發(fā)布時(shí)間：2018-04-23 06:41

  本文選題：先天性心臟病 + 兒童　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:前瞻性研究先天性心臟病患兒的術(shù)前營(yíng)養(yǎng)狀況,并對(duì)其術(shù)后臨床結(jié)局進(jìn)行分析,尋求手術(shù)前后營(yíng)養(yǎng)水平的變化特點(diǎn),以期提供患兒的營(yíng)養(yǎng)支持依據(jù),有的放矢地進(jìn)行營(yíng)養(yǎng)支持治療,以改善患兒的臨床結(jié)局。方法:1病例選擇:2013年1月~2016年12月在邢臺(tái)市人民醫(yī)院、邢臺(tái)市第三醫(yī)院住院的0~6歲先天性心臟病且行手術(shù)治療的患兒。2評(píng)價(jià)方法:根據(jù)年齡、身高、體重等指標(biāo),應(yīng)用Z評(píng)分法對(duì)患兒進(jìn)行術(shù)前營(yíng)養(yǎng)評(píng)價(jià),評(píng)價(jià)計(jì)算指標(biāo)包括年齡別身長(zhǎng)Z評(píng)分(Height for Age,HAZ)、年齡別體重Z評(píng)分(Weight for Age,WAZ)和身高別體重Z評(píng)分(Weight for Height,WHZ)。根據(jù)不同指標(biāo)評(píng)價(jià)的營(yíng)養(yǎng)不良定義:年齡別體重Z評(píng)分(WAZ)-2定義為低體重,身高別體重Z評(píng)分(WHZ)-2定義為消瘦,年齡別身高Z評(píng)分(HAZ)-2定義為生長(zhǎng)遲緩。低體重或消瘦中的任一項(xiàng)判定為存在急性營(yíng)養(yǎng)不良(Acute Malnutrition,AM),以生長(zhǎng)遲緩判定為存在慢性營(yíng)養(yǎng)不良(Chronic Malnutrition,CM)。3觀察指標(biāo):3.1體格測(cè)量指標(biāo):身高、體重、頭圍。3.2血液指標(biāo)測(cè)定:包括手術(shù)前后的血清白蛋白(Alb)、血紅蛋白(Hb)、淋巴細(xì)胞總數(shù)(TLC)。3.3臨床結(jié)局指標(biāo):住院時(shí)間、住院費(fèi)用及并發(fā)癥發(fā)生情況。結(jié)果:符合入組標(biāo)準(zhǔn)的病例共130例,其中男51例,女79例。年齡為5個(gè)月~6歲。(1)以WAZ評(píng)分進(jìn)行營(yíng)養(yǎng)狀況評(píng)價(jià):低體重組34例,占26.15%,正常體重組96例,占73.85%。兩組患兒術(shù)前體重存在有顯著性差異(P0.01),但年齡、身高、頭圍、血清白蛋白、血紅蛋白、淋巴細(xì)胞總數(shù)則無明顯差異(P0.05);兩組患兒術(shù)后血清白蛋白、血紅蛋白、淋巴細(xì)胞總數(shù)均無顯著性差異(P0.05),住院時(shí)間和住院費(fèi)用也無顯著性差異(p0.05),而低體重組發(fā)生3例并發(fā)癥,其中1例壓瘡,2例肺部感染,正常體重組未發(fā)生并發(fā)癥,兩組并發(fā)癥發(fā)生率存在明顯差異(p0.05)。(2)以whz評(píng)分進(jìn)行營(yíng)養(yǎng)狀況評(píng)價(jià):消瘦組32例,占24.62%,正常組98例,占75.38%。消瘦組患兒術(shù)前的年齡、身高、體重均明顯低于正常組(p0.05),而頭圍、血清白蛋白、血紅蛋白、淋巴細(xì)胞總數(shù)在兩組間則無顯著差別(p0.05);兩組患兒術(shù)后的血清白蛋白、血紅蛋白、淋巴細(xì)胞總數(shù)均無顯著性差異(p0.05);兩組患兒住院時(shí)間和住院費(fèi)用均無顯著性差異(p0.05),而消瘦組發(fā)生3例并發(fā)癥,其中1例壓瘡,2例肺部感染,正常組未發(fā)生并發(fā)癥,兩組間并發(fā)癥發(fā)生率存在顯著性差異(p0.05)。(3)以haz評(píng)分進(jìn)行營(yíng)養(yǎng)狀況評(píng)價(jià):生長(zhǎng)遲緩組29例,占22.31%,生長(zhǎng)正常組101例,占77.69%。生長(zhǎng)遲緩組患兒術(shù)前的年齡、身高、體重、頭圍明顯低于生長(zhǎng)正常組(p0.05),而血清白蛋白、血紅蛋白、淋巴細(xì)胞總數(shù)在兩組間則無顯著性差異(p0.05);兩組患兒術(shù)后血清白蛋白水平無顯著性差異(p0.05),而生長(zhǎng)遲緩組血紅蛋白和淋巴細(xì)胞總數(shù)顯著低于生長(zhǎng)正常組(p0.05),兩組患兒住院時(shí)間和住院費(fèi)用均無顯著性差異(p0.05),而生長(zhǎng)遲緩組發(fā)生2例肺部感染,生長(zhǎng)正常組發(fā)生1例壓瘡,兩組間并發(fā)癥發(fā)生率存在顯著性差異(p0.05)。(4)不同類型營(yíng)養(yǎng)不良在不同性別患兒發(fā)病情況比較:130例先天性心臟病患兒中32例存在急性營(yíng)養(yǎng)不良,其中男孩12例,發(fā)病率為23.53%,女孩20例,發(fā)病率為25.32%,男孩和女孩急性營(yíng)養(yǎng)不良的發(fā)病率無顯著性差異(p0.05);130例先天性心臟病患兒中29例存在慢性營(yíng)養(yǎng)不良,其中男孩17例,發(fā)病率為33.33%,女孩12例,發(fā)病率為15.19%,男孩慢性營(yíng)養(yǎng)不良的發(fā)病率明顯高于女孩(p0.01)。結(jié)論:1通過z評(píng)分對(duì)先天性心臟病患兒術(shù)前的營(yíng)養(yǎng)狀況進(jìn)行評(píng)價(jià),研究發(fā)現(xiàn)先心病患兒存在不同程度的營(yíng)養(yǎng)不良,低體重、消瘦和生長(zhǎng)遲緩的發(fā)生率分別為26.15%、24.62%和22.31%。2先心病主要影響了患兒的體格發(fā)育,而對(duì)內(nèi)臟、肌肉以及免疫功能的發(fā)育沒有顯著影響。3急性營(yíng)養(yǎng)不良患兒術(shù)后的血清白蛋白、血紅蛋白和淋巴細(xì)胞總數(shù)均與正常患兒沒有顯著性差異,而慢性營(yíng)養(yǎng)不良患兒術(shù)后的血紅蛋白和淋巴細(xì)胞總數(shù)顯著低于正�；純骸＜�、慢性營(yíng)養(yǎng)不良患兒術(shù)后并發(fā)癥發(fā)生率明顯高于正常患兒,但住院時(shí)間和住院費(fèi)用與正�；純簾o顯著性差異。
