早期评估营养状况对脊髓损伤患者康复治疗的影响

Impact of Early Assessment of Nutritional Status on Rehabilitation of Patients with Spinal Cord Injury

目的探讨早期评估营养状况对脊髓损伤(SCI)患者康复治疗的影响。方法选取2016年6月至2020年6月郑州大学第一附属医院康复医学科收治的120例SCI患者。使用营养不良通用筛查工具(MUST)和脊柱营养筛查工具(SNST)评估患者的营养状况。根据MUST评分将患者分为L1组(营养不良低风险)和H1组(营养不良高风险)。根据SNST评分将患者分为L2组(营养不良低风险)和H2组(营养不良高风险)。比较不同组患者的美国脊髓损伤协会(ASIA)损伤量表评分,包括运动功能评分(AMS)和感觉功能评分(ASS)。分别于康复治疗前后采用改良Barthel指数(MBI)、脊髓独立性评定(第3版)(SCIM-Ⅲ)量表及ASIA损伤量表评估患者的功能状态。记录患者住院期间并发症发生情况。结果L1组65例(54.2%),H1组55例(45.8%)。L2组61例(50.8%),H2组59例(49.2%)。H1组康复治疗后MBI得分、SCIM-Ⅲ得分均低于L1组(P<0.05);H1组康复治疗前后AMS总分差值、ASS总分差值与L1组比较,差异无统计学意义(P>0.05)。H2组康复治疗后MBI得分、SCIM-Ⅲ得分均低于L2组(P<0.05);H2组康复治疗前后AMS总分差值、ASS总分差值与L2组比较,差异无统计学意义(P>0.05)。H1组并发症发生率较L1组高(P<0.05)。H2组并发症发生率较L2组高(P<0.05)。结论约45.0%的SCI患者存在营养不良的风险。营养不良会影响早期康复治疗效果,导致并发症增加。

Objective To explore the effect of early evaluation of nutritional status on rehabilitation of patients with spinal cord injury(SCI).Methods A total of 120 patients with SCI who were admitted to the Department of Rehabilitation Medicine in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2020 were selected.Malnutrition universal screening tool(MUST)and spinal nutrition screening tool(SNST)were used to assess the nutritional status of patients.According to the MUST score,the patients were divided into group L1(low risk of malnutrition)and group H1(high risk of malnutrition).According to the SNST score,the patients were divided into group L2(low risk of malnutrition)and group H2(high risk of malnutrition).The scores of American Spinal Injury Association(ASIA)injury scale of different groups of patients were compared,including motor function score(AMS)and sensory function score(ASS).The modified Barthel index(MBI),spinal cord independence measure(3rd edition)(SCIM-Ⅲ)scale and ASIA injury scale were used to assess the functional status of patients before and after rehabilitation.The occurrence of complications during the patients’hospitalization was recorded.Results There were 65 cases(54.2%)in group L1 and 55 cases(45.8%)in group H1.There were 61 cases(50.8%)in group L2 and 59 cases(49.2%)in group H2.The scores of MBI and SCIM-Ⅲ in group H1 after rehabilitation were lower than those in group L1(P<0.05).Compared with group L1,the differences of total score of AMS and ASS before and after rehabilitation in group H1 were not statistical different(P>0.05).The scores of MBI and SCIM-Ⅲ in group H2 after rehabilitation were lower than those in group L2(P<0.05).Compared with group L2,the differences of total score of AMS and ASS before and after rehabilitation in group H2 were not statistical different(P>0.05).The incidence of complications in group H1 was higher than that in group L1(P<0.05).The incidence of complications in group H2 was higher than that in group L2(P<0.05).Conclusion Approximately 45.0% of patients with SCI are at risk of malnutrition.Malnutrition will affect the effect of early rehabilitation treatment,leading to increased complications.