Clinical Physiology Research Laboratory, Capital Institute of Pediatrics, Beijing, China.
Cardiac Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangdong Province, China.
JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):54-62. doi: 10.1002/jpen.1314. Epub 2018 Aug 2.
Congenital heart disease (CHD) is 1 of the most common congenital malformations, and considerable numbers of infants and young children with CHD undergo cardiopulmonary bypass surgery. It has been increasingly realized that perioperative nutrition support plays an important role in improving clinical outcomes. The purpose of this review, by searching PubMed, was to examine the nutrition conditions in perioperative children with CHD and the main problems in nutrition management in the cardiac intensive care unit (CICU), based on which future directions were proposed. We found that preoperative poor nutrition status is common. This limited reserve of energy and protein is further compounded by the complex metabolic alterations with hypermetabolism, hypercatabolism, and hypoanabolism in the early postoperative course. Knowledge about energy and protein metabolism and requirements in children after cardiopulmonary bypass remains very limited. The current nutrition recommendations in the CICU are based on little evidence. Insufficient energy and protein supply to meet demands remains a norm in the immediate postoperative period. The commonly used predictive equations do not provide accurate estimate of energy requirement in individual patients during the highly dynamic postoperative course. Indirect calorimetry can provide the best estimate of energy requirements for children with CHD in the CICU. Measurement of nitrogen balance is the recommended method to determine the minimal protein requirement. During the early postoperative period, daily measurements of resting energy expenditure using indirect calorimetry and nitrogen balance in each individual child are essential to optimize energy and protein supply to meet requirements.
先天性心脏病（CHD）是最常见的先天性畸形之一，相当数量的患有 CHD 的婴儿和幼儿需要接受心肺旁路手术。人们越来越意识到围手术期营养支持对改善临床结果起着重要作用。本文通过检索 PubMed，旨在探讨围手术期 CHD 患儿的营养状况和心脏重症监护病房（CICU）营养管理中的主要问题，并提出未来的研究方向。我们发现术前营养状况差很常见。这种能量和蛋白质储备有限，再加上术后早期出现的代谢异常，如高代谢、高分解代谢和低合成代谢，进一步加重了这种情况。关于体外循环后儿童的能量和蛋白质代谢及需求的知识仍然非常有限。CICU 中的营养推荐主要基于有限的证据。在术后早期，能量和蛋白质的供给不足以满足需求仍然是一种常态。常用的预测方程并不能准确估计个体患者在高度动态的术后过程中的能量需求。间接测热法可提供 CICU 中 CHD 患儿能量需求的最佳估计。氮平衡的测量是确定最小蛋白质需求的推荐方法。在术后早期，使用间接测热法和氮平衡对每个患儿进行每日静息能量消耗测量，对于优化能量和蛋白质供给以满足需求至关重要。
