不同热量营养支持对伴吞咽困难急性卒中患者的作用

Effects of different calorific nutritional supports on patients with acute stroke accompanied with dysphagia

目的探讨不同热量营养支持对伴吞咽困难急性卒中患者的死亡率和并发症的影响。方法对143例伴吞咽困难的急性卒中患者,首选肠内营养,当胃肠功能受限者,给予肠外营养补充。根据所提供的热量不同,将患者分为两组:≥104.6 kJ·kg^(-1)·d^(-1)为高热量组,平均(114.1±10.0)kJ·kg^(-1)·d^(-1);<104.6 kJ·kg^(-1)·d^(-1)为低热量组,平均(62.8±12.3)kJ·kg^(-1)·d^(-1)。两组所提供的蛋白质量差异无统计学意义。结果①低热量组病死率(31.9%)高于高热量组(6.8%),差异具有统计学意义(χ~2=14.719,P<0.01);②低热量组的美国国立卫生研究院卒中量表(NIHSS)评分较入院前升高,高热量组的NIHSS评分较入院前降低,两组的NIHSS评分的变化,差异有统计学意义(t=55.462,P<0.01);③低热量组的低蛋白血症、肺部感染、腹泻、肾功能衰竭的发生率高于高热量组,差异具有统计学意义,P<0.05;④两组患者的心功能不全、上消化道出血、高血糖的发生率两组差异无统计学意义,P>0.05。⑤Logistic分析结果表明,低热量组的死亡危险是高热量组的8.967倍。结论对伴吞咽困难的卒中患者,不仅要注意补充蛋白质,更要注重补充足量的非蛋白热量。充足的营养支持,可以减少伴吞咽困难卒中患者的并发症,降低死亡率。

Objective To investigate the effects of different calorific levels on the mortality and complications in patients with acute stroke and dysphagia. Methods The enteral nutrition was selected first for 143 patients with acute stroke and dysphagia. When the gastrointestinal function of the patients was impaired, the parenteral nutritional supplements were given. According to the different calorie levels, the patients were divided into a high calorie group （≥104.6kJ·kg·d^-1, mean, 114.1±10.0）kJ·k^-1·d^-1） and a low calorie group （〈104.6kJ·kg^-1·d^-1, mean, （62.8±12.3）kJ·kg^-1·d^-1. The quality of protein in both groups had no difference. Results ①The mortality in the low calorie group was higher than the high calorie group （P 〈0.01 ）. ②The National Institutes of Health Stroke Scale （NIHSS） scores in the low calorie group were higher than that before admission, while the NIHSS scores in the high calorie group were lower than that before admission. The changes of NIHSS scores in both groups had statistically significant difference （P 〈 0.01 ）. ③The incidences of hypoproteinemia, pulmonary infection, diarrhea, and renal function failure in the low calorie group were higher than that in the high calorie group, and there was significant difference （P 〈0.05）. ④ere were no significant differences in the incidences of heart failure, upper gastrointestinal hemorrhage, and hyperglycemia between the two groups （ P 〉 0. 05）. ⑤The result of logistic regression analysis indicated that the risk of death in the low calorie group was nearly 9 times higher than the high calorie group. Conclusion For patients with stroke and dysphagia, not only protein but also sufficient non-protein calories should be supplemented. Adequate nutritional support may reduce the occurance of complications and mortality in patients with stroke and dysphagia.