[Abstract]:Objective: To prospectively study the preoperative nutritional status of children with congenital heart disease (congenital heart disease), and to analyze the postoperative clinical outcome and to seek the characteristics of the changes of nutrition level before and after the operation in order to provide the basis of nutritional support for children and to improve the clinical outcome of the children with a definite target in order to improve the clinical outcome of the children. Method: 1 cases selection: ~2 in January 2013. In December, 016 years, the.2 evaluation method for children with 0~6 year old congenital heart disease and surgical treatment in Xingtai People's Hospital and Xingtai third hospital was evaluated according to age, height, weight and so on. The Z scoring method was used to evaluate the children's preoperative nutrition. The evaluation index included the age Z score (Height for Age, HAZ), and the age body. Weight Z score (Weight for Age, WAZ) and weight Z score (Weight for Height, WHZ). According to different indexes, the definition of poor body weight Z score (WAZ) is defined as low weight, tall body weight and weight score is defined as growth retardation, low weight or weight loss. Acute Malnutrition, AM, determined by growth retardation as the existence of Chronic Dystrophy (Chronic Malnutrition, CM).3 observation index: 3.1 physique measurements: height, weight, and head circumference.3.2 blood indexes: including serum albumin (Alb) before and after operation, hemoglobin (Hb), and total number of lymphocytes (TLC).3.3 Clinical outcome indexes: hospitalization time, hospitalization expenses and complications. Results: 130 cases were in accordance with the standard of admission, including 51 males and 79 females. The age was 5 months ~6 years old. (1) the nutritional status was evaluated with WAZ score: 34 cases of low body recombination, 26.15%, and 96 cases of normal weight group, and there were significant pre operation weight in group 73.85%. two. There was no significant difference in age, height, head circumference, serum albumin, hemoglobin and total lymphocyte total (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte count (P0.05) in the two groups (P0.05), and there was no significant difference in hospitalization time and hospitalization expenses (P0.05), while 3 cases had complications in low body recombination. There were 1 cases of pressure sore, 2 cases of pulmonary infection, normal weight group had no complications, the incidence of complications in the two groups was significantly different (P0.05). (2) the nutritional status was evaluated by whz score: 32 cases, 24.62% and 98 cases in the normal group. The age, height and weight of the 75.38%. emaciation group were significantly lower than those of the normal group (P0.05), and the head circumference and blood were significantly lower than that of the normal group (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte total in the two groups (P0.05). There was no significant difference between the two groups of