Zaqout Mahmoud, Vandekerckhove Kristof, Michels Nathalie, Bove Thierry, François Katrien, De Wolf Daniel
Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
J Pediatr. 2017 Dec;191:125-132. doi: 10.1016/j.jpeds.2017.08.058. Epub 2017 Sep 28.
To determine whether children who underwent surgery for congenital heart disease (CHD) are as fit as their peers.
We studied 66 children (6-14 years) who underwent surgery for ventricular septal defect (n = 19), coarctation of aorta (n = 10), tetralogy of Fallot (n = 15), and transposition of great arteries (n = 22); and 520 healthy children (6-12 years). All children performed physical fitness tests: cardiorespiratory fitness, muscular strength, balance, flexibility, and speed. Metabolic score was assessed through z-score standardization using 4 components: waist circumference, blood pressure, blood lipids, and insulin resistance. Assessment also included self-reported and accelerometer-measured physical activity. Linear regression analyses with group (CHD vs control) as a predictor were adjusted for age, body mass index, physical activity, and parental education.
Measured physical activity level, body mass index, cardiorespiratory fitness, flexibility, and total metabolic score did not differ between children with CHD and controls, whereas reported physical activity was greater in the CHD group than control group. Boys with CHD were less strong in upper muscular strength, speed, and balance, whereas girls with CHD were better in lower muscular strength and worse in balance. High-density lipoprotein was greater in boys and girls with CHD, whereas boys with CHD showed unhealthier glucose homeostasis.
Appropriate physical fitness was achieved in children after surgery for CHD, especially in girls. Consequently, children with CHD were not at increased total metabolic risk. Lifestyle counseling should be part of every patient interaction.
确定接受先天性心脏病（CHD）手术的儿童是否与其同龄人健康状况相同。
我们研究了66名接受室间隔缺损手术（n = 19）、主动脉缩窄手术（n = 10）、法洛四联症手术（n = 15）和大动脉转位手术（n = 22）的6至14岁儿童，以及520名6至12岁的健康儿童。所有儿童均进行了体能测试：心肺功能、肌肉力量、平衡能力、柔韧性和速度。通过使用腰围、血压、血脂和胰岛素抵抗4个成分的z评分标准化来评估代谢评分。评估还包括自我报告和加速度计测量的身体活动。以组（CHD组与对照组）作为预测因子进行线性回归分析，并对年龄、体重指数、身体活动和父母教育程度进行了调整。
CHD患儿与对照组在实测身体活动水平、体重指数、心肺功能、柔韧性和总代谢评分方面没有差异，而CHD组自我报告的身体活动比对照组更多。患有CHD的男孩在上肢肌肉力量、速度和平衡方面较弱，而患有CHD的女孩在下肢肌肉力量方面较好，但平衡能力较差。患有CHD的男孩和女孩的高密度脂蛋白较高，而患有CHD的男孩血糖稳态情况较差。
CHD患儿术后体能良好，尤其是女孩。因此，CHD患儿的总代谢风险没有增加。生活方式咨询应成为每次医患互动的一部分。
