背景:单心室患者需要一系列手术,最后阶段是Fontan。这种循环形式会导致一些长期并发症,但营养状况的影响和后果仍不清楚.我们试图评估Fontan患者营养不良的发生率及其对预后的影响。
方法:本研究是对1997年至2018年间接受Fontan手术的儿童进行的回顾性队列研究。临床,人口统计学,收集营养数据,包括体重,高度,体重指数(BMI),和他们各自的z分数(年龄体重的z分数[WAZ],年龄身高z得分[HAZ],和年龄BMI的z评分[BMIZ])pre-Fontan,在放电时,6个月,以及Fontan后的1年,5年和10年。使用美国肠外和肠内营养协会指南和密歇根MTool对营养不良状态进行分类。Fontan失败被定义为心脏移植或死亡的列表。
结果:在69名患者中,WAZ在任何时间点发生中重度营养不良11%(n=8),16%(n=11)的HAZ,和6%(n=4)由BMIZ。中重度营养不良在Fontan后10年持续存在6.5%-12.9%。与丰坦前期相比,随着时间的推移,这些参数没有变化。在Fontan营养不良之前的程度之间,Fontan失败没有统计学上的显着差异。
结论:Fontan患者中重度营养不良发生率为6%-16%。营养不良是一种在后续行动中仍然存在的疾病。与人体测量参数和无移植生存率无关。需要进行前瞻性多机构研究,以了解营养不良对长期结果的影响。
Single-ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long-term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes.
This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight-for-age [WAZ], z score for height-for-age [HAZ], and z score for BMI-for-age [BMIZ]) pre-Fontan, at discharge, 6 months, and 1, 5, and 10 years post-Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death.
Of the 69 patients, moderate-severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate-severe malnutrition persisted in 6.5%-12.9% at 10 years post-Fontan. Compared with the pre-Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre-Fontan malnutrition.
There is a 6%-16% incidence of moderate-severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow-up. There was no association with anthropometric parameters and transplant-free survival. A prospective multi-institutional study is needed to understand the impact of malnutrition on long-term outcomes.