Doğumsal kalp hastalığı ve büyüme geriliği arasındaki ilişkinin araştırılması
Investigation of relationship between growth retardation and congenital heart disease
- Tez No: 69132
- Danışmanlar: PROF. DR. ADNAN AKÇORAL
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 1998
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 83
Özet
ABSTRACT Investigation of the Relationship Between Gro\vth Retardation and Congenital Hcart Disease Dr.Bumin Nuri Dündar Growth retardation is a well recognised complication of congenital heart disease(CHD). Several possible explanations for this complication have been suggested; insufficient intake of nutritients, increased energy recpıirement, hypoxia, cardiac drugs, frequent respiratory infections and malabsorption. Recentiy, investigators have been demonstrated that nutritional and endocrine factors have a complex relationship in the growth of children and endocrine status is effected by the nutritional factors. We evaluated 80 patient with CHD,[ mean age 4.06 ± 3.38 (0.07-12), 29 (36%) cyanotic (13 tetralogy of fallot, 16 complex cyanotic ) and 51 ( 64%) acyanotic (33 left to right shunt, 18 obstructive type )] to estimate growth of patients in relation to nutritional and endocrine factors. Body weight and height, triceps skinfold (TSF) and mid arm circumference (MAÇ) measurements were made in ali patients and standart deviation scores (SDS) were calculated. Also, three days dietaıy history was analysed and, ratios of calorie and protein intake/expected values were calculated. in addition, frequency of lower respiratory infection throughout öne year and mother's educational status were recorded. Cyanotic and acyanotic patients were classifıed as moderate and severe according to severity of disease. Ali patients were classified according to nutritional state; nutritionally sufBcient and nutritionally insufBcient using height for age and weight for height ratios,and also TSF and MAÇ values for each patient. in addition; nutritionally insufBcient patients were seperated into three groups according to Waterlow's classifîcation (wasted, stunded and wasted +stunded ).Bood samples were obtained during catheter-angiography and complete blood count, seram electrolytes, liver function tests, oxygen saturations (for cyanotic patients), serum zinc levels, thyroid function tests,Insulin-like growth factor 1(IGF-I) and IGF-I binding protein 3 (IGFBP3) levels were measured. A control group of 20 well-nourished children in the similar age were formed in order to compare the values of IGF-I and IGFBP-3 between control and study groups. Cyanotic and acyanotic patients showed marked retardation in both weight and height, but there was no signifîcant difference between weight and height among two groups (p>0.05). in two groups, there were not significant differences between weight and length within each group (weight SDS -1.46 ±0.85 and-1.11 ± 1.39, p>0.05; height SDS -1.16 ± 1.29 and -1.05 ± 1.21, respectively; p>0.05). Complex cyanotic patients were more severely retarded in weight (weight SDS -1.69 ± 0.71, height SDS -1.14 ± 1.04,p0.05). When we evaluated IXthe patients according to the severity of disease, a high ratio of nutritionally insufficient children were determined in severe disease groups compared with moderate disease groups in TOF, complex cyanotic and left to right shunt groups (p
Özet (Çeviri)
ABSTRACT Investigation of the Relationship Between Gro\vth Retardation and Congenital Hcart Disease Dr.Bumin Nuri Dündar Growth retardation is a well recognised complication of congenital heart disease(CHD). Several possible explanations for this complication have been suggested; insufficient intake of nutritients, increased energy recpıirement, hypoxia, cardiac drugs, frequent respiratory infections and malabsorption. Recentiy, investigators have been demonstrated that nutritional and endocrine factors have a complex relationship in the growth of children and endocrine status is effected by the nutritional factors. We evaluated 80 patient with CHD,[ mean age 4.06 ± 3.38 (0.07-12), 29 (36%) cyanotic (13 tetralogy of fallot, 16 complex cyanotic ) and 51 ( 64%) acyanotic (33 left to right shunt, 18 obstructive type )] to estimate growth of patients in relation to nutritional and endocrine factors. Body weight and height, triceps skinfold (TSF) and mid arm circumference (MAÇ) measurements were made in ali patients and standart deviation scores (SDS) were calculated. Also, three days dietaıy history was analysed and, ratios of calorie and protein intake/expected values were calculated. in addition, frequency of lower respiratory infection throughout öne year and mother's educational status were recorded. Cyanotic and acyanotic patients were classifıed as moderate and severe according to severity of disease. Ali patients were classified according to nutritional state; nutritionally sufBcient and nutritionally insufBcient using height for age and weight for height ratios,and also TSF and MAÇ values for each patient. in addition; nutritionally insufBcient patients were seperated into three groups according to Waterlow's classifîcation (wasted, stunded and wasted +stunded ).Bood samples were obtained during catheter-angiography and complete blood count, seram electrolytes, liver function tests, oxygen saturations (for cyanotic patients), serum zinc levels, thyroid function tests,Insulin-like growth factor 1(IGF-I) and IGF-I binding protein 3 (IGFBP3) levels were measured. A control group of 20 well-nourished children in the similar age were formed in order to compare the values of IGF-I and IGFBP-3 between control and study groups. Cyanotic and acyanotic patients showed marked retardation in both weight and height, but there was no signifîcant difference between weight and height among two groups (p>0.05). in two groups, there were not significant differences between weight and length within each group (weight SDS -1.46 ±0.85 and-1.11 ± 1.39, p>0.05; height SDS -1.16 ± 1.29 and -1.05 ± 1.21, respectively; p>0.05). Complex cyanotic patients were more severely retarded in weight (weight SDS -1.69 ± 0.71, height SDS -1.14 ± 1.04,p0.05). When we evaluated IXthe patients according to the severity of disease, a high ratio of nutritionally insufficient children were determined in severe disease groups compared with moderate disease groups in TOF, complex cyanotic and left to right shunt groups (p
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