评估儿童心脏畸形手术中营养不良及其对术后结果的影响

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-09-01 DOI:10.1016/j.acvd.2025.06.023

Rémi Barbaud, Elodie Garnier, Nathalie Soulé, Jean Issa, Paul Neville, Jean Marc El Arid, Bruno Lefort

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引用次数: 0

摘要

研究表明，营养不良与死亡率和术后并发症的增加有关。根据新的HAS （Haute autorit de sant）关于诊断营养不良的建议，我们研究的目的是：1)测量在图尔大学医院接受先天性心脏病手术的儿童的营养不良程度，2)确定与营养不良相关的潜在因素，以及3)评估营养不良对术后并发症发生的影响。方法回顾性收集图尔大学医院2021 ~ 2024年间连续300例患儿的围手术期医疗资料。根据HAS，体重指数（BMI）低于IOTF 18.5曲线（国际肥胖工作组曲线）定义为营养不良，BMI - IOTF≤17定义为严重营养不良。结果该队列中56%的儿童术前营养不良，37%为严重营养不良。伴有室间隔缺损、二尖瓣反流或动脉干的儿童营养不良最严重。此外，营养不良与心力衰竭、使用速尿和/或ACE抑制剂治疗以及年龄更小显著相关。在人道主义组织的支助下，非洲裔儿童营养不良的情况也较多。术前一天营养不良的儿童出现更多的伤口裂开、更长的主动脉夹紧、更低的血红蛋白水平和更多的血小板输入量。然而，营养不良儿童和非营养不良儿童的死亡率、住院时间或感染情况没有差别。结论在我中心接受心脏手术的患儿中有50%以上存在营养不良。导致营养不良的主要因素是心力衰竭。最佳术前营养支持似乎是必要的，以防止术后并发症，这在这些儿童中更常见。

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Evaluation of malnutrition and its impact on postoperative outcomes in children operated on for a cardiac malformation

Introduction

It has been shown that malnutrition is associated with an increase in mortality and postoperative complications. Based on the new HAS (Haute Autorité de Santé) recommendations for diagnosing malnutrition, the objectives of our study were: 1) to measure the extent of malnutrition in children undergoing congenital heart disease surgery at the University Hospital of Tours, 2) to identify factors potentially associated with malnutrition, and 3) to evaluate the impact of malnutrition on the occurrence of postoperative complications.

Method

The perioperative medical data of 300 consecutive children who underwent cardiac surgery between 2021 and 2024 at the University Hospital of Tours were retrospectively collected. Malnutrition was defined according to the HAS by a body mass index (BMI) below the IOTF 18.5 curve (International Obesity Task Force curves), and severe malnutrition by a BMI–IOTF ≤ 17.

Results

56% of the children in the cohort were malnourished the day before surgery, and 37% had severe malnutrition. Children with a ventricular septal defect (VSD), mitral regurgitation, or a truncus arteriosus were the most malnourished. Moreover, malnutrition was significantly associated with heart failure, treatment with Furosemide and/or ACE inhibitors, and a younger age. Children of African origin, supported by humanitarian organizations, were also more malnourished.

Malnourished children on the day before surgery experienced more wound dehiscence, longer aortic clamping, lower hemoglobin levels, and a higher number of platelet transfusions. However, mortality, length of hospital stay, or infections did not differ between malnourished and non-malnourished children.

Conclusion

More than 50% of children who underwent cardiac surgery at our center were malnourished. The main factor for malnutrition was the presence of heart failure. Optimal preoperative nutritional support seems necessary to prevent postoperative complications, which are more frequent in these children.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.