The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR).
The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR).
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DOI：
10.1016/j.jtcvs.2013.03.023
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发表时间：
2014-01
影响因子：
6
通讯作者：
Fineman, Jeffrey
中科院分区：
文献类型：
--
作者：
Radman, Monique;Mack, Ricardo;Barnoya, Joaquin;Neda, Aldo Casta;Rosales, Monica;Azakie, Anthony;Mehta, Nilesh;Keller, Roberta;Datar, Sanjeev;Oishi, Peter;Fineman, Jeffrey
目的：探讨先天性心脏病(CHD)患儿手术前营养状况与术后结局的关系。71名冠心病患者参加了一项前瞻性的双中心队列研究。我们使用冠心病手术的标准化风险调整分数对基线风险差异进行了调整。我们为每个受试者在手术前的三头肌皮褶测量分配了世界卫生组织的Z评分，这是对全身脂肪质量的评估。术前测定血浆营养状态标志物(前白蛋白、白蛋白)和心肌应激标志物(B型利钠肽，BNP)。寻找术前营养状况指数和临床结果之间的联系。受试者的平均年龄(IQR)为10.2(33)个月。在UCSF队列中，机械通气时间(中位数19小时，IQR 29)、ICU住院时间(中位数5天，IQR 5)、任何持续肌力输注的时间(中位数66小时，IQR 72)和术前BNP水平(中位数30 pg/mL，IQR 75)与术前较低的三头肌皮褶Z评分相关(p<；0.05)。持续肌力输注时间越长，术前BNP水平越高，术前白蛋白(12.1±0.5 mg/dL)和白蛋白(3.2±0.1)越低(p<；0.05)。在资源丰富的加州大学旧金山分校接受CHD手术的儿童中，较低的全身脂肪质量以及急性和慢性营养不良与较差的临床结果相关。总体脂肪质量与脑钠素水平呈负相关。随着营养状况指标的减少，正性肌力支持的持续时间和BNP也随之增加，这支持了营养不良与心肌功能下降有关的假设。
To determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). Seventy-one patients with CHD were enrolled in a prospective, two-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization Z-score for each subjects’ preoperative triceps skinfold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide, BNP). Associations between indices of preoperative nutritional status and clinical outcomes were sought. Subjects had a median (IQR) age of 10.2 (33) months. In the UCSF cohort, duration of mechanical ventilation (median 19 hours, IQR 29), length of ICU stay (median 5 days, IQR 5), duration of any continuous inotropic infusion (median 66 hours, IQR 72) and preoperative BNP levels (median 30 pg/mL, IQR 75) were associated with a lower preoperative triceps skinfold Z-score (p<0.05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1) (p<0.05). Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
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影响因子：
3.4
作者：
POLLACK, MM;RUTTIMANN, UE;WILEY, JS
通讯作者：
WILEY, JS
影响因子：
5.2
作者：
Okoromah CA;Ekure EN;Lesi FE;Okunowo WO;Tijani BO;Okeiyi JC
通讯作者：
Okeiyi JC
DOI：
10.1053/pcsu.2002.31497
发表时间：
2002-01-01
期刊：
Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
影响因子：
--
作者：
Rodefeld, Mark D;Hanley, Frank L
通讯作者：
Hanley, Frank L
DOI：
10.1016/j.jtcvs.2007.10.040
发表时间：
2008-04-01
影响因子：
6
作者：
Hsu, Jong-Hau;Oishi, Peter E.;Fineman, Jeffrey R.
通讯作者：
Fineman, Jeffrey R.
DOI：
10.1016/j.jtcvs.2005.10.052
发表时间：
2006-03-01
影响因子：
6
作者：
Shih, CY;Sapru, A;Fineman, JR
通讯作者：
Fineman, JR