心脏手术后婴儿早期的高能量喂养：一项随机对照试验。
Early high-energy feeding in infants following cardiac surgery: a randomized controlled trial.
作者信息
Chen Xi, Zhang Mingjie, Song Yixiao, Luo Yiwen, Wang Liping, Xu Zhuoming, Bao Nan
机构信息
Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Transl Pediatr. 2021 Oct;10(10):2439-2448. doi: 10.21037/tp-21-360.
BACKGROUND
Effective nutrition programs are beneficial for nutritional recovery in infants. Few studies have focused on the effect of early high-energy feeding after open heart surgery. This study sought to assess the effects of early high-energy feeding in infants after congenital heart surgery.
METHODS
Patients at a tertiary pediatric cardiology center who underwent open heart surgery between July 2016 and July 2018 were recruited and randomly allocated to 1 of the following 2 groups: (I) the intervention group (postoperative early high-energy feeding; n=124); and (II) the control group (no intervention; n=120).The primary endpoints of average energy delivery and growth Z-scores [i.e., weight-for-height Z-score (WHZ), weight-for-age Z-score (WAZ), and height-for-age Z-score (HAZ)] were recorded preoperatively, during the intensive care unit (ICU) stay, at discharge, and at 1 and 3 months postoperatively. The secondary endpoints of malnutrition recovery, ventilator support time, infection rate, and cardiac ICU (CICU) stay were also recorded.
RESULTS
A total of 244 infants were included in the study. There were no significant differences in the baseline features between the 2 groups. The intervention group received higher calories on average than the control group (44.5 34.7; P<0.001). At discharge from the ICU, the WHZ (-2.29 -2.76; P<0.001) and WAZ (-3.08 -3.43; P=0.005) of patients in the intervention group were higher than those of patients in the control group. Ventilator support time (P=0.004), CICU stay (P=0.045), and infection rate (P=0.001) were significantly lower in the intervention group than the control group. At 3 months post-surgery, the intervention group exhibited a higher malnutrition recovery rate than the control group (19.4% 6.5%; P=0.002).
CONCLUSIONS
The administration of early high-energy feeding to infants after congenital heart surgery is associated with improved growth, reduced CICU stay, decreased ventilator support time, and reduced postoperative infection rates.
TRIAL REGISTRATION
ClinicalTrials NCT04609358.
背景
有效的营养方案对婴儿的营养恢复有益。很少有研究关注心脏直视手术后早期高能量喂养的效果。本研究旨在评估先天性心脏病手术后早期高能量喂养对婴儿的影响。
方法
招募2016年7月至2018年7月在一家三级儿科心脏病中心接受心脏直视手术的患者，并随机分为以下2组之一：（I）干预组（术后早期高能量喂养；n = 124）；（II）对照组（无干预；n = 120）。术前、重症监护病房（ICU）住院期间、出院时以及术后1个月和3个月记录平均能量供应和生长Z评分[即身高体重Z评分（WHZ）、年龄体重Z评分（WAZ）和年龄身高Z评分（HAZ）]等主要终点指标。还记录了营养不良恢复、呼吸机支持时间、感染率和心脏重症监护病房（CICU）住院时间等次要终点指标。
结果
本研究共纳入244例婴儿。两组的基线特征无显著差异。干预组平均摄入的热量高于对照组（44.5对34.7；P<0.001）。在从ICU出院时，干预组患者的WHZ（-2.29对-2.76；P<0.001）和WAZ（-3.08对-3.43；P = 0.005）高于对照组患者。干预组的呼吸机支持时间（P = 0.004）、CICU住院时间（P = 0.045）和感染率（P = 0.001）显著低于对照组。术后3个月，干预组的营养不良恢复率高于对照组（19.4%对6.5%；P = 0.002）。
结论
先天性心脏病手术后对婴儿进行早期高能量喂养与生长改善、CICU住院时间缩短、呼吸机支持时间减少以及术后感染率降低有关。
试验注册
ClinicalTrials NCT04609358。
Zotero 插件