高能量密度配方奶喂养室间隔缺损并重症肺炎患儿的有效性研究

目的 通过评价不同能量喂养对先天性心脏病合并重症肺炎患儿的营养状态、临床经过及转归情况的影响,为制定先天性心脏病患儿的营养管理策略提供临床依据。方法 纳入2017年1月1日至12月30日诊断为"室间隔缺损合并重症肺炎"并行外科手术治疗,且术前合并营养不良的6个月以下婴儿43例为研究对象,随机分为观察组（n=21）和对照组（n=22）,观察组术后以高能量密度配方奶（100 kcal/100 mL）进行喂养,对照组术后以普通热量配方奶（67 kcal/100 mL）进行喂养。通过连续观察两组患儿3个月,记录体格测量结果、实验室指标、营养风险筛查结果等,并对患儿进行营养状态评估,同时对两组的预后及不良反应进行比较分析。结果 两组患儿入院时体格测量结果、实验室指标、营养评估及营养风险筛查结果比较差异均无统计学意义（P > 0.05）。对照组出院时、术后1个月及术后3个月,营养不良程度及营养风险等级均高于观察组（P < 0.05）。重复测量方差分析结果显示体重、上臂围、年龄别体重Z值、年龄别身高Z值、身高别体重Z值及白蛋白水平均存在时间因素及分组因素差异,且分组因素与时间因素均有交互作用（P < 0.05）。观察组住院期间平均每日摄入液体量低于对照组,而平均每日摄入能量高于对照组,喂养不足发生率低于对照组（P < 0.05）。观察组住院时间、机械通气时间、术后发热时间及住院费用均较对照组明显减少（P < 0.05）,两组患儿均无明显不良反应。结论 适当增加先天性心脏病患儿术后的热量供应可以改善患儿的营养不良状况及临床转归。

Clinical effect of feeding with calorie-enriched formula in children with ventricular septal defect and severe pneumonia

Objective To study the effect of different energy feeding patterns on the nutritional status, clinical course, and outcome of children with congenital heart disease (CHD) and severe pneumonia. Methods A total of 43 malnourished infants, aged <6 months, who were diagnosed with ventricular septal defect and severe pneumonia and underwent surgical operation from January 1 to December 30, 2017 were enrolled. They were randomly divided into an observation group with 21 infants and a control group with 22 infants. The infants in the observation group were given calorie-enriched formula milk powder (100 kcal/100 mL) after surgery, and those in the control group were given formula milk powder with normal calories (67 kcal/100 mL). The two groups were observed for 3 months to record physical measurements, laboratory markers and nutritional risk screening results. Nutritional status was evaluated for all infants. The two groups were compared in terms of prognosis and adverse events. Results There were no significant differences between the two groups in physical measurements, laboratory markers, nutritional assessment and nutritional risk screening results on admission (P > 0.05). At discharge and 1 and 3 months after surgery, the control group had significantly higher degree of malnutrition and level of nutritional risk than the observation group (P < 0.05). The analysis of variance with repeated measures showed significant differences in body weight, upper arm circumference, weight-forage Z-score, height-for-age Z-score, weight-for-height Z-score, and albumin level at different time points and between different groups, and there was an interaction between group factors and time factors (P < 0.05). Compared with the control group, the observation group had a significantly lower average daily intake of fluid, a significantly higher average daily intake of energy, and a significantly lower incidence rate of insufficient feeding during hospitalization (P < 0.05). Compared with the control group, the observation group had significantly shorter length of hospital stay, duration of mechanical ventilation, and duration of postoperative pyrexia, as well as significantly lower hospital costs (P < 0.05). No significant adverse reactions were observed in either group. Conclusions An appropriate increase in postoperative energy supply for children with CHD can improve the status of malnutrition and clinical outcome.