先心病患儿营养评估及营养干预效果评价

目的:对先天性心脏病患儿进行营养评估，根据患儿情况进行个体化高能量营养干预并评估效果。方法:选取2018年6月—2019年7月入院的694例0～5岁先心病患儿，根据Z评分法，即年龄别身高（HAZ）、年龄别体重（WAZ）、身高别体重（WHZ）进行营养状况评估。通过提高奶液浓度、增加能量摄入量，对营养不良患儿进行为期3个月的营养干预及随访。结果:694例患儿中，各年龄段患儿营养状况均不佳，营养不良共计165例，占比为23.8%，0～1岁患儿营养不良比例最高，其中身高正常，仅体重不达标（HAZ正常，WAZ或WHZ<-2）的患儿占营养不良总数的比例为64.2%。通过3个月的营养干预，患儿营养状况明显改善，0～1岁患儿体重增加最明显，男性患儿平均每日体重增长量为（23.2 ± 8.2）g，女性患儿平均每日体重增长量为（25.6 ± 10.2）g，营养不良好转率均在90%以上，然而随着年龄的增长，各年龄段的平均体重增长量均下降（男性:F=7.348，P=0.002；女性:F=8.093，P=0.001），各年龄段营养好转率均逐渐下降。结论:先心病患儿营养不良发生率高，越早评估患儿营养状况并进行个体化高能量营养干预，改善效果越明显，有助于尽早实现生长追赶。

Nutritional assessment of children with congenital heart disease and effect evaluation of nutritional intervention

Objective: To evaluate the nutritional status of children with congenital heart disease and the effect of individualized high-energy nutrition intervention according to the children′s situation. Methods: 694 children aged 0-5 years with congenital heart disease admitted to our hospital from June 2018 to July 2019 were selected and their nutritional status was evaluated according to Z-score method，which include weight-for-age（WAZ），height-for-age（HAZ），and weight-for-height（WHZ）. Nutritional intervention and follow-up were carried out for 3 months by increasing milk concentration and energy intake. Results: Among the 694 cases，the nutritional status of all age groups was poor,165 cases were malnourished，accounting for 23.8%. The proportion of malnourished children aged 0-1 was the highest,the proportion of children with normal height and unormal weight（HAZ normal,WAZ or WHZ < - 2） was 64.2%. After 3 months of nutritional intervention，the nutritional status of the children was significantly improved. The weight gain of children aged 0-1 was the most obvious. The average daily weight gain of male children was （23.2 ± 8.2） g，and that of female children was（25.6 ± 8.2） g，however，with the increase of age，the average weight gain of all age groups decreased（male:F=7.348，P=0.002；female:F=8.093，P=0.001），and the nutrition improvement rate of all age groups decreased gradually. Conclusion: Children with congenital heart disease have a high incidence of malnutrition. Earlier evaluation of nutritional status and individualized high-energy nutrition intervention can significantly improve the effect，which is helpful to achieve catch-up growth as soon as possible.