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

摘要：

目的 探讨肺移植患儿术后生长发育的纵向变化特征及其相关影响因素，为临床制订肺移植患儿术后生长发育管理方案提供参考。 方法 采用回顾性研究设计，通过便利抽样法，选取2021年1月—2023年10月在杭州市某三级甲等综合医院接受肺移植并完成至少24个月随访的患儿作为研究对象，收集其移植前及术后3、6、12、24个月的生长发育、肺功能、骨密度及糖皮质激素暴露水平。采用年龄别身高Z评分（height-for-age Z score，HAZ）和年龄别BMI Z评分（BMI-for-age Z score，BAZ）评估生长发育水平，并以HAZ、BAZ评分变化值反映生长发育速率。采用描述性统计分析变化趋势，采用Spearman相关分析探讨生长发育速率与肺功能、骨密度及糖皮质激素暴露水平的关系。 结果 共纳入11例肺移植患儿。术后24个月HAZ总体呈改善趋势，中位数由-1.27（-1.70，-1.05）升至-0.77（-1.85，-0.34）。BAZ由移植前的-2.48（-4.22，-0.44）升至术后12个月的0.11（-0.29， 0.91），24个月降为-0.36（-1.86，1.34），消瘦比例由移植前的63.64%降至术后12个月的9.09%，24个月升至18.18%。相关性分析显示，身高及BMI增长速率与肺功能呈正相关，与糖皮质激素暴露水平呈负相关，术后早期身高增长速率与骨密度呈负相关（均P<0.05）。结论 肺移植术后患儿生长发育呈改善趋势，可能存在年龄及阶段性差异，骨健康改善相对滞后。糖皮质激素暴露及肺功能变化可能与生长恢复存在关联。临床护理中可加强分阶段管理，促进生长发育与骨健康协同改善。

关键词: 肺移植, 儿童, 生长发育, 护理