Toole Benjamin J, Toole Lindsay E, Kyle Ursula G, Cabrera Antonio G, Orellana Renán A, Coss-Bu Jorge A
Division of Cardiology and Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine, Houston, Tex, USA.
Congenit Heart Dis. 2014 Jan-Feb;9(1):15-25. doi: 10.1111/chd.12064. Epub 2013 Apr 22.
To assess the effect of nutritional status and cardiovascular risk on hospital outcomes after congenital heart surgery in infants and children.
Retrospective study.
Cardiac intensive care unit in a tertiary-care children's hospital.
One hundred twenty-one patients <24 months of age admitted to the cardiovascular intensive care unit (CVICU) for >48 hours following cardiac surgery.
Demographics, Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), Paediatric Index of Mortality 2, and Pediatric Risk of Mortality III scores were obtained on admission. CVICU nutritional intake was calculated for 7 days. Energy and protein needs were estimated using recommended guidelines. Risk Adjustment for Congenital Heart Surgery-1 was categorized as (1-3) or (4-6). Malnutrition was categorized by Waterlow criteria and correlated with mortality risk, days of mechanical ventilation, and hospital and CVICU length of stay.
Ninety-one patients who underwent cardiac surgery were categorized as RACHS-1 (1-3) and RACHS-1 scores of (4-6) (n = 30). Patients with RACHS-1 (4-6) had higher mortality risk by Pediatric Risk of Mortality III (4.9% vs. 2.6%, P < .01), longer CVICU (10.4 days vs. 4.8 days) and hospital stays (28 days vs.14 days), and more days of mechanical ventilation (4 days vs. 2 days) (all P < .005) than RACHS-1 (1-3). The prevalences of acute protein-energy malnutrition and chronic protein-energy malnutrition were 51.2% and 40.5%. The median hospital stay for mild, moderate, and severe chronic protein-energy malnutrition was 31, 10, and 22.5 days, respectively, vs. normal, 15 days (Kruskal-Wallis, P < .005). The average energy and protein requirements met on day 7 were 68 ± 27(SD)% and 68 ± 40%, respectively.
Although nearly half of the patients were malnourished at surgery, only two-thirds of their recommended caloric and protein requirements were provided by week 1. To improve hospital outcomes, care should be taken to optimize the nutritional condition of infants and children prior to and following surgical correction of congenital heart disease to improve hospital outcomes.
评估营养状况和心血管风险对婴幼儿先天性心脏病手术后住院结局的影响。
回顾性研究。
一家三级儿童专科医院的心脏重症监护病房。
121例年龄小于24个月的患者，心脏手术后在心血管重症监护病房（CVICU）住院超过48小时。
入院时获取人口统计学资料、先天性心脏病手术风险调整-1（RACHS-1）、儿童死亡率指数2和儿童死亡风险III评分。计算CVICU 7天的营养摄入量。根据推荐指南估算能量和蛋白质需求。将先天性心脏病手术风险调整-1分为（1-3）或（4-6）。根据沃特洛标准对营养不良进行分类，并与死亡风险、机械通气天数以及住院和CVICU住院时间相关联。
91例行心脏手术的患者被分类为RACHS-1（1-3），30例为RACHS-1评分（4-6）。RACHS-1（4-6）的患者儿童死亡风险III更高（4.9%对2.6%，P＜0.01），CVICU住院时间更长（10.4天对4.8天）和住院时间更长（28天对14天），机械通气天数更多（4天对2天）（所有P＜0.005）。急性蛋白质-能量营养不良和慢性蛋白质-能量营养不良的患病率分别为51.2%和40.5%。轻度、中度和重度慢性蛋白质-能量营养不良的中位住院时间分别为31天、10天和22.5天，而正常为15天（Kruskal-Wallis检验，P＜0.005）。第7天满足的平均能量和蛋白质需求分别为68±27（标准差）%和68±40%。
尽管近一半的患者在手术时营养不良，但到第1周时仅提供了三分之二的推荐热量和蛋白质需求。为改善住院结局，应注意在先天性心脏病手术矫正前后优化婴幼儿的营养状况，以改善住院结局。
