脑卒中患者神经功能缺损与肠内营养支持的关系

Neurological Deficits and Enteral Nutrition Support in Stroke Patients

目的探讨脑卒中患者神经功能缺损程度与肠内营养支持的关系。方法将95例脑卒中患者按美国国立卫生研究所脑卒中评分(NHISS)为高危组(NHISS>8分)和低危组(NHISS≤8分)。对两组患者实施相同的营养支持方案,观察两组患者营养支持前、营养支持后第13～15天血总蛋白(TP)、清蛋白(ALB)、胆固醇(CHOL)、总淋巴细胞计数(TLC)、血红蛋白(Hb)的水平;监测营养支持期间两组患者胃肠道并发症的发生率。结果两组患者营养支持前TP、ALB、CHOL、TLC、Hb水平间差异均无统计学意义(P>0.05);营养支持后第13～15天高危组患者TP、ALB、CHOL水平较低危组降低,消化道出血、腹泻、便秘的发生率较低危组增加,差异均有统计学意义(P<0.05),但TLC、Hb水平及呕吐发生率两组比较差异无统计学意义(P>0.05)。结论脑卒中患者神经功能缺损程度可以影响肠内营养支持效果,神经功能缺损程度越严重,营养支持效果越差。

Objective To study the relation of neurological deficit degree with enteral nutrition support in patients with stroke.Methods Totally 95 stroke patients were divided, according to the Stroke Score of American National Institutes of Health （NIHSS）, as high risk group （NIHSS〉8） and low risk group（NIHSS〈8）. The patients in both groups were given the same enteral nutrition support （EN）, and then the levels of serum total protein （TP）, albumin （ALB）, cholesterol （CHOL）, total lymphocyte count （TLC） and hemoglobin （HGB） were observed before EN and at 13th to 15th day after EN, and the incidences of gastrointestinal complications were monitored.Results There was no significant difference before EN between the two groups in serum nutritional indices of TP, ALB, CHOL, TLC and HGB. At 3th to 15th day after EN the levels of TP, ALB and CHOL in the high risk group decreased as compared with those in the low risk group, but the incidence rates of gastrointestinal bleeding, diarrhea and constipation increased （P〈0.05） . However differences in levels of TLC and HGB, as well as in incidence rate of vomiting between the two groups were not statistically significant （P〉 0.05）.Conclusion The degree of neurology deficits in patients with stroke can influence the effect of EN, and the severer the neurological deficit is, the less the effect is.