急性缺血性脑卒中伴吞咽困难患者营养支持治疗临床观察

Clinical observation on nutritional supports for patients with acute ischemic stroke accompanied with dysphagia

目的:探讨三种营养支持治疗方法对急性缺血性脑卒中伴吞咽困难患者的临床价值。方法:回顾性分析急性缺血性脑卒中伴吞咽困难患者150例的临床资料。按不同营养方式分为3组:肠内营养治疗组(EN组),肠外营养治疗组(PN组),肠内外联合营养治疗组(EN+PN组),每组50例。分别于住院第1、第7及第14天检测患者血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、甘油三酯(TG)、血红蛋白(Hb)及淋巴细胞计数(LYM)等,记录3组治疗期间并发症的发生率,并以美国国立卫生研究院卒中量表(NIHSS)评分评价神经功能缺损情况。结果:EN+PN组TP、ALB、PA、Hb及LYM等指标优于EN组和PN组(均P<0.05)。而EN组与PN组比较,仅PA下降程度差异有统计学意义。入院第14天时,EN+PN组并发症发生率显著低于EN组和PN组(P<0.05),而EN组和PN组比较无明显差异。第14天时,3组神经功能缺损情况与入院时比较差异均有统计学意义(P<0.05);EN+PN组神经功能恢复情况显著优于EN组和PN组(P<0.05),而EN组和PN组比较差异无统计学意义。结论:采用肠内外联合营养治疗可有效改善患者的营养状况、降低并发症发生率、促进神经功能恢复,短期临床结局优于肠内或肠外营养支持治疗组,而肠内与肠外营养治疗组比较并无优势。

Objective： To explore the clinical value of three kinds of nutritional support therapy in patients with acute ischemic stroke accompanied with dysphagia. Methods： Clinical data of 150 cases with acute ischemic stroke accompanied with dysphagia were analyzed retrospectively. Patients were divided into three groups： enteral nutrition（ EN）,parental nutrition（ PN） and EN ＋ PN support group,50 cases for each group. Blood total protein（ TP）,albumin（ ALB）,prealbumin（ PB）,triglyceride（ TG）,lymphocyte count（ LYM） and hemoglobin（ Hb） were determined in patients of 3 groups at 1st,7th,and14 th day after admission. The incidence of complications were recorded during the treatment,and the neurologic deficits were evaluated by the score of National Institute of Health Stroke（ NIHSS）. Results： TP,ALB,PA,HGB and LYM in EN ＋ PN group were superior to those of EN or PN group（ P〈0. 05）. There were no differences between the EN and PN group except PA. The incidence of complications in EN ＋ PN group was significantly lower than that in EN group or the PN group at the14 th day（ P〈0. 05）. The recovery of neurological function in EN ＋ PN group was more significant than EN or PN group（ P〈0. 05）,but there was no statistical difference between EN group and PN group. Conclusions： The combination of enteral and parental nutritional support can improve the nutritional status of patients with acute ischemic stroke accompanied with dysphagia,reduce the incidence of complications and promote the rehabilitation of neurological function. The short-term clinical outcome was better than EN or PN group,while the EN group had no difference in the clinical efficacy compared with the PN group.