先心病患儿的营养.ppt

先天性心脏病患儿 的营养先天性心脏病和营养概述先天性心脏病和营养概述先天性心脏病患儿的生长发育状况先天性心脏病患儿的生长发育状况先天性心脏病患儿营养不良的原因先天性心脏病患儿营养不良的原因 先天性心脏病患儿的喂养先天性心脏病患儿的喂养概概 述述先天性心脏病：约占新生活产的8‰～10‰心脏及大血管解剖结构异常紫绀型及非紫绀型营养：摄取、消化、吸收、代谢及利用身高、体重及智力发育综合素质的提高营养的评估方法：身体测量是最可靠的指标身高、体重、皮褶厚度生长发育状况 大量心内分流 发育迟缓青紫型、心功能不全 发育迟缓• 遗传性疾病（唐氏综合症、卵巢发育不良）伴先心 病 原疾病所致• 小样儿、青春期后的患儿 术后不改变体型营养不良的原因营养不良的原因心脏畸形的类型和严重程度青紫型、大分流、肺动脉高压、充血性心力衰竭摄入不足：进食过少，能量摄入仅正常人76%胃肠道功能紊乱，早饱、胃排空迟缓体内低血糖能量消耗的增多：基础代谢率增加25～30%能量需要多50%启动低效率的无氧酵解营养不良的原因营养不良的原因肠内吸收不良和蛋白质的丢失氨基酸吸收减少蛋白质合成减少 ，肌肉和骨骼生长减缓，免疫力低下治疗和药物的影响利尿剂---肾脏失钙，营养素流失前列腺素超过120h---胃梗阻抗凝剂---胃肠道慢性失血先心病患儿的喂养先心病患儿的喂养先心病婴幼儿的喂养 母乳喂养 ：优先选用-经皮血氧高于人工喂养-体位：紫绀患儿采用屈膝体位-合理添加辅食，家长行为习惯起主导作用人工喂养奶嘴应质软、孔呈圆形优于十字型孔径大小合适，牛奶呈滴状速度约1秒1滴 增加食物的能量密度-浓缩：不减少营养素的量，减少多余水分的量一匙奶粉＋60ml水＝20Kcal一匙奶粉＋45ml水＝20Kcal- 补充：添加高能量密度的物质一匙奶粉＋60ml水＝20Kcal一匙半奶粉＋60ml水＝24Kcal能量密度的增加以患儿耐受为前提先心病患儿的喂养先心病患儿的喂养先心病儿童的营养 改变进食行为尽早手术及介入治疗：- 术后生长激素明显增加- 术后5年能量消耗接近正常先心病患儿的喂养先心病患儿的喂养药物和饮食进食前服用单独服用不混食呕吐后不补药防止电解质紊乱，食物补充钾盐香蕉、橙汁、菌类、干果类等小小 结结先心病是小儿常见的心血管疾病，疾病的特殊性引起患儿进食行为的改变,导致患儿生长发育迟缓先心病患儿的营养是一个长期的复杂的过程，我们积极寻求依据指导自己和家长科学的喂养孩子参考文献参考文献1.1.Nutrition management of cardiac conditions.American Dietetic Nutrition management of cardiac conditions.American Dietetic Association Pediatric Nutrition Manual.2003;Chapter 30.Association Pediatric Nutrition Manual.2003;Chapter 30. 2.2.Constantine Mavroudis,Carl L,Backer.Pediatric Carsiac Constantine Mavroudis,Carl L,Backer.Pediatric Carsiac Surgery.First published 2004.Surgery.First published 2004. 3.3.Hopkins,-K .Food for life, love and hope: an exemplar of the Hopkins,-K .Food for life, love and hope: an exemplar of the philosophy of palliative care in action. Proc-Nutr-Soc. 2004 philosophy of palliative care in action. Proc-Nutr-Soc. 2004 Aug; 63(3): 427-9.Aug; 63(3): 427-9. 4.4.郭红卫郭红卫. . 医学营养学，复旦大学出版社，医学营养学，复旦大学出版社，2002.2002. 5.5.何志谦何志谦. . 人类营养学，人民卫生出版社，人类营养学，人民卫生出版社，2001.2001. 6.6.黄先玫，康曼丽黄先玫，康曼丽. .小儿先天性心脏病患者体格生长状况小儿先天性心脏病患者体格生长状况. .杭州医学高等杭州医学高等 专科学校学报第二十卷，专科学校学报第二十卷，19991999年第年第1 1期期. . 7.7.Unger R,Dekleermaeker M,Gidding SS,Christoffel KK.Improved Unger R,Dekleermaeker M,Gidding SS,Christoffel KK.Improved weight gain with dietary intervention in congenital heart weight gain with dietary intervention in congenital heart disease.Am J Dis child.1992;146:1078-1084.disease.Am J Dis child.1992;146:1078-1084.参考文献（续）参考文献（续）8.8.Varan B,Tokel K,Yilmaz GMalnutrition and growth failure in cyanotic and Varan B,Tokel K,Yilmaz GMalnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary acyanotic congenital heart disease with and without pulmonary hypertension.Arch Dis child.1999;81:49-52.hypertension.Arch Dis child.1999;81:49-52. 