营养支持对急性卒中患者血清氨基酸谱和神经功能的影响

Effects of nutritional support on serum amino acid spectrum and neurological function in acute stroke patients

目的探讨不同营养支持因素对急性卒中患者产生的血清氨基酸谱变化及其对神经功能的影响。方法采用随机数字表法将60例急性卒中伴吞咽困难的患者分为肠内营养组（30例）和对照组（30例），分别检测入院后48h内、入院后（7±1）d及入院后（14±1）d时患者血清氨基酸谱、血红蛋白、总蛋白、白蛋白、前白蛋白、免疫球蛋白、补体、神经功能缺损评分（NIHSS）及Barthel日常生活能力指数评分（BI）、感染率。随访发生急性卒中后的1、3个月患者的NIHSS及BI评分。结果肠内组患者入院（7±1）d及（14±1）d的血清氨基酸谱、血红蛋白、总蛋白、白蛋白、前白蛋白、免疫球蛋白、补体、神经功能缺损评分均优于对照组，感染率低于对照组；随访1、3个月，NIHSS评分肠内组（9．0±1．4，7．9±1．3）优于对照组（11．1±1．5，10．6±1．4），差异有统计学意义（F=46．042，P〈0．05），而BI评分肠内组（50．1±1．8，52．0±2．4）与对照组（49．0±2．1，51．3±2．8）间差异无统计学意义（F=2．707，P〉0．05）。结论对急性卒中伴吞咽障碍患者早期给予肠内营养支持可改善机体的血清氨基酸水平，从而改善机体的营养状况，减少感染并发症，促进近期神经功能恢复，改善预后。

Objective To investigate serum amino acid spectrum in patients with acute stroke in response to different nutritional support strategies and its effects on neurological function. Methods A total of 60 cases of acute stroke with dysphagia were randomly distributed into two groups ： enteral nutrition group （30 cases） and control group （30 cases） using simple randomized design. Serum amino acid spectrum, hemoglobin, total protein, albumin, prealbumin, immunoglobulins, complement, and infection rate were assessed at three time points ： within 48 hours, （ 7 ± 1 ） days and （ 14 ± 1 ） days after admission, and neurological deficit and activities of daily living are scored according to National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI）. Results （7 ± 1 ）, （ 14 ± 1 ） days after admission, serum amino acid spectrum, hemoglobin, total protein, albumin, prealbumin, immunoglobulins, complement, and neurological deficit scores of enteral nutrition group patients were significantly better than those of non-enteral nutrition control group; and infection rate was lower than that of control group. Follow-up for a month, 3 months, NIHSS of enteral nutrition group patients （ 9. 0 ± 1.4,7.9 ± 1.3 ） were significantly better than non- enteral nutrition control group （ 11.1 ± 1.5,10. 6 ± 1.4, F = 46. 042, P 〈 0. 05 ）. While BI score seemed to be not insignificant different between enteral nutrition group （ 50. 1 ± 1.8,52. 0 ± 2. 4 ） and control group （49.0±2. 1,51.3 ±2.8, F =2.707,P 〉0.05）. Conclusion For patients suffering acute stroke with dysphagia, enteral nutrition support could reduce infectious complications, improve short-term neurological function and long-term prognosis by improving serum amino acids level and thus the whole body＇ s nutritional status.