| Background and ObjectiveCoronary atherosclerotic heart disease means to heart disease resulted from coronary artery atherosclerosis causing vascular cavity stenosis or occlusion,giving rise to myocardial ischemia and hypoxia or even necrosis,also known as coronary heart disease(CHD),or ischemic heart disease.Epidemiological data show that with the aging of Chinese population and the continuous improvement of inhabitants’ living standards,the incidence of coronary heart disease is increasing year by year since 2012 and the age of onset is becoming younger,which has become a serious social public health problem.At present,the treatment of coronary heart disease has formed a standardized clinical path.The conventional surgical treatment is mainly based on Percutaneous coronary intervention(PCI),which has the advantages of smaller wound and quicker effect,and has become the preferred surgical treatment for patients with coronary heart disease.According to the China Cardiovascular Health and Disease Report 2021,there are about 11.39 million patients with coronary heart disease in China,about 35% of whom will be treated by percutaneous coronary intervention surgery.At present,the focus and difficulty of surgical treatment for coronary heart disease lies in the prevention and treatment of surgical complications and postoperative restenosis in stents.In addition to the improvement of clinical diagnosis and treatment technology,nutritional status of patients,especially perioperative nutritional status,is one of the important factors affecting the postoperative complications and mortality of PCI patients.A study has shown that 72% of cardiovascular deaths are directly or indirectly caused by dietary factors;Newest studies have shown that malnutrition is an independent risk factor for all-cause mortality during short-and long-term follow-up after PCI.Whether it is disease prevention,intraoperative adjuvant treatment,or postoperative recovery,healthy nutrition concept and reasonable nutrition treatment should be throughout and have a very positive role.The rational implementation of nutritional therapy depends on accurate nutritional assessment of patients.Due to the limitations of traditional nutrition assessment methods in cost,applicability and objectivity,a more convenient and objective new method is urgently needed to facilitate the comprehensive treatment of PCI patients with coronary heart disease.Bioelectrical impedance analysis(BIA)technology is an objective,non-invasive,simple and rapid new technology for measuring body composition and assessing clinical nutritional risk.It can effectively make up for the deficiency of conventional nutritional assessment methods.The derived Phase angle(PA)reflects the health degree of cells and the nutritional status of the body to some extent.Inflammation,disease,malnutrition and chronic physical inactivity adversely affect the bioelectrical properties of body tissues,resulting in significantly lower phase values than in healthy individuals.In recent years,phase Angle has been widely used to evaluate the nutritional status of inpatients and predict the clinical outcome because it can timely and accurately evaluate the nutritional status of inpatients.Heart failure and water and sodium retention are common manifestations of cardiac function impairment in patients with coronary heart disease.Human body component analysis can monitor the intracellular and external water content of patients in real time,so as to judge the degree of water and sodium retention in patients.Therefore,human body component analysis can well unify the nutritional status and cardiac function of patients with coronary heart disease.For the nutritional assessment of patients with PCI of coronary heart disease,whether body component analysis is more accurate and objective than other conventional assessment methods is an urgent question for us to verify.However,the application of phase Angle in nutritional evaluation of patients undergoing PCI for coronary heart disease is rarely reported at present.Due to the different pathophysiological mechanisms of various diseases,the response of body composition changes may be different.Therefore,the changes and related mechanisms of phase Angle measurement in patients in various systemic diseases have not been clarified.All these restrict the application of bioelectrical impedance technology in cardiovascular patients to some extent.In summary,the purpose of this study was to investigate the application of body composition analysis to evaluate perioperative nutritional status of PCI patients with coronary heart disease,and the application of body composition analysis related indicators to evaluate the effect of perioperative precision nutritional therapy and clinical outcome of PCI patients with coronary heart disease.In view of the above situation,in this study,inpatients who underwent PCI surgery in the Department of Cardiology,the Second Affiliated Hospital of Army Medical University were recruited from April 2021 to July 2022 according to inclusion and exclusion criteria.Various indexes of perioperative body composition analysis,some laboratory indexes and nutrition-related indexes of these patients were collected.In the second part of the study,patients who met study inclusion criteria were randomly grouped and different nutritional treatment plans were implemented to verify the application value of phase Angle value in perioperative nutritional evaluation of patients with coronary heart disease PCI,and to explore the influence of different nutritional treatment methods on patients’ therapeutic effect and clinical outcome,so as to provide evidence-based medical evidence for perioperative nutritional treatment of patients with coronary heart disease PCI.MethodsIn this study,a cross-section design was used to enroll hospitalized patients who underwent PCI in the Department of Cardiology,Second Hospital Affiliated to the Army Medical University from April to July 2021,based on inclusion and exclusion criteria.Basic data and NRS-2002 nutritional risk screening were collected by questionnaires.Inbody-S10 body composition analyzer was used for body composition analysis and measurement.Data from nutrition-related laboratory tests were recorded.In addition,the dietary intake of patients within three days was recorded,calculated and evaluated in detail by using a 3-day24-hour dietary questionnaire.According