【摘要】：目的：評估法洛四聯(lián)癥(TOF)患兒的神經(jīng)心理發(fā)育及營養(yǎng)狀況水平,研究影響法洛四聯(lián)癥患兒神經(jīng)心理發(fā)育及營養(yǎng)狀況的相關(guān)因素,并探討法洛四聯(lián)癥根治術(shù)對法洛四聯(lián)癥患兒營養(yǎng)狀況的影響。 方法： 第一部分：運用貝利嬰幼兒發(fā)展量(BSID)表對我科法洛四聯(lián)癥患兒進行神經(jīng)心理發(fā)育評估,根據(jù)評分結(jié)果將患兒分為正常和異常兩組。比較各擬相關(guān)因素在正常和異常組之間的差異,將有統(tǒng)計學(xué)意義的研究因素進行單因素線性回歸分析,再將單因素線性回歸分析有意義的變量納入多元線性回歸模型進行分析,篩選出影響嬰幼法洛四聯(lián)癥患兒神經(jīng)心理發(fā)育的相關(guān)因素。 第二部分：測量我科法洛四聯(lián)癥患兒的身高、體重,同時收集患兒人口學(xué)及臨床資料,采用Z評分法綜合評估患兒營養(yǎng)狀況,根據(jù)評估結(jié)果分為營養(yǎng)不良組及非營養(yǎng)不良組,并對兩組患兒的特征進行單因素分析,再將單因素分析有意義的因素,納入多因素回歸分析,篩出法洛四聯(lián)癥患兒營養(yǎng)不良的危險因素。 第三部分：隨訪法洛四聯(lián)癥根治術(shù)后1月、3月、6月和1年時患兒的身高、體重,對比患兒手術(shù)前后營養(yǎng)狀況變化。 結(jié)果： 第一部分：83例TOF患兒平均智力發(fā)展指數(shù)(MDI)為98.07±16.83,平均精神運動發(fā)展指數(shù)(PDI)為26.62±11.31。智力量表和運動量表評估都無非常優(yōu)秀者,智力量表優(yōu)秀者3例(3.6%),中上14例(16%),中等33例(39.8%),中下17例(20.5%),臨界狀態(tài)11例(13.3%),發(fā)育遲滯5例(6.0%),運動量表優(yōu)秀者0、中上4例(4.8%)、中等37例(44.6%)、中下20例(24.1%)、臨界狀態(tài)16例(19.3%)、發(fā)育遲滯6例(7.2%)。多元線性回歸分析結(jié)果顯示,MaGoon指數(shù)、左心室舒張末容量指數(shù)(LVEDI)和手術(shù)時年齡與患兒神經(jīng)心理-智力發(fā)育具有相關(guān)性,而MaGoon指數(shù)、LVEDI與患兒神經(jīng)心理-運動發(fā)育存在相關(guān)性。 第二部分：142例患兒,營養(yǎng)正常81例(57%),營養(yǎng)不良58例(47%),其中低體重36例(25.4%),的消瘦31例(21.8%),生長遲緩21人(14.8%)。回歸分析結(jié)果顯示低出生體重、早產(chǎn)是患兒低體重的主要影響因素,低出生體重、早產(chǎn)、紫紺、是患兒消瘦的主要影響因素,早產(chǎn)、母親BMI18.5、LVEDI20ml/m2是患兒生長遲緩的主要影響因素。 第三部分：根治術(shù)后1年平均體重別年齡Z評分(ZWA)(0.64±0.86vs-1.12±1.23)、平均體重別身高Z評分(ZWH)(0.56±1.02vs-1.03±1.05)、平均身高別年齡Z評分(ZHA)(0.51±0.18vs-1.06±1.75),術(shù)后1低體重、消瘦和發(fā)育遲滯發(fā)生率分別為11.5%、8.7%和10.1%。 結(jié)論： 1.法洛四聯(lián)癥患兒存在一定程度的神經(jīng)心理發(fā)育落后,一定范圍內(nèi)隨MaGoon指數(shù)、LVEDI的增加,患兒的神經(jīng)心理發(fā)育落后的風(fēng)險會隨之降低,隨著手術(shù)年齡的減小患兒神經(jīng)發(fā)育落后的風(fēng)險降低。 2.嬰幼法洛四聯(lián)癥患兒普遍存在營養(yǎng)不良,與低出生體重、早產(chǎn)、紫紺、LVEDI20ml/m2等因素有關(guān)。 3.法洛四聯(lián)癥根治術(shù)后患兒營養(yǎng)狀況較術(shù)前好轉(zhuǎn),法洛四聯(lián)癥根治術(shù)有助于患兒改善營養(yǎng)狀況。
[Abstract]:Objective: to evaluate the neuropsychological development and nutritional status in children with tetralogy of Fallot (TOF), and to study the related factors affecting neuropsychological development and nutritional status in children with tetralogy of Fallot. To investigate the effect of radical operation of tetralogy of Fallot on nutritional status of children with tetralogy of Fallot. Methods: the first part was to evaluate the neuropsychological development of tetralogy of Cofaclor by using (BSID) table of Bailey's infant development. According to the score, the children were divided into two groups: normal group and abnormal group. To compare the differences between normal and abnormal groups, single factor linear regression analysis was carried out, and the significant variables of single factor linear regression analysis were incorporated into multivariate linear regression model to analyze the difference between normal and abnormal groups. The factors related to neuropsychological development of infants with tetralogy of Fallot were screened. The second part: measuring the height and weight of the children with tetralogy of Cofaclor, collecting the demographic and clinical data of the children, and synthetically evaluating the nutritional status of the children by using Z score method. According to the