先心病患儿的营养课件

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

先天性心脏病患儿的喂养

概述先天性心脏病：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

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小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（续）VaranB,TokelK,YilmazG..Malnutritionandgrowthfailureincyanoticandacyanoticcongenitalheartdiseasewithandwithoutpulmonaryhypertension.ArchDischild.1999;81:49-52.HansenSR,DorupI.Energyandnutritionintakesincongenitalheartdisease.ActaPaediatr.1993Feb;82(2):166-172.ClementeC,BarnesJ,ShinebourneE,SteinA.Areinfantbehaviouralfeedingdifficultiesassociatedwithcongenitalheartdisease?ChildAndHealthDev.2001;27:47-59.CavellB.Gastricemptyingininfantswithcongenitalheartdisease.ActaPaediatrScand.1981;70:517-520.LundellKH,SabelKG,ErikssonBO,MellgrenG..Glucosemetabolismandinsulinsecretioninchildrenwithcyanoticcongenitalheartdisease.ActaPaediatr.1997Oct;86(10):1082-4.LeithCA.Growth,nutritionandenergyexpenditureinpediatricheartfailure.ProgPediatrCardiol.2000.Sep1;11(3):195-202.LeffML,HillJO,YatesAA,HeymsfieldSB.Restingmetabolicrate:measurementreliability.JPEN-J-parenter-Enteral-Nutr.1987.Jul-Aug;11(14):354-9.GilgerM,JensenC,KesslerB,NanjundiahP,KlishWJ.Nutrition,growth,andthegastrointestinalsystem:basicknowledgeforthepediatriccardiologist.TheScienceAndPediatricCardiology.1990;2354-2370.MenonG,PostkittEM,Whydoescongenitalheartdiseasecausefailuretothrive?ArchDisChild.1985Dec;60(12):1134-9.参考文献（续）JeffreyC,Wheat.Nutritionalmanagementofchildrenwithcongenitalheartdisease.2002,Vol.8:No.2,Article5.柯雪琴，杨敏，薛品荣.先天性心脏病患儿血清氨基酸浓度的改变.中华预防医学，1998.11：356-358.WesselJJ.Cardiology.in:SamourPQ,HelmKK,LangCE,eds.HandbookofPediatricNutrition.Gaithersburg,Md:AspenPublishersIns;1999;413-423.PeledN,DaganO,BabynP.Gastricoutletobstructioninducedbyprostaglandintherapyinneonates.NEnglJMed.1992;327:505-510.Feedingyourinfantwithcongenitalheartdisease.AmericanHeartAssociation.May5,2005.MarinoBL,O’BrienP,LoreH.Oxygensaturationsduringbreastandbottlefeedingininfantswithcongenitalheartdisease.JPediatrNurs.1995Dec;10(6):360-4.顾晓蓉先心病婴儿喂养知识.上海儿童医学中心心胸外科,2005.NancyMC,DanielMD.Nutritionforinfantswithcongenitalheartdisease.UniversityofVirginiaHealthSystem.May6,2005.盛锋,田杰.照顾先心病孩子要当心.家庭医药,2003年7期.SchwardSM,GewitzMH,SeeCC,BerezinS,Gla