脑卒中住院患者不同时间点营养状况影响因素研究

Analysis of Influencing Factors of the Nutritional Status in Stoke Patients Hospitalized at Different Time Points

背景脑卒中患者常发生营养不良,既往研究大多关注其入院时的营养状况,对住院期间及出院时营养状况的研究较少,若能动态观察并分析脑卒中住院患者不同时间点营养状况的影响因素,则能改善脑卒中患者的营养状况及预后。目的分析脑卒中住院患者不同时间点(入院、住院7 d、出院时)营养状况的影响因素。方法选取2021年1—12月入住郑州大学第一附属医院康复医学科的177例脑卒中患者为研究对象,根据不同时间点的营养状况分为不同时间点的营养正常组和营养不良组。收集患者的一般资料,包括性别、年龄、高血压、糖尿病、卒中后肺炎、卒中后焦虑抑郁、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、吸烟饮酒史、营养支持方式〔仅经口进食、仅鼻胃管(NGT)、仅间歇经口至食管管饲法(IOE)、合并肠外营养(PN)〕。采用洼田饮水试验(WST)评估患者的吞咽功能,采用美国国立卫生研究院卒中量表(NIHSS)评估患者的神经功能缺损程度。采用单因素及多因素Logistic回归分析探讨脑卒中住院患者不同时间点营养状况的影响因素。结果脑卒中患者入院、住院7 d、出院时营养不良发生率分别为11.9%(21/177)、32.2%(57/177)、19.8%(35/177),其中住院7 d时营养不良发生率高于入院及出院时营养不良发生率(P<0.05)。单因素分析结果显示:入院时营养正常组(156例)和营养不良组(21例)脑卒中患者年龄、吸烟饮酒史、营养支持方式、WST评分比较,差异有统计学意义(P<0.05);住院7 d时营养正常组(120例)和营养不良组(57例)脑卒中患者年龄、卒中后肺炎、营养支持方式、WST评分、NIHSS评分比较,差异有统计学意义(P<0.05);出院时营养正常组(142例)和营养不良组(35例)脑卒中患者营养支持方式、WST评分、NIHSS评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:WST评分〔OR=2.118,95%CI(1.390,3.226),P<0.001〕为脑卒中患者入院时营养不良的影响因素;年龄〔OR=1.035,95%CI(1.001,1.070),P=0.028〕、营养支持方式中合并PN〔OR=19.206,95%CI(3.188,115.707),P=0.001〕及NIHSS评分〔OR=1.108,95%CI(1.029,1.194),P=0.007〕为脑卒中患者住院7 d时营养不良的影响因素;营养支持方式中仅NGT〔OR=13.518,95%CI(1.783,102.493),P=0.012〕、合并PN〔OR=18.445,95%CI(2.870,118.531),P=0.002〕为脑卒中患者出院时营养不良的影响因素。结论脑卒中患者入院、住院7 d、出院时营养不良发生率均较高。WST评分为脑卒中患者入院时营养不良的影响因素;年龄、营养支持方式中合并PN、NIHSS评分为脑卒中患者住院7 d时营养不良的影响因素;营养支持方式中仅NGT及合并PN为脑卒中患者出院时营养不良的影响因素。

Background Malnutrition is frequently observed in stroke patients.Most of the previous studies focused on their nutritional status at the time of admission,but there is a lack of studies on the nutritional status in different periods of hospitalization.Objective To investigate the influencing factors of nutritional status in stroke patients at different time points(admission,the 7th day and discharge).Methods The study comprised 177 patients with the diganosis stroke admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Zhengzhou University between January and December 2021.According to the nutritional status,the patients were divided into nutritional normal and malnutrition groups at different time points.General data of the patients were being collected,including gender,age,hypertension,diabetes,post-stroke pneumonia,post-stroke anxiety and depression,obstructive sleep apnea hypoventilation syndrome(OSAHS),history of smoking and alcohol consumption,and mode of nutritional support〔oral feeding only,nasogastric tube only(NGT),intermittent oral to esophageal tube feeding only(IOE),combined parenteral nutrition(PN)〕.Assessment of patients´swallowing function using the Water Swallow Test(WST),and the degree of neurological deficits can be evaluated by the National Institutes of Health Stroke Scale(NIHSS).Univariate and multifactorial Logistic regression analyses were used to determine the factors influencing the nutritional status of stroke inpatients at different time points.Results The incidence of malnutrition in stroke patients at admission,the 7th day and discharge were 11.9%,32.2%and 19.8%,respectively.The rate of malutrition on the 7th day of admission was higher than admission and discharge(P<0.05).At the time of admission,between the normal nutrition group(n=156)and the malnutrition group(n=21)in the age,smoking and drinking history,nutritional support mode,and WST score,there were significantly different(P<0.05).On the 7th day of hospitalization,the normal nutrition group(n=120)was significant differences in age,post-stroke pneumonia,nutritional support mode,WST score and NIHSS score compared with malnutrition group(n=57)(P<0.05).At the time of discharge,the differences were statistically significant in nutrition support mode,WST score and NIHSS score between the normal nutrition group(n=142)and malnutrition group(n=35)(P<0.05).At the time of admission,WST score〔OR=2.118,95%CI(1.390,3.226),P<0.001〕was the influencing factor of malnutrition.On the 7th day,age〔OR=1.035,95%CI(1.001,1.070),P=0.028〕,combined-PN〔OR=19.206,95%CI(3.188,115.707),P=0.001〕and NIHSS score〔OR=1.108,95%CI(1.029,1.194),P=0.007〕were influencing malnutrition.Only-NGT〔OR=13.518,95%CI(1.783,102.493),P=0.012〕and combined-PN〔OR=18.445,95%CI(2.870,118.531),P=0.002〕are the influencing factors at the time of discharge.Conclusion The incidence of malnutrition is higher in stroke patients at admission,the 7th day and discharge.WST score is an influential factor for malnutrition at the time of admission.On the 7th day,the age,PN,and NIHSS score are influencing factors relevant to malnutrition.At the time of discharge,only-NGT and combined-PN are meaningful factors for malnutrition.