肝移植患儿术后营养状况变化的影响因素分析及护理启示

doi:10.3761/j.issn.0254-1769.2025.09.014

摘要/Abstract

摘要：

目的了解肝移植手术患儿出院后6个月内的营养状况变化趋势并探讨其影响因素，为临床制订个性化的营养干预方案提供指导。方法采用便利抽样法，于2023年1月—2024年1月，选取在杭州市某三级甲等医院肝移植中心行肝移植手术的153例患儿为调查对象，收集其基本资料及临床资料，通过儿童营养状况的标准差评价方法评估其术前1 d及出院后1、3、6个月的营养状况，并根据其营养状况变化趋势进行分组分析。采用单因素分析和多因素Logistic回归分析肝移植患儿术后营养状况变化的影响因素。结果最终纳入144例肝移植患儿。肝移植患儿出院后1、3、6个月时营养不良发生率分别为66.0%、54.9%和53.5%。根据肝移植患儿营养状况变化趋势分为营养状况良好组54例（37.5%）、营养状况波动组24例（16.7%）、营养状况不良组66例（45.8%）。多因素Logistic回归分析结果显示，出生体重、出生后6个月内喂养方式、照顾者年龄及营养知识学习情况是肝移植患儿术后发生营养状况变化的影响因素（P<0.05）。结论肝移植患儿出院后6个月内营养不良发生率高，医护人员应与家庭紧密合作，依据患儿的具体情况和影响因素，制订并实施阶段性的个性化营养干预措施，有效改善移植患儿术后的营养状况。

关键词: 肝移植, 营养评价, 影响因素分析, 儿科护理学

Abstract:

Objective To understand the changing trend of nutritional status of children undergoing liver transplantation within 6 months after discharge，and to explore its influencing factors，in order to provide guidance for the clinical formulation of personalized nutritional intervention programs. Methods By the convenient sampling method，153 children undergoing liver transplantation admitted to the liver transplantation center of a tertiary A hospital in Hangzhou from January 2023 to January 2024 were selected as the research subjects. Their basic and clinical data were collected. The nutritional status at the 1 day before surgery and 1 month，3 months，and 6 months after discharge was evaluated by the standard deviation evaluation method of children’s nutritional status. According to the changing trend of their nutritional status，they were grouped. Univariate and multivariate Logistic regression were used to analyze the influencing factors of the changing trend of nutritional status in children undergoing liver transplantation. Results A total of 144 children who underwent liver transplantation were ultimately included in the study. The incidence of malnutrition at 1 month，3 months，and 6 months after discharge was 66.0%，54.9%，and 53.5%，respectively. According to the changing trend of nutritional status of children undergoing liver transplantation，they were divided into 3 groups：54 cases（37.5%） in the good nutritional status group，24 cases（16.7%） in the fluctuating nutritional status group，and 66 cases（45.8%） in the poor nutritional status group. The results of multivariate Logistic regression analysis showed that birth weight，feeding method within 6 months after birth，age of caregivers and learning situation of nutritional knowledge were the influencing factors of the changing trend of nutritional status in children undergoing liver transplantation（P<0.05）. Conclusion The incidence of malnutrition in children undergoing liver transplantation is high within 6 months after discharge； medical staff should closely collaborate with families to formulate and implement staged personalized nutritional intervention measures based on the specific conditions and influencing factors of the children to effectively improve the nutritional status of the children after transplantation.

Key words: Liver Transplantation, Nutritional Evaluation, Root Cause Analysis, Pediatric Nursing

杨静, 王华芬, 卢芳燕, 鲍瑞洁, 朱莉. 肝移植患儿术后营养状况变化的影响因素分析及护理启示[J]. 中华护理杂志, 2025, 60(9): 1113-1119.

YANG Jing, WANG Huafen, LU Fangyan, BAO Ruijie, ZHU Li. Analysis influencing factors of nutritional status changes in pediatric liver transplant patients and nursing revelation[J]. Chinese Journal of Nursing, 2025, 60(9): 1113-1119.