evaluation results, the children were divided into two groups: malnutrition group and non-malnutrition group. The characteristics of the two groups were analyzed by univariate analysis, and then the significant factors were analyzed, and the risk factors of malnutrition in tetralogy of Fallot were screened out by multivariate regression analysis in order to identify the risk factors of malnutrition in children with tetralogy of Fallot. Part three: the height, weight and nutritional status of the children at 1 month, 3 months, 6 months and 1 year after radical operation of tetralogy of Fallot were followed up. Results: in the first part, the average intelligence development index (MDI) was 98.07 鹵16.83 and the average psychomotor development index (PDI) was 26.62 鹵11.31 in 83 children with TOF. There were 3 cases (3.6%), 14 cases (16%), 33 cases (39.8%) and 17 cases (20.5%) of intelligence scale and motor scale. Critical state 11 cases (13.3%), developmental retardation 5 cases (6.0%), excellent motor scale 0, middle and upper 4 cases (4.8%), middle 37 cases (44.6%), middle and lower 20 cases (24.1%), critical state 11 cases (13.3%), development retardation 5 cases (6.0%), motor scale excellent 4 cases (4.8%), middle and lower 20 cases (24.1%). Critical state 16 cases (19.3%), development retardation 6 cases (7.2%). Multiple linear regression analysis showed that MaGoon index, left ventricular end-diastolic volume index (LVEDI) and age at the time of operation were correlated with neuropsychological and intellectual development, while MaGoon index. There was a correlation between LVEDI and neuropsychological-motor development in children. The second part: among 142 children, 81 (57%) had normal nutrition, 58 (47%) were malnourished, 36 (25.4%) were low weight, 31 (21.8%) were wasting, 21 (14.8%) were stunted. The results of regression analysis showed that low birth weight and premature delivery were the main influencing factors of low birth weight. Low birth weight, premature delivery and cyanosis were the main factors influencing the weight loss of children, preterm birth and mother BMI18.5,. LVEDI20ml/m2 is the main factor affecting growth retardation in children. The third part: the average age of body weight (ZWA) () was 0.64 鹵0.86vs-1.12 鹵1.23 (1 year after radical mastectomy), and the average weight and height (Z) score was 0.56 鹵1.02vs-1.03 鹵1.05 (ZWH) (0.56 鹵1.05). The average height age Z score (ZHA) () was 0.51 鹵0.18vs-1.06 鹵1.75). The incidence of low body weight, wasting and stunting was 11.5% and 10.1% respectively. Conclusion: 1. Children with tetralogy of Fallot had a certain degree of neuropsychological backwardness, and the risk of neuropsychological retardation decreased with the increase of MaGoon index and LVEDI in a certain range. The risk of neurodevelopmental retardation decreases with the age of surgery. 2. Malnutrition is common in infants with tetralogy of Fallot, which is associated with low birth weight, premature delivery, cyanosis and LVEDI20ml/m2. 3. The nutritional status of children with tetralogy of Fallot was improved after radical operation.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.4

