高脂肪肠内营养液改善脑卒中病人营养状况和预后

The improving effect of high-fat enteral nutrition on nutritional status and clinical prognosis in acute stroke patients

目的:评价高脂肪EN液对脑卒中病人营养状况和预后的影响。方法:将56例脑卒中病人随机分为高脂肪营养液(瑞能)组和标准营养液(Nutrison Fiber)对照组,每组28例。于住院营养支持前,营养支持第1、10和21天分别检测两组病人的血糖、Hb、血清ALB、TG、TC、HDL和LDL水平以及美国国立卫生院卒中量表(NIHSS)评分。观察病人EN支持过程中胃肠道不良反应的发生情况。入院30 d时,进行日常生活能力量表(ADL)评定。结果:两组病人EN支持第1天各项指标与营养支持前相比无显著性差异。EN支持第10和21天时,对照组病人各项营养指标除Glu外均有下降;高脂肪营养组病人仅血清ALB水平有一定程度的下降,血脂维持在正常水平。两组病人胃肠道并发症无显著性差异。第21天时,高脂肪营养组病人NIHSS评分改善较对照组更为显著(P<0.01),第30天高脂肪营养组ADL评分明显好于对照组(P<0.01)。结论:早期高脂肪EN支持可明显改善重症脑卒中病人的营养状况,改善预后,不会升高血脂。

Objective ： To evaluate the effect of high-fat enteral nutrition on nutritional status and clinical prognosis in acute stroke patients. Methods： 56 cases Of acute stroke patients were randomly divided into high-fat enteral nutrition （Supportan） group （high-fat group, 28 cases） and standard enteral nutrition （Nutrison Fiber） group （control group, 28 cases）. All patients were treated by conventional therapy. The levels of blood glucose, hemoglobin, serum albumin, triglyceride, cholesterol, high density lipoprotein and low density lipoprotein, neurologic impairment score （ NIHSS）, and gastrointestinal side effects were measured before and at the 1 st, the 10th, and the 21st day after enteral nutrition. Activity of daily living （ADL） was also observed at the 30th day after enteral nutrition. Results： The nutrition were not different between groups before EN. All nutrition indexes, except of blood glucose, were decreased at the 10th and the 21st day after enteral nutrition in control group. However, in high-fat group only the serum albumin level was decreased and the blood lipid level was maintained normally. The gastrointestinal side effects in two groups were not different. In high-fat group, NIHSS at the 21st day and ADL at the 30th day were markedly improved compared with those in control group （P 〈 0.01 ）. Conclusion： Early high-fat enteral nutrition support can significantly improve nutritional blood lipid stability in patients with severe acute stroke, which is helpful for clinical prognosis