先天性心脏病患儿术前营养状况及影响因素分析
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摘要
目的先天性心脏病患儿因心脏畸形而导致心功能不全,可导致肠道功能紊乱而影响营养的吸收,营养不良发生率明显高于正常儿童,而术前营养状况对患儿并发症、术后伤口愈合时间、住院时间及再入院率等均有较大影响。本研究探讨先天性心脏病患儿术前营养状况及影响因素,为临床相关研究提供参考依据。方法选取郑州大学附属儿童医院2015-01-01-2017-12-31接诊的130例先天性心脏病患儿进行研究。采用问卷调查的方法进行研究,调查工具包括自制一般资料调查表及《先天性心脏病婴幼儿喂养和营养风险筛查工具》(汉化版)。单因素分析两样本间比较采用t检验,多组间比较采用F检验,多因素分析采用Logistic回归。结果本组调查对象《先天性心脏病婴幼儿喂养和营养风险筛查工具》得分为(12.95±2.33)分。单因素分析结果显示,先天性心脏病患儿术前营养状况与患儿年龄(t=6.156,P<0.001)、家庭收入(F=43.180,P<0.001)、家庭来源(t=11.639,P<0.001)、获得营养知识途径(F=25.371,P<0.001)、出生体质量(F=3.742,P=0.038)、确诊时间(t=-8.298,P<0.001)、住院次数(F=56.649,P<0.001)及有无术前感染(t=10.114,P<0.001)有关。多因素分析结果显示,家庭来源农村(OR=0.529,95%CI为0.422～0.683,P<0.001)、获得营养知识途径(OR=1.408,95%CI为1.213～1.499,P<0.001)、出生体质量(OR=0.375,95%CI为0.282～0.461,P=0.024)和住院次数(OR=0.492,95%CI为0.309～0.617,P=0.042)为先天性心脏病患儿术前营养状况的独立影响因素。结论先天性心脏病患儿存在营养风险,患儿营养状况主要受出生体质量、获得营养知识途径、住院次数及家庭来源的影响,护理时应注意对以上因素进行针对性干预。
OBJECTIVE Cardiac dysfunction caused by cardiac malformation in children with cardiac malformation can lead to intestinal dysfunction and influence the absorption of nutrition.The incidence of malnutrition is significantly higher than that of normal children.The preoperative nutritional status has a great influence on the complications of children,the time of wound healing,the time of hospitalization and readmission rate.The study investigates the preoperative nutritional status and influencing factors of children with congenital heart disease.METHODS Convenient sampling method was used in our hospital from January 2015 to December 2017.130 cases of congenital heart disease were studied.The survey was conducted using aquestionnaire survey.The survey tools included a self-made general information questionnaire and a screening tool for infant and child feeding and nutritional risk of congenital heart disease(Chinese version).Single factor analyzed comparison between two samples using t test or multigroup comparison using Ftest.Multivariate analysis was performed using Logistic regression.RESULTS The score of this tool"screening tools for infant feeding and nutritional risk of congenital heart disease"was(12.95±2.33)points.Univariate analysis showed that preoperative nutritional status of children with congenital heart disease was related to children's age,family income,family origin,access to nutrition knowledge,birth weight,time of diagnosis,number of hospitalizations and preoperative infection,all P<0.05.Multivariate Logistic analysis showed that the family originated from rural areas(OR=0.529,95%CI:0.422-0.683,P<0.001),access to nutrition knowledge(OR=1.408,95%CI:1.213-1.499,P<0.001),normal birth weight(OR=0.375,95%CI:0.282-0.461,P=0.024),numbers of hospitalization(OR=0.492,95%CI:0.309-0.617,P=0.042)were independent factors affecting preoperative nutritional status in children with congenital heart disease.CONCLUSIONS There is nutritional risk in children with congenital heart disease.The nutritional status of the children is mainly affected by birth weight,access to nutritional knowledge,number of hospitalizations and family origins.Attention should be paid to the targeted intervention of the above factors in nursing care.
