住院卒中患者合并营养不良相关因素分析

Risk Factors of Malnutrition in Hospitalized Patients with Acute Stroke

目的观察住院急性卒中患者营养不良发生情况;研究卒中后合并营养不良的相关因素与营养不良的关系。方法选取连续住院的203例急性卒中患者为研究对象进行横断面研究。以血清前白蛋白水平作为营养学指标,观察其变化趋势。以血清前白蛋白<200mg/L作为营养不良的诊断标准,研究基线资料、主要合并症、神经功能等因素与营养不良的相关性。结果随着住院时间的延长,不同时间点血清前白蛋白水平有下降趋势(P<0.05)。有110例患者出现营养不良,住院脑卒中患者营养不良发生率为54.2%。随着住院时间的延长合并营养不良的发生率逐渐增加。男性、年龄、合并消化道出血、腹泻、发热、感染、认知功能障碍、卒中后抑郁、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、吞咽障碍以及禁食和(或)胃肠减压、胃肠营养等治疗措施与营养不良发生均有相关性(P<0.05)。年龄(OR=1.723,95%CI 2.204～15.498)、卒中后抑郁(OR=4.604,95%CI 1.952～10.860)、NIHSS(OR=1.159,95%CI 1.020～1.316)是卒中患者合并营养不良的独立危险因素。结论急性卒中住院患者合并营养不良有较高的发生率。随着住院时间的延长,合并营养不良的发生率逐渐增加。年龄、卒中后抑郁、NIHSS评分是卒中患者合并营养不良的独立危险因素。

Objective To find out the malnutrition incidence rate and distribution of hospitalized patients with acute stroke. To investigate the important factors which were related to malnutrition in patients with acute stroke. Methods Two hundreds and three consecutive patients admitted to hospital with a recent stroke were enrolled. The method of cross-sectional study was used. The main nutrition index was the level of serum prealbumin. The diagnosis standard of malnutrition was that the level of serum prealbumin is lower than 200 mg/L. Data on nutritional status, clinical complications and the severity of nerve functions losses were collected in after hospitalization. The changes of the level of serum prealbumin were observed. The correlations between the baseline data, clinical complications and malnutrition were studied. The SPSS 11.5 software was used for statistical analysis. Results With the extension of hospital stay, the serum prealbumin levels decreased at different time points （P〈0.05）. There were 110 patients complicated with malnutrition. The incidence rate of malnutrition in hospitalized patients with acute stroke was 54.2% in our research and it increased with the lasting of the length of stay. Sex, age, infection, alimentary tract hemorrhage, fever, abrosia or gastrointestinal decompression, enteral nutrition, the National Institutes of Health Stroke Scale（N1HSS） scales, cognition disorder, depression after stroke onset and swallowing difficulties were related to malnutrition （P〈0.05）. After adjustmnet for the other factors, age（OR=1.723,95%C1：2.204-15.498）, the NIHSS（OR=l.159,95%C1：1.020-1.316） scales and depression （OR=4.604, 95%CI 1.952-10.860） were independent risk factors of malnutrition in patients with acute stroke. Conclusion There was high incidence rate of malnutrition in hospitalized patients with acute stroke in our research and it increased with the lasting of the length of stay. Age, the NIHSS scales and depression were independent risk factors of malnutrition in patients with acute stroke.