早期肠内营养对老年缺血性脑卒中静脉溶栓病人早期神经功能恶化逆转作用的临床观察

Effects of different calorific early enteral nutrition on the reversal of post-thrombolysis early neurological deterioration in the elderly patients with ischemic stroke

目的探讨早期肠内营养方案对65岁以上老年缺血性卒中静脉溶栓病人早期神经功能恶化(early neurological deterioration,END)的逆转作用。方法回顾性纳入南京医科大学附属南京医院神经内科卒中登记数据库中经历END并伴有吞咽困难的老年缺血性卒中静脉溶栓病人85例,所有病人均在入重症室第1个24 h开始肠内营养,并持续至少2周。根据病人END是否在28 d内逆转,症状恢复到静脉溶栓后即刻,分为END逆转组(A组,n=40)和END未逆转组(B组,n=45)。比较2组病人的基线资料及早期肠内营养能量水平。结果 2组间糖尿病病史(P=0.002)、基线NIHSS评分(P=0.048)、糖化血红蛋白(P=0.043)水平差异有统计学意义;2组间营养水平比较,差异有统计学意义(P=0.001);经校正Logistic回归分析,END能否逆转与营养水平是否充足(OR=3.342,95%CI:1.161~9.620,P=0.025)、糖尿病病史(OR=0.166,95%CI:0.033~0.829,P=0.029)相关。结论早期足够能量水平的肠内营养方案有利于老年缺血性卒中静脉溶栓病人END逆转,糖尿病病史不利于老年缺血性卒中静脉溶栓病人END逆转。

Objective To investigate the effects of different calorific early enteral nutrition on the reversal of post-thrombolysis early neurological deterioration(END) in the patients with acute ischemic stroke complicated with dysphagia.Methods A total of 85 consecutive elderly patients with acute ischemic stroke were enrolled in this study.According to the reversal of post-thrombolysis END,the patients were divided into END reversed group(group A,n = 40) and END-non-reversed group(group B,n = 45).Results Compared with group B,group A showed lower proportions of diabetes(P =0.002),lower levels of NIHSS(P = 0.048) and glycated hemoglobin(P = 0.043).After adjustment,Logistic regression analysis demonstrated that the reversal of post-thrombolysis END was related to the energy level of early enteral nutrition(OR = 3.342,95% CI: 1.161-9.620,P = 0.025) and history of diabetes(OR = 0.166,95%CI: 0.033-0.829,P = 0.029).Conclusions Early enteral nutrition with sufficient energy level is beneficial to the reversal of post-thrombolysis END in the elderly patients with acute ischemic stroke.History of diabetes is harmful to the reversal of post-thrombolysis END in the elderly patients with acute ischemic stroke.