高能量密度配方奶粉对紫绀型先天性心脏病患儿术后生长追赶的影响：前瞻性随机对照研究

Effect of calorie-enriched formula on postoperative catch-up growth in infants with cyanotic congenital heart disease: a propective randomized controlled study

摘要:

目的 探讨高能量密度配方奶粉对紫绀型先天性心脏病（CHD）患儿术后生长追赶的影响。方法 前瞻性纳入2017年1~12月行外科手术的紫绀型CHD婴儿100例，随机分配至高能量组（术后给予高能量密度配方奶粉）和常规组（术后给予普通配方奶粉），每组50例，随访观察6个月。观察指标包括术前、术后脱机拔管时、术后1个月、术后3个月、术后6个月的身高、体重、前白蛋白、N末端B型利钠肽原；计算年龄别身高Z评分（HAZ）、年龄别体重Z评分（WAZ）和身高别体重Z评分（WHZ）；同时记录两组不良反应。结果 术前高能量组和常规组分别有25例（50%）和21例（42%）营养不良，两组营养不良率差异无统计学意义（P > 0.05）。两组患儿术后6个月营养状况均有改善（P < 0.05）。术后6个月高能量组营养不良率低于常规组（18% vs 36%，P < 0.05）；高能量组WAZ < -2的比例低于常规组（P < 0.05）；高能量组营养不良患儿HAZ、WAZ、WHZ均高于常规组（P < 0.05）。两组患儿住院期间均未出现胃肠道不耐受。结论 高能量密度配方奶粉较普通配方奶粉更有助于紫绀型CHD患儿术后生长追赶。

Abstract:

Objective To study the effect of calorie-enriched formula on postoperative catch-up growth in infants with cyanotic congenital heart disease (CHD). Methods A total of 100 infants with cyanotic CHD who underwent surgical operation from January to December, 2017, were randomly divided into a high-calorie group (receiving calorie-enriched formula after surgery) and a conventional group (receiving standard formula after surgery), with 50 infants in each group. All infants were followed up for 6 months. The observation indices included body height, body weight, prealbumin, and N-terminal pro-brain natriuretic peptide before surgery, at the time of ventilator weaning and extubation after surgery, and at 1, 3, and 6 months after surgery. Height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height Z-score (WHZ) were also assessed. Adverse reactions were recorded for both groups. Results There were 25 cases (50%) and 21 cases (42%) of malnutrition in the high-calorie group and the conventional group respectively before surgery (P > 0.05). The nutritional status of the two groups improved 6 months after surgery (P < 0.05). At 6 months after surgery, compared with the conventional group, the high-calorie group had a lower proportion of infants with malnutrition (18% vs 36%, P < 0.05) and also a lower proportation of infants with a WAZ score of < -2 (P < 0.05). The infants with malnutrion in the high-calorie group had higher HAZ, WAZ, and WHZ than those in the conventional group (P < 0.05). No gastrointestinal intolerance was observed in both groups during hospitalization. Conclusions Compared with the standard formula, calorie-enriched formula can better help with postoperative catch-up growth in infants with cyanotic CHD.