先心病患兒的營養(yǎng)課件

先天性心臟病患兒的營養(yǎng)先天性心臟病和營養(yǎng)概述先天性心臟病患兒的生長發(fā)育狀況先天性心臟病患兒營養(yǎng)不良的原因

先天性心臟病患兒的喂養(yǎng)

概述先天性心臟?。杭s占新生活產(chǎn)的8‰～10‰心臟及大血管解剖結(jié)構(gòu)異常紫紺型及非紫紺型生長發(fā)育狀況大量心內(nèi)分流發(fā)育遲緩青紫型、心功能不全發(fā)育遲緩遺傳性疾?。ㄌ剖暇C合癥、卵巢發(fā)育不良）伴先心病原疾病所致小樣兒、青春期后的患兒術(shù)后不改變體型營養(yǎng)不良的原因心臟畸形的類型和嚴重程度青紫型、大分流、肺動脈高壓、充血性心力衰竭攝入不足：進食過少，能量攝入僅正常人76%胃腸道功能紊亂，早飽、胃排空遲緩體內(nèi)低血糖能量消耗的增多：基礎(chǔ)代謝率增加25～30%能量需要多50%啟動低效率的無氧酵解營養(yǎng)不良的原因腸內(nèi)吸收不良和蛋白質(zhì)的丟失氨基酸吸收減少蛋白質(zhì)合成減少，肌肉和骨骼生長減緩，免疫力低下治療和藥物的影響利尿劑---腎臟失鈣，營養(yǎng)素流失前列腺素超過120h---胃梗阻抗凝劑---胃腸道慢性失血先心病患兒的喂養(yǎng)

先心病嬰幼兒的喂養(yǎng)

母乳喂養(yǎng)：優(yōu)先選用經(jīng)皮血氧高于人工喂養(yǎng)體位：紫紺患兒采用屈膝體位合理添加輔食，家長行為習(xí)慣起主導(dǎo)作用人工喂養(yǎng)奶嘴應(yīng)質(zhì)軟、孔呈圓形優(yōu)于十字型孔徑大小合適，牛奶呈滴狀速度約1秒1滴

先心病患兒的喂養(yǎng)先心病兒童的營養(yǎng)改變進食行為盡早手術(shù)及介入治療：術(shù)后生長激素明顯增加術(shù)后5年能量消耗接近正常小結(jié)先心病是小兒常見的心血管疾病，疾病的特殊性引起患兒進食行為的改變,導(dǎo)致患兒生長發(fā)育遲緩先心病患兒的營養(yǎng)是一個長期的復(fù)雜的過程，我們積極尋求依據(jù)指導(dǎo)自己和家長科學(xué)的喂養(yǎng)孩子參考文獻（續(xù)）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):1134-9.參考文獻（續(xù)）JeffreyC,Wheat.Nutritionalmanagementofchildrenwithcongenitalheartdisease.2002,Vol.8:No.2,Article5.柯雪琴，楊敏，薛品榮.先天性心臟病患兒血清氨基酸濃度的改變.中華預(yù)防醫(yī)學(xué)，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.顧曉蓉先心病嬰兒喂養(yǎng)知識.上海兒童醫(yī)學(xué)中心心胸外科,2005.NancyMC,DanielMD.Nutritionforinfantswithcongenitalheartdisease.UniversityofVirginiaHealthSystem.May6,2005.盛鋒,田杰.照顧先心病孩子要當(dāng)心.家庭醫(yī)藥,2003年7期.SchwardSM,GewitzMH,SeeCC,BerezinS,Gla