OBJECTIVE Cardiac dysfunction caused by cardiac malformation in children with cardiac malformation can lead to intestinal dysfunction and influence the absorption of nutrition.The incidence of malnutrition is significantly higher than that of normal children.The preoperative nutritional status has a great influence on the complications of children,the time of wound healing,the time of hospitalization and readmission rate.The study investigates the preoperative nutritional status and influencing factors of children with congenital heart disease.METHODS Convenient sampling method was used in our hospital from January 2015 to December 2017.130 cases of congenital heart disease were studied.The survey was conducted using aquestionnaire survey.The survey tools included a self-made general information questionnaire and a screening tool for infant and child feeding and nutritional risk of congenital heart disease(Chinese version).Single factor analyzed comparison between two samples using t test or multigroup comparison using Ftest.Multivariate analysis was performed using Logistic regression.RESULTS The score of this tool"screening tools for infant feeding and nutritional risk of congenital heart disease"was(12.95±2.33)points.Univariate analysis showed that preoperative nutritional status of children with congenital heart disease was related to children's age,family income,family origin,access to nutrition knowledge,birth weight,time of diagnosis,number of hospitalizations and preoperative infection,all P<0.05.Multivariate Logistic analysis showed that the family originated from rural areas(OR=0.529,95%CI:0.422-0.683,P<0.001),access to nutrition knowledge(OR=1.408,95%CI:1.213-1.499,P<0.001),normal birth weight(OR=0.375,95%CI:0.282-0.461,P=0.024),numbers of hospitalization(OR=0.492,95%CI:0.309-0.617,P=0.042)were independent factors affecting preoperative nutritional status in children with congenital heart disease.CONCLUSIONS There is nutritional risk in children with congenital heart disease.The nutritional status of the children is mainly affected by birth weight,access to nutritional knowledge,number of hospitalizations and family origins.Attention should be paid to the targeted intervention of the above factors in nursing care.
引文
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[11]Amugsi DA,Mittelmark MB,Lartey A,et al.Influence of childcare practices on nutritional status of Ghanaian children:A regression analysis of the Ghana demographic and health surveys[J].Bmj Open,2014,4(11):e005340.
[12]陈想英.421例儿科住院患者入院时营养状况评价[J].湖北科技学院学报(医学版),2016,30(3):249-251.
[13]魏昆.0~5岁住院儿童营养状况及影响因素分析[J].中国儿童保健杂志,2017,25(8):857-859.
[14]贺赞群,孙袁,杨惠萍,等.贵阳市5岁以下儿童家庭情况对儿童营养状况的影响分析[J].贵州医药,2017,41(8):870-872.
[15]汪钱华,冯君,顾燕萍,等.上海市某镇民营托幼机构新入园儿童营养不良现况调查及影响因素分析[J].中国初级卫生保健,2017,31(12):35-38.
[2]Vehmeijer JT,Brouwer TF,Limpens J,et al.Implantable cardioverter-defibrillators in adults with congenital heart disease:Asystematic review and meta-analysis[J].Eur Heart J,2016,37(18):1439-1448.
[3]Wei H,Roscigno CI,Hanson CC,et al.Families of children with congenital heart disease:A literature review[J].Heart Lung,2015,44(6):494-511.
[4]张亚黎.胎儿及新生儿早期先天性心脏病筛查现状的流行病学评价[J].中国生育健康杂志,2013,24(4):2001.
[5]杨玉霞,顾莺,叶岚,等.先天性心脏病婴幼儿喂养和营养风险筛查工具的汉化及信效度研究[J].中华护理杂志,2017,52(4):507-510.
[6]吕建波,吕璐,李增宁.先天性心脏病手术儿童营养状况评价[J].河北医药,2014,36(20):3141-3142.
[7]Mitting R,Marino L,Macrae D,et al.Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease[J].Pediatr Crit Care Med,2015,16(5):448.
[8]李浩嫙.超低出生体重儿的生存现状及远期生活质量[J].国际儿科学杂志,2015,42(1):62-66.
[9]Mariante Giesta J,Ramón da Rosa S,Moura Pessoa JS.Prenatal factors associated with birth weight and length and current nutritional status of hospitalized children aged 4-24months[J].Nutr Hosp,2015,31(6):2487-2495.
[10]Motil KJ.Sensitive measures of nutritional status in children in hospital and in the field[J].Int J Cancer Suppl,2015,78(S11):2-9.
[11]Amugsi DA,Mittelmark MB,Lartey A,et al.Influence of childcare practices on nutritional status of Ghanaian children:A regression analysis of the Ghana demographic and health surveys[J].Bmj Open,2014,4(11):e005340.
[12]陈想英.421例儿科住院患者入院时营养状况评价[J].湖北科技学院学报(医学版),2016,30(3):249-251.
[13]魏昆.0~5岁住院儿童营养状况及影响因素分析[J].中国儿童保健杂志,2017,25(8):857-859.
[14]贺赞群,孙袁,杨惠萍,等.贵阳市5岁以下儿童家庭情况对儿童营养状况的影响分析[J].贵州医药,2017,41(8):870-872.
[15]汪钱华,冯君,顾燕萍,等.上海市某镇民营托幼机构新入园儿童营养不良现况调查及影响因素分析[J].中国初级卫生保健,2017,31(12):35-38.