9.9.Hansen SR,Dorup I.Energy and nutrition intakes in congenital heart Hansen SR,Dorup I.Energy and nutrition intakes in congenital heart disease.Acta Paediatr.1993Feb;82(2):166-172.disease.Acta Paediatr.1993Feb;82(2):166-172. 10.10.Clemente C,Barnes J,Shinebourne E,Stein A.Are infant behavioural feeding Clemente C,Barnes J,Shinebourne E,Stein A.Are infant behavioural feeding difficulties associated with congenital heart disease?Child And Health difficulties associated with congenital heart disease?Child And Health Dev.2001;27:47-59.Dev.2001;27:47-59. 11.11.Cavell B.Gastric emptying in infants with congenital heart disease.Acta Cavell B.Gastric emptying in infants with congenital heart disease.Acta Paediatr Scand.1981;70:517-520.Paediatr Scand.1981;70:517-520. 12.12.Lundell KH,Sabel KG,Eriksson BO,Mellgren GGlucose metabolism and insulin Lundell KH,Sabel KG,Eriksson BO,Mellgren GGlucose metabolism and insulin secretion in children with cyanotic congenital heart disease.Acta secretion in children with cyanotic congenital heart disease.Acta Paediatr.1997Oct;86(10):1082-4.Paediatr.1997Oct;86(10):1082-4. 13.13.Leith CA.Growth,nutrition and energy expenditure in pediatric heart Leith CA.Growth,nutrition and energy expenditure in pediatric heart failure.Prog Pediatr Cardiol.2000.Sep1;11(3):195-202.failure.Prog Pediatr Cardiol.2000.Sep1;11(3):195-202. 14.14.Leff ML,Hill JO,Yates AA,Heymsfield SB.Resting metabolic rate:measurement Leff ML,Hill JO,Yates AA,Heymsfield SB.Resting metabolic rate:measurement reliability.JPEN-J-parenter-Enteral-Nutr.1987.Jul-Aug;11(14):354-9.reliability.JPEN-J-parenter-Enteral-Nutr.1987.Jul-Aug;11(14):354-9. 15.15.Gilger M,Jensen C,Kessler B,Nanjundiah P,Klish WJ.Nutrition,growth,and the Gilger M,Jensen C,Kessler B,Nanjundiah P,Klish WJ.Nutrition,growth,and the gastrointestinal system:basic knowledge for the pediatric cardiologist.The gastrointestinal system:basic knowledge for the pediatric cardiologist.The Science And Pediatric Cardiology.1990;2354-2370.Science And Pediatric Cardiology.1990;2354-2370. 16.16.Menon G,Postkitt EM,Why does congenital heart disease cause failure to Menon G,Postkitt EM,Why does congenital heart disease cause failure to thrive?Arch Dis Child.1985Dec;60(12):1134-9.thrive?Arch Dis Child.1985Dec;60(12):1134-9.参考文献（续）参考文献（续）17.17.Jef。