先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素，并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿，采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况，统计CHD患儿术前营养不良发生率，采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素，并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中，有31例出现术前营养不良，34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素，母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05），营养不良组的住院时间长于非营养不良组，住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高，CD8⁺下降，且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高，且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素，而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降，生存质量降低，临床结局相对偏差。

Analysis of Risk Factors of Preoperative Malnutrition in Children with Congenital Heart Disease and Its Influence on Postoperative Clinical Outcome, Immune Function and Quality of Life

ABSTRACT Objective: To analyze the risk factors of preoperative malnutrition in children with congenital heart disease (CHD), and to observe the effect of preoperative malnutrition on postoperative clinical outcome, immune function and quality of life of children. Methods: 65 children with CHD who were admitted to Jiangsu Provincial People''s Hospital from January 2020 to June 2022 were selected, the nutritional status of children with CHD was assessed using the relevant nutritional diagnostic criteria developed by the National Center for Health Statistics of the United States, as recommended by the World Health Organization (WHO), and the incidence of preoperative malnutrition of children with CHD was calculated. Univariate and multivariate Logistic regression were used to analyze the risk factors of preoperative malnutrition in children with CHD, and the effects of preoperative malnutrition on postoperative clinical outcome, immune function and quality of life were also observed. Results: Among the enrolled children in this study, 31 had preoperative malnutrition, and 34 had no preoperative malnutrition. According to their nutritional status, the children were divided into malnutrition group (n=31) and non-malnutrition group (n=34). Multivariate Logistic regression analysis showed that low birth weight at birth, maternal anxiety and maternal depression were risk factors for preoperative malnutrition in children with CHD, and maternal initiative to acquire disease knowledge was the protective factor (P<0.05). There was no significant difference in the incidence of complications in the two groups (P>0.05). The length of hospital stay in the malnutrition group was longer than that in the non-malnutrition group, and the hospitalization cost was higher than that in the non-malnutrition group (P<0.05). 3 months after operation, CD3⁺, CD4⁺, CD4⁺/CD8⁺ increased in the two groups, while CD8⁺ decreased, and the improvement effect in the non-malnutrition group was better than that in the malnutrition group (P<0.05). Preoperative communication problems, heart problems and symptoms, treatment anxiety, perceived physical appearance and cognitive psychological problems scores were all increased in the two groups at 3 months after operation, and the improvement effect in the non-malnutrition group was better than that in the malnutrition group (P<0.05). Conclusion: Low birth weight at birth, maternal anxiety and maternal depression are risk factors for preoperative malnutrition in children with CHD, while maternal initiative to acquire disease knowledge is a protective factor for preoperative malnutrition in children with CHD. Preoperative malnutrition will lead to postoperative decreased immune function, reduced quality of life, and relatively poor clinical outcome in children with CHD.