个性化肠内营养支持对老年急性脑卒中患者营养状况及预后的影响

Effect of individualized enteral nutrition on prognosis and nutritional status of elderly acute stroke patients

目的 评价个性化肠内营养支持对老年急性脑卒中患者营养状况及预后的影响.方法 将90例老年急性脑卒中患者按入院顺序随机分成两组,即营养支持组（45例）和对照组（45例）.两组都采用基本药物治疗,营养支持组在个性化营养评估的基础上给与院内自制营养液,对照组给予50％院内自制营养液和50％自带食物匀浆进行肠内营养.在住院第1d、10 d和21 d时分别检测两组患者皮褶厚度（TSF）、非瘫痪侧上臂肌肌围（MAMC）、血红蛋白（Hb）、血清白蛋白（Alb）、总淋巴细胞计数（TLC）和美国国立卫生院卒中量表（NIHSS）评分,并统计肠道并发症发生情况;通过重复测量方差分析、t检验、x2检验,对两组的疗效进行统计分析.结果 重复测量方差分析显示,与基线相比,两组Hb、Alb、TSF、MAMC、TLC等营养指标及NIHSS评分均下降（P＜0.05）.两组患者住院第10 d时,对照组Hb、Alb和MAMC均低于营养支持组,差异有统计学意义（P＜0.05）.住院第21 d时,对照组Hb、TSF和TLC均低于营养支持组,差异有统计学意义（P＜0.05）,营养支持组NIHSS评分低于对照组（P＜0.05）.营养支持组患者腹泻发生例数（5例）少于对照组（14例）,差异有统计学意义（P＜0.05）.结论 个体化肠内营养支持可改善老年急性脑卒中患者的营养状况和神经功能情况,降低肠道并发症的发生.

Objective To evaluate the effect of individualized enteral nutrition on prognosis and nutritional status of el- derly acute stroke patients. Methods Ninety elderly acute stroke patients were randomly divided into 2 groups, namely the nutritional support group （45 cases） and control group （45 cases）. Based on the basic drug treatments, nutrition support group was given individualized nutritional assessment and nutrient fluid which prepared by the nutritional department, the control group adopted normal juice flow nasal feeding and nutrient fluid that was same as the nutrition support group. Patients in both groups were detected with skin-fold thickness （TSF）, non-paralyzed side triceps muscle circumference （MAMC）, hemoglobin （Hb）, serum albumin （ALB）, total lymphocyte count （TLC）, the United States National Institutes of Health Stroke Scale （NIHSS） score, and intestinal complications on the 1st, 10th and 21st day. Repeated measures, t test, and test statistical analysis were conducted on the effect of the two groups. Results Repeated measures revealed that nutritional indexes and NIHSS scores of two groups were decreased significantly. On the 10th day, significant statistic different in Hb, Alb and MAMC were found between the nutritional support group and control group （P〈0.05）; on the 21st day, significant statistic different in Hb, TSF and TLC were found between the nutritional support group and control group （P〈0.05）. What＇s more, N1HSS scores of nutrition support group decreased significantly than that of the control group （P〈0.05）. Five cases of diarrhea were found in nutritional support group but 14 cases in control group （P〈0.05）. Conclusion Individualized enteral nutrition can improve the nutritional status and neurological function？ of stroke patients, and reduce the incidence of intestinal complications.