先天性心脏病术后患儿营养不良风险预测模型的构建及验证研究

doi:10.3761/j.issn.0254-1769.2024.19.013

摘要/Abstract

摘要：

目的构建先天性心脏病术后患儿营养不良风险预测模型，进行内部及外部验证。方法采用便利抽样法，选取2018年1月—2021年12月山东省某三级甲等医院收治的300例6月龄以下的先天性心脏病术后患儿作为建模组，选取2022年1月—2023年6月收治的129例患儿作为验证组。回顾性收集患儿的一般资料、疾病相关资料、治疗和护理相关资料，通过单因素、Logistic回归分析构建先天性心脏病术后患儿营养不良风险预测模型，绘制列线图并评价其预测效果。结果先天性心脏病术后患儿营养不良发生率为33.10%，Logistic回归分析结果显示，出生体重<2.5 kg、术前营养不良、术后1周液体负平衡、体外循环时间较长是患儿发生营养不良的危险因素（P<0.05）。该模型建模组受试者操作特征曲线下面积为0.933，灵敏度为83.30%，特异度为90.90%，Hosmer-Lemeshow检验显示，χ²=7.765（P=0.457）。验证组受试者操作特征曲线下面积为0.918，灵敏度为87.20%，特异度为90.00%，Hosmer-Lemeshow检验显示，χ²=4.947（P=0.763）。两组校准曲线均显示，该模型具有较好的校准度；临床决策曲线显示，该模型具有较好的临床实用性。结论该研究构建的风险预测模型具有较好的预测能力，可为医护人员早期识别先天性心脏病术后营养不良高危患儿，制订针对性干预措施提供参考。

关键词: 先天性心脏病, 营养不良, 风险预测模型, 儿科护理学

Abstract:

Objective To develop a risk prediction model for postoperative malnutrition in children with congenital heart disease（CHD） and to verify it both internally and externally. Methods By a convenience sampling method，300 CHD children treated at a tertiary hospital in Shandong Province from January 2018 to December 2021 were selected as a modeling group，and 129 children from January 2022 to June 2023 were selected as a validation group. Data on patient demographics，disease-specific variables，therapeutic interventions，and nursing care parameters were collected. Single factor and logistic regression were employed to construct a risk prediction model for postoperative malnutrition in CHD children，and the nomogram was drawn and its prediction effect was evaluated. Results The incidence of postoperative malnutrition among CHD children was 33.10%. Logistic regression analysis revealed that risk factors for malnutrition in children included birth weight<2.5 kg，preoperative malnutrition，negative fluid balance 1 week after surgery，and long duration of cardiopulmonary bypass（P<0.05）. The area under the receiver operating characteristic curve of the modeling group was 0.933；the sensitivity was 83.30%；the specificity was 90.90%. The Hosmer-Lemeshow test showed that χ²=7.765（P=0.457）. The AUC of the validation group was 0.918；the sensitivity was 87.20%；the specificity was 90.00%. The Hosmer-Lemeshow test showed that χ²=4.947（P=0.763）. Calibration curves for both groups indicated good calibration of the model，and the clinical decision curves demonstrated its practical clinical utility. Conclusion The risk prediction model developed in this study exhibits good predictive ability，which can provide a reference for medical staff to early identify high-risk infants for postoperative malnutrition following CHD surgery and to formulate targeted intervention measures.

Key words: Congenital Heart Disease, Malnutrition, Risk Prediction Model, Pediatric Nursing

韩林, 李敏敏, 李雨欣, 陆柳伊, 张琦, 王雪婷, 鞠萍, 杨丽娟. 先天性心脏病术后患儿营养不良风险预测模型的构建及验证研究[J]. 中华护理杂志, 2024, 59(19): 2396-2403.

HAN Lin, LI Minmin, LI Yuxin, LU Liuyi, ZHANG Qi, WANG Xueting, JU Ping, YANG Lijuan. Construction and verification of a risk prediction model for postoperative malnutrition in infants with congenital heart disease[J]. Chinese Journal of Nursing, 2024, 59(19): 2396-2403.

