-term outcomes of P-CCHD infants were satisfactory. However, the long-term outcomes remain to be determined.
基金supported by National Science&Technology Support Program during the Twelfth Fiveyear Plan Period(No.2011BAI11B22)
文摘Background Currently it remains controversial whether intensive control of glucose is required for pediatric hyperglycemia. Few studies are available on the blood glucose control for the infants receiving congenital heart disease operation. However, there are no uniform standards to control hyperglycemmia after congenital heart disease operation. In this study, we determined the ranges and methods of postoperative blood glycemic control in infants with congenital heart disease. Methods Eighty-two infants younger than 6 months of age, who underwent correction of congenital heart disease in our hospital from 06/01/2014 to 06/01/2015, participated in this study. All patients were randomly divided into two groups: group A (insulin control group) and groupB (non-insulin control group). Each group was randomly divided into three subgroups (A1-A3.B1-B3). Children in group A were treated using the glycemic control therapy with insulin. Children in group B received a glycemic control therapy without insulin. Femoral vein blood was drew in 72 hours after the operation to check WBC, CRP, lactate, ALT and Cr. The duration of ICU, incidence of lung infection, hypoglycemia and mortality were recorded. Results The differences of Cr ALT, WBC and CRP indexes were statistically significant (P 〈 0.05) in A and B subgroups, but not between the A and B groups (P 〉 0.05). The ICU stay time of group A2 and B2 was less than that of other groups, but the difference was not statistically significant (P 〉 0.05). The incidence of pulmonary infection and hypoglycemia in 2 groups was lower than that in A1 and A3 group. The incidence of complications in group B2 was lower than that in B1 group and B3 group, but there was no significant difference (P 〉 0.05). There was no significant difference between the A and B groups (P 〉 0.05). Conclusions Hyperglycemia can increase postoperative pulmonary infection. Aggressive control of blood glucose does not improve patient outcomes, but increases the incidence of hypoglycemia.
基金supported by National Science&Technology Support Program during the Twelfth Five-year Plan Period(No.2011BAI11B22)
文摘Background It remains controversial whether intensive control of glucose is required for pediatric hyperglycemia and no consensus has been reached on the threshold for blood glucose control for perioperative pediatric patients. Few studies have been available on the blood glucose control for the infants receiving congenital heart disease operation. So far, there are no uniform standards to control hyperglycemmia after congenital heart disease operation. In this paper, we determined the ranges and methods of postoperative blood glycemic control in infants with congenital heart disease. Methods Eighty-two infants under 6 months of age, who underwent correction of congenital heart disease in our hospital from 06/01/2014 to 06/01/2015, participated in this study. All patients were randomly divided into two groups according to random number table method: group A (insulin control group) and group B (non-insulin control group). Each group was furhter divided into three subgroups (A1-A3, B1- B3). Children in group A were treated using the glycemic control therapy with insulin. Children in group B received a glycemic control therapy without insulin. Femoral vein blood was drew in 72 hours after the operation to check WBC, CRP, lactate, ALT and Cr. The duration of ICU, incidence of lung infection, incidence of hypogly- cemia, and mortality were measured and computed. Results The differences of Cr, ALT, WBC and CRP index between A and B subgroups were statistically significant (P 〈 0.05). There were no significant differences in ALT, Cr, WBC and CRP levels between the A and B groups (P 〉 0.05). The stay time of ICU in group A2 was significantly less than that in A1 or A3 group. ICU stay time was significantly less in group B2 than in B1 or B3 group. The incidence of pulmonary infection and hypoglycemia in 2 groups were lower than those in A1 and A3 group. There was no significant difference (P 〉 0.05) in the incidence of complications in B subgroups and between the two groups. Conclusions High blood sugar can increase postoperative pulmonary infection. Aggressive control of blood sugar does not improve patient outcomes, but increases the incidence of hypoglycemia.