Clinical Observation On Nutritional Evaluation And Nutrition Support In Preoperative Patients With Severe Valvular Heart Disease

Objective: Nutritional status of patients with severe valve heart disease was evaluated by a variety of methods. The proportion of malnourished patients was calculated before surgery, and compared accuracy and relevance between the methods, postoperative recovery under different nutritional conditions, incidence of postoperative complications and mortality. Patients with severe malnutrition were treat before operation to observe the perioperative information and effects.Methods and Results: The study was composed with two parts.Part I: Evaluation of the nutritional status of patients with severe valvular heart disease.Methods: 271 patients who underwent valve replacement in Shenyang PLA General Hospital from 2007, January to 2010, October were observed within 48 hours of admission. All patients were measured and calculated body mass index (BMI), triceps skinfold thickness (TSF), arm circumference (AC), arm muscle circumference (AMC). The nutritional status of patients was assessed with subjective global assessment(SGA) and mini nutritional assessment(MNA). Nutritional status of preoperative patients were observed and compared postoperative recovery under different nutritional conditions and postoperative complications and mortality.Results: Patients with severe malnutrition who underwent valvar replacement were 24.1 to 58.3 percent. The methods of nutritional evaluation drew different conclusions. Preoperative adjustment time, ventilator time, ICU time, postoperative hospital stay, dopamine dosage and incidence of postoperative complications of nutrition group were less than control group. Postoperative complications and mortality rates of severe malnutrition were higher than normal.Part II: Clinical observation on nutrition management in preoperative patients with severe valve heart disease and severe malnutritionMethods: 60 patients with severe valvar heart disease and severe malnutrition were randomly divided into nutritional group and control group. Patients from nutritional group were supported with nutritious meals from department of nutrition, daily diet included heat 1740 kcal, protein 64g, fat 56g, carbohydrates 210g, other substances (vegetables, etc.) 60g . Patients from control group received conventional treatment, their food was provided by their families. Two groups were compared in preoperative adjustment time, operation time, CPB time, aortic clamp time, ICU time, ventilator time, hospital stay, dopamine dosage, complications and mortality.Results: Preoperative adjustment time, ventilator time, ICU time, postoperative hospital stay, dopamine dosage and incidence of postoperative complications of nutrition group were less than control group. There were no significant differences between two groups of patients in surgery time, cardiopulmonary bypass time, aortic clamp time and mortality.Conclusion:1. The incidence of malnutrition in severe valvular heart disease by various methods is different. The status of nutrition should assessed with the methods synthetically.2. Preoperative adjustment time,ICU time,breathing machines and hospital stay time was prolonged in malnourished patients who need more dopamine than normal patients.3. The incidence of postoperative complications and mortality was lower in nutrition group. Preoperative evaluation of nutritional status and nutritional support is of great significance;4. Preoperative treatment of aggressive nutritional support can shorten preoperative adjustment time,ICU time,hospital stay, reduce the amount of dopamine and postoperative complication rate.