图/表 6

表1 先天性心脏病术后患儿的一般资料及营养不良的单因素分析结果

Table 1 The general information and univariate analysis of malnutrition in children with CHD after surgery

表2 自变量赋值情况

Table 2 The assignment of the independent variables

表3 先天性心脏病术后患儿营养不良的Logistic回归分析结果(n=300)

Table 3 Multivariate Logistic regression analysis of the influencing factors of postoperative malnutrition in children with CHD(n=300)

图1 先天性心脏病术后患儿营养不良发生风险预测模型列线图

Figure 1 Predictive nomogram for postoperative malnutrition in children with CHD

图2 建模组先天性心脏病术后患儿营养不良风险预测模型的受试者操作特征曲线

Figure 2 Receiver operating characteristic curve of the modeling group for predicting the risk of postoperative malnutrition in children with CHD

图3 验证组先天性心脏病术后患儿营养不良风险预测模型的受试者操作特征曲线

Figure 3 Receiver operating characteristic curve of the validation group for predicting the risk of postoperative malnutrition in children with CHD

参考文献 25

[1]	傅唯佳, 顾莺, 杨玉霞, 等. 先天性心脏病患儿营养风险筛查及评估循证决策支持系统的构建与应用[J]. 中华护理杂志, 2023, 58(17):2059-2066. DOI URL
	Fu WJ, Gu Y, Yang YX, et al. The construction and evaluation of an evidence-based decision support system for the nutrition risk screening of congenital heart disease children[J]. Chin J Nurs, 2023, 58(17):2059-2066. DOI URL
[2]	Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition:a paradigm shift toward etiology-related definitions[J]. JPEN J Parenter Enteral Nutr, 2013, 37(4):460-481.
[3]	张媛媛, 王海燕, 杨巧芳. 双重固定式约束衣在先天性心脏病患儿术后的应用[J]. 中华护理杂志, 2019, 54(1):137-139.
	Zhang YY, Wang HY, Yang QF. The application effect of double fixed binding cloth in children with congenital heart disease surgery[J]. Chin J Nurs, 2019, 54(1):137-139.
[4]	Martini S, Beghetti I, Annunziata M, et al. Enteral nutrition in term infants with congenital heart disease:knowledge gaps and future directions to improve clinical practice[J]. Nutrients, 2021, 13(3):932.
[5]	Brief F, Guimber D, Baudelet JB, et al. Prevalence and associated factors of long-term growth failure in infants with congenital heart disease who underwent cardiac surgery before the age of one[J]. Pediatr Cardiol, 2022, 43(8):1681-1687. DOI PMID
[6]	顾晓蓉, 陈伟敏, 管咏梅. 6个月以下先天性心脏病患儿术后营养摄入状况的调查[J]. 解放军护理杂志, 2016, 33(12):49-50.
	Gu XR, Chen WM, Guan YM. Investigation of postoperative nutrient intake of children with congenital heart disease aged under 6 months[J]. Nurs J Chin PLA, 2016, 33(12):49-50.
[7]	Ross FJ, Radman M, Jacobs ML, et al. Associations between anthropometric indices and outcomes of congenital heart operations in infants and young children:an analysis of data from the Society of Thoracic Surgeons Database[J]. Am Heart J, 2020, 224:85-97.
[8]	李莉娟, 胡春梅, 龚婷, 等. 先天性心脏病患儿术后1年营养不良影响因素分析[J]. 中华儿科杂志, 2023, 61(5):440-445. PMID
	Li LJ, Hu CM, Gong T, et al. Factors associated with malnutrition in infants with congenital heart disease within one year after surgery[J]. Chin J Pediatr, 2023, 61(5):440-445. DOI PMID
[9]	Shi H, Yang D, Tang KC, et al. Explainable machine learning model for predicting the occurrence of postoperative malnutrition in children with congenital heart disease[J]. Clin Nutr, 2022, 41(1):202-210. DOI PMID
[10]	左茜, 苏洁, 陶柯宏, 等. 需体外循环手术干预的先天性心脏病婴幼儿的营养评估[J]. 心脏杂志, 2024, 36(2):191-195.
	Zuo Q, Su J, Tao KH, et al. Nutritional assessment of infants with congenital heart disease requiring surgical intervention with extracorporeal circulation[J]. Chin Heart J, 2024, 36(2):191-195.
