Nutrition Services, Alberta Health Services, Stollery Children's Hospital, Edmonton, Canada.
Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
Nutr Clin Pract. 2018 Jun;33(3):397-403. doi: 10.1177/0884533617712502. Epub 2017 Dec 14.
Pediatric heart failure is a complex disease occurring when cardiac output is unable to meet the metabolic demands of the body. With improved surgical interventions and medical therapies, survival rates have improved, and care has shifted from focusing on survival to optimizing quality of life and health outcomes. Based on current literature, this review addresses the nutrition needs of infants and children in heart failure and describes the pathophysiology and metabolic implications of this disease. The prevalence of wasting in pediatric heart failure has been reported to be as high as 86%, highlighting the importance of nutrition assessment through all stages of treatment to provide appropriate intake of energy, protein, and micronutrients. The etiology of malnutrition in pediatric heart failure is multifactorial and involves hypermetabolism, decreased intake, increased nutrient losses, inefficient utilization of nutrients, and malabsorption. Children in heart failure often present with tachypnea, tachycardia, fatigue, nausea, and vomiting and consequently may not be able to meet their nutrition requirements through oral intake alone. Nutrition support, including enteral nutrition and parenteral nutrition, should be considered an essential part of routine care. The involvement of multiple allied health professionals may be needed to create a feeding therapy plan to support patients and their families. With appropriate nutrition interventions, clinical outcomes and quality of life can be significantly improved.
儿科心力衰竭是一种复杂的疾病，当心脏输出量无法满足身体的代谢需求时就会发生这种疾病。随着外科干预和医疗治疗的改善，存活率有所提高，治疗重点也从关注生存转移到优化生活质量和健康结果。基于目前的文献，这篇综述探讨了心力衰竭患儿的营养需求，并描述了这种疾病的病理生理学和代谢影响。据报道，儿科心力衰竭患者中出现消瘦的比例高达 86%，这突出表明在治疗的所有阶段都需要进行营养评估，以提供适当的能量、蛋白质和微量营养素摄入。儿科心力衰竭患者营养不良的病因是多因素的，涉及代谢亢进、摄入减少、营养物质丢失增加、营养物质利用效率降低和吸收不良。心力衰竭患儿常表现为呼吸急促、心动过速、疲劳、恶心和呕吐，因此可能无法仅通过口服摄入来满足其营养需求。营养支持，包括肠内营养和肠外营养，应被视为常规护理的重要组成部分。可能需要多个相关专业医疗人员的参与，以制定喂养治疗计划，为患者及其家属提供支持。通过适当的营养干预，可以显著改善临床结果和生活质量。
