Moore C, Chowdhury Z, Young J B
Dietary Service, Methodist Hospital, Houston, Texas.
J Heart Lung Transplant. 1991 Jan-Feb;10(1 Pt 1):50-5.
Cardiac cachexia and nutritional inadequacies have been cited as risk factors for poor outcome after heart transplantation. To evaluate the current status of nutritional support programs for heart transplant patients, we conducted a national survey of major transplant centers. Surveys were sent to 26 institutions, with 20 hospitals responding to the written questionnaire and providing samples of educational material from their nutrition programs. Although 80% of the hospitals surveyed included a dietitian as a member of the nutritional support team, dietitians participated in only 50% of the pretransplant teaching conferences. Nutritional status and care plans were discussed with patients and family members during the pretransplant conferences. At most centers (88%) nutritional status was assessed on a routine basis before the procedure. After transplantation, nutritional assessments were usually performed every 7 to 10 days. During the 2 to 4 weeks after surgery, the most common diets prescribed were low-fat, low-cholesterol diets that typically limited sodium intake. Thirty percent of the hospitals also restricted patients from eating fresh fruits and vegetables for 3 to 4 weeks after surgery, theoretically to minimize risk of certain infections. After patient discharge, most centers (68%) monitored nutritional status of patients during periodic clinic visits and yearly evaluations. This study demonstrated that nutritional management has become an important factor in the total medical care of the heart transplant patient. Findings of this survey were used to develop nutritional support program guidelines for heart transplant recipients at our institution. Further research is necessary before a standardized procedure for assessing and monitoring nutritional status of heart transplant patients can be developed.
心脏恶病质和营养不足被认为是心脏移植后预后不良的风险因素。为评估心脏移植患者营养支持项目的现状，我们对主要移植中心进行了一项全国性调查。调查问卷被发送至26家机构，20家医院回复了书面问卷并提供了其营养项目的教育材料样本。尽管80%接受调查的医院将营养师纳入营养支持团队成员，但营养师仅参与了50%的移植前教学会议。在移植前会议期间，会与患者及其家属讨论营养状况和护理计划。在大多数中心（88%），术前会定期评估营养状况。移植后，营养评估通常每7至10天进行一次。在术后2至4周内，最常规定的饮食是低脂、低胆固醇饮食，通常会限制钠的摄入量。30%的医院还在术后3至4周限制患者食用新鲜水果和蔬菜，理论上是为了将某些感染的风险降至最低。患者出院后，大多数中心（68%）在定期门诊就诊和年度评估期间监测患者的营养状况。这项研究表明，营养管理已成为心脏移植患者整体医疗护理中的一个重要因素。本次调查结果被用于制定我们机构心脏移植受者的营养支持项目指南。在制定评估和监测心脏移植患者营养状况的标准化程序之前，还需要进一步研究。