[11]	Centeno-Malfaz F, Moráis-López A, Caro-Barri A, et al. Nutrition in congenital heart disease:consensus document[J]. An Pediatr, 2023, 98(5):373-383. DOI PMID
[12]	El-Chouli M, Meddis A, Christensen DM, et al. Lifetime risk of comorbidity in patients with simple congenital heart disease:a Danish nationwide study[J]. Eur Heart J, 2023, 44(9):741-748.
[13]	Hansson L, Lind T, Wiklund U, et al. Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus[J]. Acta Paediatr, 2019, 108(11):1985-1992. DOI
[14]	高华炜, 陈求名, 赵韡, 等. 三种先天性心脏病手术风险评分系统预测效能的比较[J]. 中华心血管病杂志, 2019, 47(5):388-392. PMID
	Gao HW, Chen QM, Zhao W, et al. Predictive value of 3 different risk stratification models for patients after congenital heart surgeries[J]. Chin J Cardiol, 2019, 47(5):388-392. DOI PMID
[15]	何洋, 李文星, 唐军, 等. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2020, 22(10):1047-1055.
	He Y, Li WX, Tang J, et al. Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants(2020)[J]. Chin J Contemp Pediatr, 2020, 22(10):1047-1055.
[16]	Eveleens RD, Joosten KFM, et al. Definitions,predictors and outcomes of feeding intolerance in critically ill children:a systematic review[J]. Clin Nutr, 2020, 39(3):685-693. DOI PMID
[17]	丁文雯, 向奕瑾, 马佳莉, 等. 极低出生体重早产儿校正月龄12个月内体格生长情况及影响因素分析[J]. 中华护理杂志, 2019, 54(1):52-57.
	Ding WW, Xiang YJ, Ma JL, et al. Analysis on features and related factors of physical growth in very low birth weight preterm infants in 12 months of corrected age[J]. Chin J Nurs, 2019, 54(1):52-57.
[18]	林淑皖, 张红, 涂惠琼. 母乳口腔运动干预对婴儿体外循环术后胃肠功能恢复的影响[J]. 护理学杂志, 2022, 37(21):36-39.
	Lin SW, Zhang H, Tu HQ. Impact of olfactory stimulation with breast milk on digestive function recovery in infants after cardiopulmonary bypass[J]. J Nurs Sci, 2022, 37(21):36-39.
[19]	Yilmaz Ferhatoglu S, Yurdakok O, Yurtseven N. Malnutrition on admission to the paediatric cardiac intensive care unit increases the risk of mortality and adverse outcomes following paediatric congenital heart surgery:a prospective cohort study[J]. Aust Crit Care, 2022, 35(5):550-556.
[20]	Wen BJ, Njunge JM, Bourdon C, et al. Systemic inflammation and metabolic disturbances underlie inpatient mortality among ill children with severe malnutrition[J]. Sci Adv, 2022, 8(7):eabj6779.
[21]	Tsintoni A, Dimitriou G, Karatza AA. Nutrition of neonates with congenital heart disease:existing evidence,conflicts and concerns[J]. J Matern Fetal Neonatal Med, 2020, 33(14):2487-2492. DOI PMID
[22]	吴珍, 富智, 缪红军. 先天性心脏病新生儿围手术期营养支持的研究[J]. 肠外与肠内营养, 2017, 24(6):365-368,373.
	Wu Z, Fu Z, Miu HJ. Nutrition support in neonates with congenital heart disease during the perioperative period[J]. Parenter Enter Nutr, 2017, 24(6):365-368,373.
[23]	Banerji N, Sudhakar A, Balachandran R, et al. Early weight trends after congenital heart surgery and their determinants[J]. Cardiol Young, 2020, 30(1):89-94. DOI PMID
[24]	Hatami S, Hefler J, Freed DH. Inflammation and oxidative stress in the context of extracorporeal cardiac and pulmonary support[J]. Front Immunol, 2022, 13:831930.
[25]	Floh AA, McCrindle BW, Manlhiot C, et al. Feeding may modu-late the relationship between systemic inflammation,insulin resistance,and poor outcome following cardiopulmonary bypass for pediatric cardiac surgery[J]. JPEN J Parenter Enteral Nutr, 2020, 44(2):308-317.