青年卒中患者的营养风险筛查及营养不良的危险因素研究

An investigation on nutritional risk screening and risk factors of malnutrition in younger patients with stroke

目的对青年卒中患者进行营养风险筛查并探讨营养不良的危险因素。方法前瞻性连续选取青年卒中患者，采用营养风险筛查2002（nutritional risk screening 2002，NRS 2002）进行入院营养风险筛查，根据结果将患者分为营养风险组和无营养风险组，以血清前白蛋白〈200 mg/L作为营养不良的诊断标准，在入院和入院14 d分别比较2组患者的营养不良检出率。采用多变量Logistic回归分析对青年卒中患者人口统计学和基线临床特征进行分析，分别确定入院和入院14 d青年卒中患者营养不良的独立危险因素。结果最终纳入青年卒中患者152例，营养风险组51例，无营养风险组101例，营养风险检出率为33.6%（51/152）。入院营养不良检出率为13.8%（21/152），其中营养风险组营养不良检出率为25.5%（13/51），无营养风险组营养不良检出率为7.9%（8/101）；入院14 d营养不良检出率为32.2%（49/152），其中营养风险组营养不良检出率为60.8%（31/51），无营养风险组营养不良检出率为17.8%（18/101）。多变量Logistic回归分析显示，高龄（36-45岁）、男性、糖尿病、甲亢是青年卒中患者营养不良的独立危险因素，入院营养不良的独立危险因素还有近期手术史和吸烟，入院14 d营养不良的独立危险因素还有卒中相关性肺炎、卒中后抑郁、吞咽障碍、睡眠障碍和中重度神经功能缺损。结论具有营养风险的青年卒中患者的营养不良发生率较高，应尽早进行营养风险筛查，以便及时对存在营养风险的患者给予营养支持治疗和危险因素干预。

Objective To evaluate the nutritional risk screening for younger patients with stroke and to explore risk factors of malnutrition. Methods Younger patients with stroke were enrolled in a prospective way. The patients were evaluated by nutritional risk screening 2002 （NRS 2002） at their admission for nutritional risk screening, and were divided into nutritional risk group and no nutritional risk group according to the evaluation results. Prealbumin less than 200 mg/L was defined as malnutrition. Demographic and baseline clinical characteristics of the patients were analyzed with multivariate logistic regression analysis to determine independent risk factors for malnutrition at the admission and the 14-＇ day. Results （1） A total of 152 young stroke patients were enrolled, including 51 in nutritional risk group, 101 in no nutritional risk group, the rate of nutritional risk was 33.6% （51/152）. （2） The rate of malnutrition at admission was 13.8% （21/152）, the rate of malnutrition in nutritional risk group was 25.5% （13/51）, and 7.9% （8/101）in no nutritional risk group on admission. While the rate of malnutrition was 32.2% （49/152）, including the rate of malnutrition in nutritional risk group was 60.78% （31/51）and 17.8% （18/101）in no nutritional risk group was at the 14th day of admission. （3） Multivariate Logistic regression analysis showed that advanced age （from 36 to 45 years）, sex, diabetes, hyperthyroidism were independent risk factors for malnutrition in younger patients with stroke. Recent history of surgery and smoking, stroke-associated pneumonia, post-stroke depression, swallowing disorder, sleep disorder, moderate and severe neurologic deficits were also risk factors for malnutrition. Conclusion The incidence of malnutrition in younger patients with stroke were higher, and earlier nutritional risk screening and nutritional support in these patients were urgent.