Differences In ICU Recovery In Patients With Congenital Heart Disease

Objective:Through the assessment of the infants' nutritional status with congenital heart disease in PICU fuwai hospital and to discuss the incidence of malnutrition in infants and young children with congenital heart disease,to analyze its relationship with clinical outcomes,provide theoretical basis for the regular nutrition risk assessment for congenital heart disease and nutritional support treatment.Methods:From January 2015 to January 2016 children with congenital heart disease surgery under the age of 2 were selected for congenital heart disease surgery risk grading RACHS-1.We set the inclusion criteria and exclusion criteria,collect children with preoperative,intraoperative and postoperative clinical data,value the nutritional status of children with congenital heart disease,compare the differences in the clinical indicators of malnutrition children and normal nutrition children,analysis the risk factors of children with malnutrition in congenital heart disease,the relevance of malnutrition in congenital heart disease and clinical outcomes.Results:In children with a total of 532 cases,306 cases of male,female 226,age(median)9months,weight when the operation(median)7.8 kg,birth weight(median)3.2 kg,height 73.0± 17.1cm,preoperative Hgb 128.2±28.3g/L,preoperative serum albumin 42.3 ± 3.7g/L,extracorporeal circulation time is 94.6 ± 71.4min,aorta blocking time 57.0±42.lmin,mechanical ventilation(median)11 hours time,ICU stay time 2 days,complications 94 cases,17%of the total,including 16 cases of death,accounting for 3%.Malnutrition children in 309 and non malnourished children in 223 cases,comparison between the two groups preoperative,intraoperative and postoperative data,RACHS-1 grade had no significant difference.But weight,height before operation,birth weight between the two groups,there were significant differences.In preoperative test,preoperative Hgb,serum albumin was not statistically different.In the postoperative indicators,postoperative mechanical ventilation time in malnutrition group was significantly prolonged,and there were statistical differences,and ICU retention time was not statistically significant,P value was 0.059,close to the statistical significance P value.Postoperative complications,malnutrition in 60 cases,accounting for the total number of cases in the group of 19.4%,non malnutrition group of complications occurred in 34 cases,accounting for the total number of cases in the group of 15.20%,the incidence of the two groups was no significant difference.Multivariate analysis found that children in malnutrition group with congenital heart disease,age,low birth weight can exacerbate malnutrition.Complications were refined,in malnutrition group secondary intubation rate and mortality rate was significantly more than non malnutrition children,and has statistical significance,other complications between the two groups were not significantly different.Conclusion:The malnutrition ratio in in infants and young children with congenital heart disease is on the high side.The severity of malnutrition has relationship with the surgery age and low birth weight.Malnourished children with congenital heart disease have prolonged mechanical ventilation,secondary intubation rate and mortality rate,which is higher than the children with non malnutrition.In the future we need nutrition evaluation system,and set up a complete congenital heart disease nutritional support strategies,in order to improve clinical outcomes.Objective:To analyze the early outcome of surgical treatment of Anomalous Left Coronary Artery From the Pulmonary Artery(ALCAPA)in our hospital and to summarize the early treatment experience of this disease,in order to make clear the relationship of cardiac function changes and postoperative outcomes.Methods:A total of 65 patients with Anomalous Left Coronary Artery From the Pulmonary Artery surgery,37 males and 28 females were enrolled in our hospital from January 2012 to December 2016,and collect the preoperative cardiac function index,Postoperative ultrasound,postoperative ventilator time,ICU retention time and other related indicators.Of all 65 patients underwent Ejection Fraction(EF)30%preoperative group,EF<30%of children in 26 cases,the remaining 39 cases,compared between the two groups of monitoring indicators of the differences.Results:65 patients were selected,37 males and 28 females,median age(median),preoperative weight(median)8.5 kg,preoperative EF 44.23 ±22.6%,left ventricular size 39.69 ± 7.73 mm,The time of cardiopulmonary bypass was 121.67 ± 56.04min,the aortic occlusion time(median)was 67min,22 cases were treated with mitral valve replacement due to large mitral regurgitation,ventilator support time,(mecdian)ICU retention time(median)3 days,death in 2 cases,secondary intubation in 7 cases,ECMO in 3 cases,delayed chest closure in 8 cases,6 cases of peritoneal dialysis.For EF 30%as the grouping index,EF<30%of the children in 26 cases,the remaining 39 cases,compared the two groups of preoperative,EF<30%of children age,body weight was significantly smaller than EF ? 30%group,and EF ?30%group of children with preoperative left ventricular size less than EF<30%group of children,and a statistically significant difference.There was no significant difference in cardiopulmonary bypass time,aortic occlusion time and ECMO between the two groups.The number of mitral valve formation in EF?30%group was significantly higher than that in EF<30%group.The number of delayed sternal closure was signifieantly higher in EF<30%group than in EF? 30%group,and the difference was statistically significant.Mortality ratio,the overall death of 2 people,were EF<30%group of children,the two groups were no significant difference.There was no significant difference in EF between the control group and the control group.The EF was significantly different from the preoperation.Left ventricular size,extubation left ventricular size was significantly smaller than the size of the left ventricular left before discharge was significantly smaller than the left ventricular size before surgery.Conclusion:Anomalous Left Coronary Artery From the Pulmonary Artery of children with early results satisfactory,most patients with cardiac function and mitral regurgitation will have different degrees of improvement.Poor cardiac function had a significant effect on early postoperative outcomes.EF<30%of children had postoperative ICU time,significantly prolonged use of ventilator,secondary intubation,delayed sternal closure,and increased risk of renal replacement therapy Longer delay recovery process.