Objective: To explore the risk factors of malnutrition in infants with congenital heart disease within one year after surgery. Methods: This retrospective cohort study selected 502 infants with congenital heart disease who underwent surgical treatment in Guangzhou Women and Children's Medical Center from February 2018 to January 2019. Their basic information and clinical data were analyzed, and their nutrition status after the surgery was followed up by questionnaire survey. Weight-for-age Z score (WAZ)≤-2 one year after operation was defined as malnutrition group, and WAZ>-2 was non-malnutrition group. The perioperative indicators and complementary food advancement were compared between the two groups by chi-square test, t-test, and Kruskal-Wallis test. The risk factors of malnutrition were analyzed by Logistic regression. Results: A total of 502 infants were selected, including 301 males and 201 females, with the age of 4.1 (2.0, 6.8) months. There were 90 cases in malnutrition group and 412 cases in non-malnutrition group. The body length and weight at birth in the malnutrition group were lower than those in the non-malnutrition group ((47.8±3.8) vs. (49.3±2.5) cm, (2.7±0.6) vs.(3.0±0.5) kg, both P<0.001). The proportion of paternal high school education or above and the proportion of family per capita income of 5 000 yuan or above in the malnutrition group were lower than those in the non-malnutrition group ((18.9% (17/90) vs. 30.8% (127/412), 18.9% (17/90) vs. 33.7% (139/412), both P<0.05). Compared to the non-malnutrition group, the proportion of complex congenital heart disease in the malnutrition group was higher (62.2% (56/90) vs. 47.3% (195/412), P<0.05). The postoperative mechanical ventilation time, postoperative intensive care unit (ICU) stay time, postoperative hospital stay, total length of ICU stay and total hospital stay in the malnutrition group were significantly longer than those in non-malnutrition group (all P<0.05). The proportion of egg and fish supplementation over 2 times/week within one year after the surgery was also lower in the malnutrition group (both P<0.05). Logistic regression analysis showed that mother's weight at delivery (OR=0.95,95%CI 0.91-0.99), the pre-operative WAZ≤-2 (OR=6.04, 95%CI 3.13-11.65), the complexity of the cardiac disease (OR=2.23, 95%CI 1.22-4.06), the hospital stay after the surgery over 14 days (OR=2.61, 95%CI 1.30-5.26), the types of complementary food<4 (OR=2.57, 95%CI 1.39-4.76), and the frequency of meat and fish<2 times/week (OR=2.11, 95%CI 1.13-3.93) were the risk factors associated with malnutrition within one year after the surgery. Conclusion: Mother's weight at delivery pre-operative nutritional status, complexity of cardiac disease, postoperative hospital stay, types of daily supplements and frequency of fish are risk factors associated with malnutrition within one year after surgery in children with congenital heart disease.
目的： 探讨先天性心脏病（先心病）患儿术后1年持续营养不良的影响因素。 方法： 回顾性队列研究。选取2018年2月至2019年1月广州市妇女儿童医疗中心收治的年龄1岁以下、诊断为先心病且行手术治疗的共502例患儿为研究对象，回顾性分析患儿年龄、性别、胎龄、出生体重、出生身长、父母身高、父母体重、父母文化程度、家庭收入等基本资料以及先心病类型、手术和麻醉方式、体外循环时间，术后机械通气时间、重症监护病房（ICU）停留时间和总住院时间等资料，并通过问卷调查的方式随访患儿的膳食营养情况。术后1年年龄的体重（WAZ）≤-2定义为营养不良组，WAZ>-2非营养不良组，采用χ2检验、t检验或秩和检验比较两组患儿围术期指标及辅食添加情况，采用Logistic回归分析患儿营养不良的影响因素。 结果： 502例患儿中男301例、女201例，入组年龄4.1（2.0，6.8）月龄。营养不良组90例，非营养不良组412例。营养不良组患儿出生时身长及体重均低于非营养不良组，差异均有统计学意义［（47.8±3.8）比（49.3±2.5）cm，（2.7±0.6）比（3.0±0.5）kg，均P<0.001］。营养不良组患儿父亲高中及以上文化程度的比例和家庭人均月收入5 000元及以上的比例均低于非营养不良组，差异均有统计学意义［18.9%（17/90）比30.8%（127/412），18.9%（17/90）比33.7%（139/412），均P<0.05］。营养不良组患儿复杂先心病占比更高，差异有统计学意义［62.2%（56/90）比47.3%（195/412），P<0.05］。营养不良组患儿术后机械通气时间、术后ICU停留时间、术后住院时间、总ICU停留时间及总住院时间均明显长于非营养不良组，差异均有统计学意义（均P<0.05）。营养不良组患儿术后1年蛋类及鱼肉类的添加频次≥2次/周的比例明显低于非营养不良组，差异均有统计学意义（均P<0.05）。Logistic回归多因素分析显示母亲产时体重<50 kg（OR=0.95，95%CI 0.91~0.99）、术前WAZ≤-2（OR=6.04，95%CI 3.13~11.65）、先心病复杂程度高（OR=2.23，95%CI 1.22~4.06）、术后住院时间>14 d（OR=2.61，95%CI 1.30~5.26）、术后1年每天添加食物种类<4种（OR=2.57，95%CI 1.39~4.76）、术后1年食用鱼肉频次<2次/周（OR=2.11，95%CI 1.13~3.93）的患儿术后1年营养不良发生风险明显增加。 结论： 母亲产时体重、患儿术前营养状况、先心病复杂程度、术后住院时间、每天添加辅食种类及食用鱼肉频次是先心病患儿术后1年营养不良的影响因素。.