肥胖是腔肺双向分流术成本增加的风险因素

　　腔静脉肺动脉双向分流术（BDG）是治疗肺血减少型复杂性先天性心脏病的有效姑息手术。有研究表明，对于实施该手术的左心发育不全综合征的患儿而言，低体重提示结局不良、机械通气时间及重症监护病房（ICU）住院时间延长。

　　为了探讨超重与接受BDG患儿机械通气及ICU住院时间的相关性，美国范德堡大学医学中心回顾分析了2010年1月～2015年6月的123例BDG患儿。

　　结果发现，超重患儿（z评分＞90%）与正常体重患儿（z评分5%～90%）相比，机械通气时间（P=0.001）和ICU入住时间（P=0.004）更长。

　　因此，肥胖是BDG重症患儿机械通气及ICU入住时间延长的风险因素。

JPEN J Parenter Enteral Nutr. 2017;41(2):266-267.

Obesity: risk factor for increased resource utilization at bidirectional Glenn.

Ashley C. Newell; Kelly Davis; Mark Clay.

Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) published data in 2012 revealing that patients with hypoplastic left heart syndrome who failed to meet their interstage caloric recommendations and who had lower weight-for-age z scores at the time of their bidirectional Glenn (BDG) were at increased risk for adverse outcomes and were more likely to have increased resourced utilization. The purpose of our study was to determine whether patients who exceeded caloric recommendations as defined by weight-for-length z score greater than the 90th percentile were also at increased risk for resource utilization as defined by mechanical ventilation times and intensive care unit (ICU) length of stay.

Methods: All infants at our institution undergoing BDG from January 2010 to June 2015 were included unless they had significant atrioventricular valvular regurgitation, significant single-ventricle dysfunction, pulmonary vascular resistance >3 woods units, diaphragmatic paralysis, or significant unrepaired anatomical lesions such as pulmonary vein stenosis and pulmonary artery stenosis. Patient demographics, original anatomy, operative procedure, cardiopulmonary bypass times, and complications were recorded. Mechanical ventilation hours and ICU length of stay were recorded as surrogates of resource utilization. Patients were divided into 3 categories: (1) underweight (z score <5th percentile), (2) healthy weight (z score 5th-90th percentile), and (3) overweight (z score >90th percentile). The median age at time of BDG was 159 days (interquartile range, 129-203), and mean weight-for-length z score was −0.48.

Results: Approximately 15% of patients were overweight, 65% were healthy weight, and 20% of patients were underweight. Of those who were underweight compared with those who were a healthy weight, there was no difference in mechanical ventilation time (P = .734) or ICU length of stay (P = .366). However, overweight patients compared with those who were of a healthy weight had significantly longer mechanical ventilation times (P = .001) and longer ICU lengths of stay (P = .004).

Conclusions: Our data suggest that single-ventricle patients who exceed their caloric recommendations and are overweight at the time of their BDG are at significantly increased risk for resource utilization compared with those who meet or fail to meet their caloric recommendations. This could pose a different target for interstage risk caloric recommendations

DOI: 10.1177/0148607116686023