hospitalized time and hospitalization expenses (P0.05), and 3 cases in the emaciation group, including 1 cases of pressure sores, 2 There were no complications in the normal group. There was a significant difference in the incidence of complications between the two groups (P0.05). (3) the nutritional status was evaluated by HAZ score: 29 cases of growth retardation group, 22.31% and 101 cases of normal growth group, and the age, height, weight, and head circumference of the 77.69%. growth retardation group were significantly lower than that of the normal growth group (P0.05). There was no significant difference in serum albumin, hemoglobin and total lymphocyte count between the two groups (P0.05). There was no significant difference in serum albumin level in the two groups (P0.05), but the total number of hemoglobin and lymphocyte in the growth retardation group was significantly lower than that of the normal growth group (P0.05). There was no significant difference in the hospitalization time and hospitalization expenses between the two groups. (P0.05), there were 2 cases of pulmonary infection in the growth retardation group and 1 cases of pressure ulcers in the normal growth group. There was a significant difference in the incidence of complications between the two groups (P0.05). (4) the incidence of different types of malnutrition in children with different sex was compared: 32 of the 130 children with congenital heart disease had acute malnutrition, of which 12 cases were boys and the incidence was 23. .53%, 20 girls, the incidence was 25.32%, there was no significant difference in the incidence of acute dystrophy between boys and girls (P0.05). 130 children with congenital heart disease had chronic malnutrition, including 17 boys, 33.33% and 12 girls, the incidence was 15.19%, and the incidence of chronic malnutrition in boys was significantly higher than that of girls (P0.01). Conclusions: 1 the nutritional status of children with congenital heart disease was evaluated by Z score. The study found that children with congenital heart disease had different degrees of malnutrition, low weight, emaciation and growth retardation rate of 26.15%, 24.62% and 22.31%.2, which mainly affected the physical development of the children, and the viscera, muscle and immunity. The development of the function did not significantly affect the serum albumin after the operation of.3 children with acute dystrophy. The hemoglobin and the total number of lymphocytes were not significantly different from those of the normal children, while the postoperative hemoglobin and the total number of lymphocytes in the children with chronic malnutrition were significantly lower than those of the normal children. The rate of birth was significantly higher than that of normal children, but there was no significant difference between hospitalization time and hospitalization expenses.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.5;R459.3

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