【相似文獻】

相關(guān)期刊論文 前10條

1 敦靜;;法洛四聯(lián)癥患兒的手術(shù)配合[J];護理實踐與研究;2007年06期

2 莫緒明;谷興琳;錢龍寶;張儒舫;顧海濤;左維嵩;施曉華;夏建海;戴約;王振喜;蔡紅星;孫劍;仇萬山;沈立;丁晉陽;;小兒法洛四聯(lián)癥臨床及應(yīng)用基礎(chǔ)研究[J];醫(yī)學(xué)研究雜志;2007年07期

3 趙建美;朱善良;李筠;高偉;;法洛四聯(lián)癥合并畸形與平均額面心電軸的關(guān)系[J];臨床兒科雜志;2006年01期

4 Reddy S.;Osorio J.C.;S. Mital;朱啟明;;法洛四聯(lián)癥患兒右室適應(yīng)性衰竭[J];世界核心醫(yī)學(xué)期刊文摘(心臟病學(xué)分冊);2007年01期

5 錢紅娣;胡黎星;楊定清;朱小蓮;張焰;;22例低體重法洛四聯(lián)癥糾治術(shù)的麻醉管理[J];臨床麻醉學(xué)雜志;2009年10期

6 張鴻玲;劉健;肖穎彬;;法洛四聯(lián)癥根治術(shù)后急性肝功能衰竭1例[J];第三軍醫(yī)大學(xué)學(xué)報;2007年01期

7 李桂芝;紀(jì)靜;;1例復(fù)雜性先天性心臟病的手術(shù)護理配合[J];國際護理學(xué)雜志;2006年11期

8 劉承東;鐘文靜;楊彩明;鄧菊芳;;彩超診斷法洛四聯(lián)癥合并右室流出道黏液瘤1例[J];臨床超聲醫(yī)學(xué)雜志;2007年01期

9 葛方英;蘭仲秋;羅淑英;;法洛四聯(lián)癥矯治手術(shù)的護理配合[J];現(xiàn)代醫(yī)藥衛(wèi)生;2007年21期

10 陳忠建;翟波;王鵬高;和東陽;董向陽;楊房;;改良Blalock-Taussig分流術(shù)治療法洛四聯(lián)癥25例[J];中華實用診斷與治療雜志;2009年05期

相關(guān)會議論文 前10條

1 安珊珊;;“一站式”雜交手術(shù)治療法洛四聯(lián)癥的術(shù)后監(jiān)護體會[A];第8屆全國重癥監(jiān)護�？谱o理新進展研討會論文匯編[C];2011年

2 吳欣然;魏琳;;法洛四聯(lián)癥合并氣管狹窄術(shù)后護理一例[A];中國心臟大會（CHC）2011暨北京國際心血管病論壇論文集[C];2011年

3 安珊珊;萬蔚蔚;;“一站式”雜交手術(shù)治療法洛四聯(lián)癥的術(shù)后監(jiān)護體會[A];中國心臟大會（CHC）2011暨北京國際心血管病論壇論文集[C];2011年

4 劉宏宇;張學(xué)鋒;王柏春;李春雨;;成人法洛四聯(lián)癥側(cè)支循環(huán)的處理[A];中國心臟大會（CHC）2011暨北京國際心血管病論壇論文集[C];2011年

5 陳會文;蘇肇伉;徐志偉;劉錦紛;丁文祥;;對法洛四聯(lián)癥中右心室流出道梗阻的再認(rèn)識[A];中華醫(yī)學(xué)會第七次全國胸心血管外科學(xué)術(shù)會議暨2007中華醫(yī)學(xué)會胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊[C];2007年

6 李玉曼;謝明星;王新房;呂清;;二維超聲斑點追蹤顯像技術(shù)評價法洛四聯(lián)癥患者右室整體縱向功能[A];中華醫(yī)學(xué)會第十次全國超聲醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];2009年

7 胡型銻;趙琦峰;吳國偉;杜杰;費建斌;;1歲以內(nèi)法洛四聯(lián)癥外科根治術(shù)[A];2008年浙江省胸心外科學(xué)學(xué)術(shù)年會暨浙江省醫(yī)學(xué)會胸心外科學(xué)分會體外循環(huán)學(xué)組、胸腔鏡學(xué)組成立大會論文匯編[C];2008年

8 張小安;陳露苗;趙鑫;;多排螺旋CT對嬰幼兒法洛四聯(lián)癥的診斷價值[A];2009中華醫(yī)學(xué)會影像技術(shù)分會第十七次全國學(xué)術(shù)大會論文集[C];2009年

9 徐明;陳鑫;石開虎;;成人法洛四聯(lián)癥的外科治療[A];中華醫(yī)學(xué)會第七次全國胸心血管外科學(xué)術(shù)會議暨2007中華醫(yī)學(xué)會胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊[C];2007年

10 石開虎;龔文輝;張飛;徐盛松;宣海洋;曹煒;趙旭東;;成人和小兒法洛四聯(lián)癥外科治療[A];中國心臟大會（CHC）2011暨北京國際心血管病論壇論文集[C];2011年

相關(guān)重要報紙文章 前10條

1 冀民;河北啟動“慈善關(guān)愛行動”救助重大疾病貧困患兒[N];中國社會報;2009年

2 記者 張虎林　通訊員 許春林;農(nóng)村大病患兒報銷比例提高[N];泰州日報;2010年

3 通訊員 王芳　記者 呂s，

本文編號：2314641