中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

二期 Fontan 术患儿各手术阶段生长发育情况分析

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目的 调查行二期全腔静脉肺动脉连接术(Fontan 术)患儿各手术阶段的生长发育情况。 方法 回顾性分析 2012 年 1 月至 2015 年 12 月我院行二期 Fontan 术 152 例患儿的临床资料,其中男 84 例、女 68 例,年龄 4~16 岁。评估患儿各手术阶段的身高、体重,并转换为 WHO Z 评分,描述患儿的生长发育模式。 结果 患儿各手术阶段年龄别体重 Z 评分(weight for age Z-score,WAZ)、年龄别身高 Z 评分(height for age Z-score,HAZ)出生时分别为–0.73 和 0.06, 双向腔肺吻合术(Glenn 术)前分别为–1.27±1.37 和–1.27±1.72,Fontan 术前分别为–0.47±1.08 和–0.69±1.17,术后随访时分别为–0.42±1.18 和–0.39±1.48。其中 Glenn 术前与出生时、二期 Fontan 术前的 WAZ、HAZ 差异有统计学意义(P<0.05),Fontan 术前与随访时 HAZ 评分差异有统计学意义(P<0.05)。 结论 二期 Fontan 术患儿经过各手术阶段后其长发育模式发生变化。在 Glenn 术前出现生长低谷,术后患儿开始迅速追赶生长;至 Fontan 术前患儿身高、体重尚未达到正常水平,术后患儿追赶生长减慢;并且随访时仍然存在低体重和生长迟缓现象。未来需要采取有效措施如加强 Glenn 术前患儿的营养支持,以期待改善患儿的生长发育。

Objective To investigate somatic growth of children undergoing stageⅡ Fontan procedure. Methods Clinical data of 152 children who underwent stageⅡ Fontan procedure in Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine between January 2012 and December 2015 were reviewed. There were 84 males and 68 females at age of 4-16 years. The weight and height of those children in each operative stage were assessed, and WHO Z-score was obtained to describe the pattern of growth of the children. Results Mean weight for age Z-score (WAZ) and height for age Z-score (HAZ) were –0.73 and 0.06 at birth, –1.27±1.37 and –1.27±1.72 before Glenn procedure, –0.47±1.08 and –0.69±1.17 before Fontan procedure, –0.42±1.18 and –0.39±1.48 at follow-up, respectively. A significant decline (P<0.05) in WAZ and HAZ was found before Glenn procedure. After the Glenn procedure, there was significant catch-up growth (P<0.05). The WAZ was stabilized after Fontan procedure, while the HAZ was reversed (P<0.05) continually. Conclusion The somatic growth is impaired in children with stageⅡ​ Fontan procedure. There is a trough of growth before Glenn procedure. Although catch-up growth occurs after Glenn procedure, low body weight and growth retardation remain at follow-up. Effective interventions such as more intensive nutritional strategies before Glenn procedure should be targeted at those children in the future, so as to improve their growth.

关键词: 单心室; 全腔静脉肺动脉连接术; 生长发育

Key words: Single ventricle; Fontan procedure; somatic growth

引用本文: 孙崇蕊, 张明杰, 徐卓明. 二期 Fontan 术患儿各手术阶段生长发育情况分析. 中国胸心血管外科临床杂志, 2017, 24(12): 912-915. doi: 10.7507/1007-4848.201709016 复制

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1. Van den Broeck J, Willie D, Younger N. The World Health Organization child growth standards: expected implications for clinical and epidemiological research. Eue J Pediatr, 2009, 168(2): 247-251.
2. Chan FT, Bellsham-Revell HR, Duggan H, et al. Interstage somatic growth in children with hypoplastic left heart syndrome after initial palliation with the hybrid procedure. Cardiol Young, 2017, 27(1): 131-138.
3. Sandberg C, Rinnström D2, Dellborg M, et al. Height, weight and body mass index in adults with congenital heart disease. Int J Cardiol, 2015, 187:219-226.
4. Francois K, Bove T, Panzer J, et al. Univentricular heart and Fontan staging: analysis of factors impacting on body growth. Eur J Cardiothorac Surg, 2012, 41(6): e139-e145.
5. Hessel TW, Greisen G, Idorn L, et al. Somatic growth in 94 single ventricle children-comparing systemic right and left ventricle patients. Acta Paediatr, 2013, 102(1): 35-39.
6. Hsu DT. The Fontan operation: the long-term outlook. Curr Opin Pediatr, 2015, 27(5): 569-575.
7. Ohuchi H. Adult patients with Fontan circulation: What we know and how to manage adults with Fontan circulation? J Cardiol, 2016, 68(3): 181-189.
8. Schumacher KR, Stringer KA, Donohue JE, et al. Fontan-associated protein-losing enteropathy and plastic bronchitis. J Pediar, 2015, 166(4): 970-977.
9. Pundi KN, Johnson JN, Dearani JA, et al. 40-year follow-up after the fontan operation: long-term outcomes of 1, 052 patients. J Am Coll Cardiol, 2015, 66(15): 1700-1710.
10. Bezuska L, Lebetkevicius V, Sudikiene R, et al. 30-year experience of Fontan surgery: single-centre’s data. J Cardiothorac Surg, 2017, 12(1): 67-67.
11. Wong JJ, Cheifetz IM, Ong C, et al. Nutrition support for children undergoing congenital heart surgeries: a narrative review. World J Pediatr Congenit Heart Surg, 2015, 6(3): 443-454.
12. Lim HG, Lee JR, Kim YJ. The effects of modification to lateral tunnel fontan procedure for prophylactic arrhythmia surgery. Ann Thorac Surg, 2017, 104(1): 197-204.
13. Hassan BA, Albanna EA, Morsy SM, et al. Nutritional status in children with un-operated congenital heart disease: an Egyptian center experience. Front Pediatr, 2015, 3:53-53.
14. Batte A, Lwabi P, Lubega S, et al. Wasting, underweight and stunting among children with congenital heart disease presenting at Mulago hospital, Uganda. BMC Pediar, 2017, 17(1): 10-10.
15. Hill G, Silverman A, Noel R, et al. Feeding dysfunction in single ventricle patients with feeding disorder. Congenit hear Dis, 2014 9(1): 26-29.
16. Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease: a challenge in children. Curr Opin Cardiol, 2013, 28(2): 122-129.
17. Gewillig M, Brown SC. The Fontan circulation after 45 years: update in physiology. Heart, 2016, 102(14): 1081-1086.