to inclusion and exclusion criteria,a total of 120 patients were joined in the study,and every patients signed informed consent before they were joined.The observation indicators included phase Angle,ECW/TBW,NRS-2002 nutritional risk screening,nutrition-related hematological indicators such as prealbumin,albumin and hemoglobin,heart-failure related indicators such as NT-pro BNP,and perioperative energy,protein,fat,some vitamins,minerals and trace elements intake of patients.SPSS 27.0 software was exerted for statistics and analysis of the collected data.Measurement data with non-normal distribution were expressed as median(interquartile distance),and measurement data with normal distribution was expressed as x±s.Independent sample t test was applied for contrast between the two groups of data,and Pearson correlation analysis was exerted for correlation test.Spearman rank correlation test was used for rank data.Test level α = 0.05.The correlation between phase Angle value and preoperative indexes in patients with coronary heart disease PCI was analyzed,and the application of bioelectrical impedance phase Angle in nutritional risk screening,nutritional status assessment and heart failure monitoring in patients with coronary heart disease PCI was discussed.(2)A randomized controlled clinical trial was used to collect hospitalized patients admitted to the Department of Cardiology,the Second Affiliated Hospital of Army Medical University from April to July 2022 for PCI surgery.According to the inclusion and exclusion criteria,a total of 80 patients were included in the study and randomly divided into the control group(40 cases receiving conventional perioperative dietary nutrition)and the intervention group(40 cases receiving conventional perioperative dietary + nutritional therapy).Baseline data,blood routine,blood biochemistry,markers of heart failure and other relevant indicators before and after surgery were recorded in both groups.Bioelectrical impedance technology was used to measure the phase Angle and other related indicators before and after surgery.The length of hospital stay,hospital cost and readmission rate within 3 months were counted.The differences in nutritional status,cardiac function and clinical outcomes between the two groups were comprehensively evaluated.SPSS 27.0 was applied for statistical analysis of all the collected data.x±s was used to describe the measurement data with normal distribution and homogeneous variance,and the median(interquartile spacing)was exerted to express the measurement data with non-normal distribution.Paired sample t test was applied for intra-group comparison,and independent sample t test was exerted for inter-group comparison.The comparison between groups of non-normally distributed data uses the non-parametric rank sum test,and to compare the rates of patient between two groups,we applied the chi-square test.Test level α= 0.05.To analyze and evaluate whether there are differences in patients’ nutritional status,cardiac function level and short-term clinical outcome under two different nutrient intake conditions,and to explore the effect of perioperative precision nutrition therapy on PCI patients with coronary heart disease and its influence on clinical outcome.Results1.Correlation between phase Angle and preoperative indexes in patients with coronary heart disease of PCI.The phase Angle value of PCI patients with coronary heart disease was negatively correlated with ECW/TBW(P < 0.001),and positively correlated with nutrition-related indexes such as BMI(P < 0.001),albumin(P < 0.05),hemoglobin(P < 0.001)and prealbumin(P < 0.001).Phase Angle was significantly negatively correlated with NRS-2002 score(P < 0.001),and negatively correlated with heart failure marker NT-pro BNP(P < 0.05).2.Comparison of clinical efficacy and outcome of precision nutrition therapy for PCI patients with coronary heart disease.Patients’ phase Angle value,ECW/TBW were significantly correlated with nutrition-related indexes and cardiac function related indexes(P < 0.001).There were no significant differences in preoperative phase Angle value,ECW/TBW,blood routine and heart failure markers between 2 groups(P > 0.05).The difference of phase Angle before and after operation(△value)was significantly higher in the intervention group than in the control group(-0.18 ± 0.31 vs 0.32 ± 1.1,P < 0.05),and the △ ECW/TBW in the intervention group was significantly lower than that in the control group(0.0001±0.0042vs-0.003±0.0045,P < 0.05).Heart failure marker NT-pro BNP after surgery in control group was significantly more than than before surgery(173[62.8,1076.5] vs236.5[45,1006.8],P < 0.05).And there was no significant change in the intervention group(188.1[73,1093.4] vs 191[39.5,1148.3],P > 0.05).NYHA score 3 months after operation in the intervention group was significantly more exceptional than in the control group(P <0.05).The readmission rate for cardiovascular disease within 3 months in the intervention group was significantly lower than in the control group(12.5% vs 0%,P < 0.05).There was no significant difference in hospitalization duration and hospitalization expense between the two groups(P > 0.05).Conclusion1.The phase Angle is closely related to the nutritional risk,nutritional status and the level of markers of heart failure in patients with coronary heart disease PCI.It is suggested that the preoperative application of phase Angle is helpful for perioperative nutritional risk identification and nutritional status assessment in patients with PCI.2.After optimal perioperative nutrition treatment,the phase angle value of PCI patients with coronary heart disease was significantly increased,suggesting that the nutritional status of patients was improved,the risk of malnutrition was reduced,and the cardiac function of patients was improved,and the readmission rate was significantly decreased in the short term.In conclusion,perioperative precise nutritional therapy for PCI patients with coronary heart disease is conducive to improving the nutritional status of patients during the perioperative period,and has a positive effect on the clinical comprehensive therapeutic effect and clinical outcome.Meanwhile,it is also found that bioelectrical impedance technology has a good value of expansion and application in the nutritional diagnosis and treatment of patients with coronary heart disease. |
PDF Full Text Request