关键词: 肺移植, 儿童, 生长发育, 护理

Abstract:

Objective To explore the longitudinal changes in postoperative growth and development and their related factors in pediatric lung transplant recipients，to provide references for the clinical formulation of post-transplant growth and development management protocols for pediatric lung transplant recipients. Methods This was a retrospective study. Using convenience sampling，14 pediatric patients who underwent lung transplantation and completed at least 24 months of follow-up in a tertiary hospital in Hangzhou from January 2021 to October 2023 were included. Data on growth and development，pulmonary function，bone mineral density，and glucocorticoid exposure were collected before transplantation and at 3，6，12，and 24 months after transplantation. Height-for-age Z score（HAZ） and BMI-for-age Z score（BAZ） were used to assess growth and development，and changes in HAZ、BAZ scores were used to reflect growth velocity. Descriptive statistical analysis were used to analyze trends over time，and Spearman correlation analysis was used to explore the relationships between growth velocity and pulmonary function，bone mineral density，and glucocorticoid exposure. Results A total of 11 pediatric patients were included. At 24 months after trans-plantation，HAZ showed an improving trend，with the median increasing from -1.27（-1.70，-1.05） to -0.77（-1.85，-0.34）. BAZ increased from -2.48（-4.22，-0.44） before transplantation to 0.11（-0.29，0.91） at 12 months and was -0.36（-1.86，1.34） at 24 months. The proportion of undernutrition decreased from 63.64% to 9.09% at 12 months and was 18.18% at 24 months. Correlation analysis showed that height and BMI growth velocity were positively correlated with pulmonary function and negatively correlated with glucocorticoid exposure，while early post-transplant height growth velocity was negatively correlated with bone mineral density（all P<0.05）. Conclusion Growth and development in pediatric lung transplant recipients showed an improving trend，with possible age- and stage-related differences，and bone health improvement appeared relatively delayed. Glucocorticoid exposure and pulmonary function changes may be associated with growth recovery. Phase-specific management may help promote the coordinated improvement of growth and bone health.

Key words: Lung Transplantation, Pediatric Children, Growth and Development, Nursing Care