图/表 3

表1 调查对象的一般资料及术后营养状况变化的单因素分析

Table 1 Univariate analysis of the general data and postoperative nutritional status of the subjects

表2 变量赋值方式

Table 2 Variable assignment method

表3 肝移植患儿术后营养状况变化的多因素Logistic回归分析（n=144）

Table 3 Multivariate Logistic regression analysis of postoperative nutritional status of children with liver transplantation（n=144）

参考文献 24

[1]	夏强, 朱欣烨. 儿童肝移植发展现状及展望[J]. 临床小儿外科杂志, 2022, 21(5):401-404.
	Xia Q, Zhu XY. Current development and future outlook of pediatric liver transplantation[J]. J Clin Pediatr Surg, 2022, 21(5):401-404.
[2]	中华医学会器官移植学分会. 中国儿童肝移植操作规范(2019版)[J]. 中华移植杂志(电子版), 2019, 13(3):181-186.
	Branch of Organ Transplantation of Chinese Medical Associa-tion. Technical specification for pediatric liver transplantation in China(2019 edition)[J]. Chin J Transplant Electron Ed, 2019, 13(3):181-186.
[3]	张丽, 陆晔峰, 张志娟. 转换方案改善肝移植患儿术后生活质量和自我管理能力的效果[J]. 护理研究, 2021, 35(19):3504-3506.
	Zhang L, Lu YF, Zhang ZJ. Effects of the transition plan on improving the quality of life and self-management ability of children after liver transplantation[J]. Chin Nurs Res, 2021, 35(19):3504-3506.
[4]	Oey RC, Aarts P, Erler NS, et al. Identification and prognostic impact of malnutrition in a population screened for liver transplantation[J]. Clin Nutr ESPEN, 2020,36:36-44.
[5]	卢芳燕, 董丽, 刘元, 等. 儿童肝移植围手术期护理质量评价指标体系的构建[J]. 中华护理杂志, 2022, 57(6):666-673. DOI
	Lu FY, Dong L, Liu Y, et al. Establishment of quality evalua-tion indicator system for perioperative nursing in pediatric liver transplantation[J]. Chin J Nurs, 2022, 57(6):666-673.
[6]	崔向丽, 沈素, 孙丽莹, 等. 儿童肝移植围手术期营养风险评估及营养支持要点[J]. 中华器官移植杂志, 2021, 42(9):566-569.
	Cui XL, Shen S, Sun LY, et al. Perioperative nutritional risk assessment and key points of nutritional support for pediatric liver transplantation[J]. Chin J Organ Transplant, 2021, 42(9):566-569.
[7]	Perteet-Jackson AD, Earthman CP, Larson-Nath CM. Body com-position post pediatric liver transplant:implications and assess-ment[J]. Nutr Clin Pract, 2021, 36(6):1173-1184. DOI PMID
[8]	Hammad A, Kaido T, Aliyev V, et al. Nutritional therapy in liver transplantation[J]. Nutrients, 2017, 9(10):1126.
[9]	国家卫生健康委员会. 《7岁以下儿童生长标准》[EB/OL].(2022-09-19)[2024-08-11]. http://www.nhc.gov.cn/cms-search/downFiles/e38068f0a62d4a1eb1bd451414444ec1.pdf.
	National Health Commission. Growth standards of children un-der 7 years old[EB/OL].(2022-09-19)[2024-08-11]. http://www.nhc.gov.cn/cms-search/downFiles/e38068f0a62d4a1eb1bd451414-444ec1.pdf.
[10]	Pawaria A, Khanna R, Sood V, et al. Subjective global nutritio-nal assessment as a nutritional tool in childhood chronic liver disease[J]. Br J Nutr, 2022, 127(6):904-913.
[11]	蔺宁, 孔明, 段钟平. 肝病肌肉减少症发病机制研究进展[J]. 实用肝脏病杂志, 2022, 25(2):301-304.
	Lin N, Kong M, Duan ZP. Pathogenesis of sarcopenia in liver diseases[J]. J Pract Hepatol, 2022, 25(2):301-304.
[12]	韩林, 李敏敏, 李雨欣, 等. 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. DOI
	Han L, Li MM, Li YX, et al. Construction and verification of a risk prediction model for postoperative malnutrition in infants with congenital heart disease[J]. Chin J Nurs, 2024, 59(19):2396-2403. DOI
