ABSTRACT
Objective:
To investigate the preoperative
nutritional status of
cardiac surgery patients in southwest
China, analyze the
incidence and characteristics of nutritional
risk, and provide basis for establishing a standardized individualized nutritional intervention program for
cardiac surgery patients.
Methods:
A
cross-sectional survey was conducted on the
nutritional status and intervention status of preoperative
patients in
cardiac surgery department of 23
general hospitals in Yunnan, Guizhou, Sichuan and Chongqing districts. At 00 00 on July 7, 2022, the
patients aged > 18 years old in
cardiac surgery departments of the above
hospitals who planned to undergo surgical
treatment were enrolled as the
survey objects to investigate the
nutritional status on July 6, 2022 (the
survey date), including basic information (general information,
nutrition indicators, etc.),
nutrition screening and evaluation (
nutrition risk screening and organ support, etc.),
nutrition treatment (
nutrition supplement
methods and
prescriptions, etc.) and
nutrition awareness of
medical staff.
Results:
The 126
questionnaires were collected, of which 125 were valid (99.2%). ① Basic information of the 125
patients, 67
patients were
male (53.6%) and 58
patients were
female (46.4%). The age ranged from 19 years old to 86 years old, with an average of (53.13±14.74) years old.
Body mass index (BMI) was (22.21±3.78) kg/m 2. The age and BMI of
men were significantly higher than those of
women [age (years old) 56.63±13.34 vs. 49.09±15.35, BMI (kg/m 2) 22.74±3.86 vs. 21.59±3.61, both P < 0.05]. Of the 125
patients, 75 had valvular
disease and 50 were with non-valvular
diseases, which mainly included
congenital heart disease [19 cases (15.2%)],
aortic dissection [13 cases (10.4%)],
coronary heart disease [12 cases (9.6%)], etc. The
course of
disease was 0.5 hour to 36 years, of which 93
patients (74.4%) were more than 6 months and 32
patients (25.6%) were equal to or less than 6 months. The proportion of
female patients with
disease duration > 6 months was significantly higher than that of
male patients [87.9% (51/58) vs. 62.7% (42/67), P < 0.01]. The basic
diseases mainly included
hypertension [38 cases (30.4%)],
coronary heart disease [12 cases (9.6%)], diabetes [7 cases (5.6%)],
chronic obstructive pulmonary disease [
COPD, 6 cases (4.8%)], etc. Among 125
patients, total
protein (TP) < 60 g/L in 24 cases (19.2%),
albumin (Alb) < 40 g/L in 64 cases (51.2%),
anemia [
male hemoglobin (Hb) < 120 g/L,
female Hb < 110 g/L] in 33 cases (26.4%). A total of 60 cases of
prealbumin data were collected, of which 23 cases (38.3%) were less than 200 mg/L.②
Nutrition screening and assessment 33.6% of the 125
patients did not undergo routine
nutrition screening after admission, including the provincial and municipal
tertiary hospitals. Among the 83
patients undergoing nutritional
screening, 41 (32.8%) were at nutritional
risk. Further
analysis of
patients with nutritional
risk showed that of the 41
patients, 20 were
male (48.8%) and 21 were
female (51.2%); 27 cases (65.9%) was with valvular
diseases and 14 cases (34.1%) was with non-valvular
diseases; the
course of
disease was more than 6 months in 30 cases (73.2%), and ≤ 6 months in 11 cases (26.7%). Statistical comparison of the above 83
patients showed that
women, basic
disease, long term-valvular
disease,
anemia, low TP, and low Alb before operation were more prone to innutrition. ③ Nutritional
therapy of the 125
patients, 5 were receiving
mechanical ventilation (4.0%) and 2 were using vasoactive
drugs (1.6%); there were 5 cases with gastrointestinal dysfunction (4.0%), mainly manifested as abdominal distension,
abdominal pain,
constipation and
diarrhea. One
patient was treated with
enteral nutrition through gastric tube combined with
parenteral nutrition support, 124
patients were fed orally, and an irregular phenomenon of injecting
amino acid fat
emulsion through peripheral
vein in 2
patients. ④
Nutrition awareness of
medical staff 124 (99.2%) of the 125
patients had a
nutrition department in their
hospital; 71 cases (56.8%) received
nutrition education, of which 37 cases (52.1%) were consulted by the
nutrition department. Of all the cases, only 38 (30.4%) were consulted by the
nutrition department, of which 1 (2.6%) did not receive
nutrition education after
consultation.
Conclusions:
At present, the
incidence of preoperative
malnutrition in
patients undergoing
cardiac surgery is high in southwest
China. The
incidence of
malnutrition in
patients with basic
diseases, long term-valvular
disease, low TP, low Alb and
anemia before operation is higher, and the
incidence of
malnutrition is hidden in
women. The
course of
disease of
women is longer than that of
men at the
time of
treatment, and
malnutrition is more likely to occur. The attending
physicians should pay
attention to the above groups. It is necessary to establish a standardized individualized nutritional intervention program and apply it to actual
clinical diagnosis and
treatment, so as to ultimately improve the
prognosis of
patients undergoing
cardiac surgery and increase the benefits of
patients in
treatment.