[13]	庞玉冰, 仝子凡, 刘文强, 等. 全身免疫炎症系数、预后营养指数对早产儿早发型败血症的预测价值[J]. 中国小儿急救医学, 2024, 31(5):327-332.
	Pang YB, Tong ZF, Liu WQ, et al. Predictive value of sys-temic immune-inflammation index and prognostic nutrition index in preterm infants with early-onset sepsis[J]. Chin Pediatr Emerg Med, 2024, 31(5):327-332.
[14]	中华预防医学会儿童保健分会. 婴幼儿喂养与营养指南[J]. 中国妇幼健康研究, 2019, 30(4):392-417.
	The Child Health Care Branch of the Chinese Preventive Medical Association. Guide to infant feeding and nutrition[J]. Chin J Woman Child Health Res, 2019, 30(4):392-417.
[15]	查新祎. 母乳中生长因子的生物学功能研究进展[J]. 国际儿科学杂志, 2020, 47(1):55-58.
	Zha XY. Biological functions of growth factors in breast milk[J]. Int J Pediatr, 2020, 47(1):55-58.
[16]	中国研究型医院学会加速康复外科专业委员会. 儿童肝移植围手术期管理专家共识[J]. 中华外科杂志, 2021, 59(3):179-191.
	Enhanced Recovery after Surgery Committee of Chinese Re-search Hospital Association. Expert consensus of perioperative management in pediatric liver transplantation[J]. Chin J Surg, 2021, 59(3):179-191.
[17]	Blackmore A, Howell B, Romme K, et al. The effectiveness of virtual lactation support:a systematic review and meta-analy-sis[J]. J Hum Lact, 2022, 38(3):452-465. DOI PMID
[18]	Atoloye AT, Samuel F, Aluko OO, et al. Factors associated with caregivers’ food safety knowledge,behavior,perception of food safety control,and the nutrition status of under-5 children in Nigeria[J]. BMC Public Health, 2024, 24(1):2813.
[19]	王超群, 俞梦盈, 刘畅, 等. 老年慢性心力衰竭患者照顾者准备度现状及影响因素分析[J]. 中华护理杂志, 2024, 59(14):1706-1712.
	Wang CQ, Yu MY, Liu C, et al. The status of caregiver rea-diness of elderly patients with chronic heart failure and its influencing factors[J]. Chin J Nurs, 2024, 59(14):1706-1712.
[20]	张莎莎, 张芳. 慢性病儿童照顾者照顾负担影响因素及相互作用关系的研究进展[J]. 中华现代护理杂志, 2023, 29(9):1148-1152.
	Zhang SS, Zhang F. Research progress on influencing factors and interaction of care burden of caregivers for children with chronic disease[J]. Chin J Mod Nurs, 2023, 29(9):1148-1152.
[21]	李辉霞, 黄广文, 王华, 等. 湖南省六岁以下儿童营养不良现状及影响因素分析[J]. 中华儿科杂志, 2021, 59(9):759-766. PMID
	Li HX, Huang GW, Wang H, et al. Prevalence and associated factors for malnutrition among children under 6 years of age in Hunan province[J]. Chin J Pediatr, 2021, 59(9):759-766. DOI PMID
[22]	涂惠琼, 龙秀红, 沈琴庆. 148例先天性心脏病患儿术后主要照顾者的居家康复护理需求现状及影响因素分析[J]. 护理学报, 2021, 28(1):45-50.
	Tu HQ, Long XH, Shen QQ. Status quo of nursing needs during home rehabilitation in main caregivers of children with congenital heart disease after surgery and its influence factors:a 148-case study[J]. J Nurs(China), 2021, 28(1):45-50.
[23]	沈子颜, 王艳, 唐诗, 等. 肝移植儿童照护者疾病进展担忧现状及影响因素分析[J]. 中国护理管理, 2024, 24(11):1641-1645.
	Shen ZY, Wang Y, Tang S, et al. Fear of progression of caregivers of children receiving liver transplantation and its influencing factors[J]. Chin Nurs Manag, 2024, 24(11):1641-1645.
[24]	王燕, 卢芳燕, 汤洒潇. 6例终末期肝病合并先天性心脏病患儿行肝移植的术后护理[J]. 中华护理杂志, 2021, 56(10):1544-1548. DOI
	Wang Y, Lu FY, Tang SX. Postoperative nursing care of 6 children with end-stage liver disease combined with conge-nital heart disease undergoing liver transplantation[J]. Chin J Nurs, 2021, 56(10):1544-1548.