老年高血压脑出血术后吞咽障碍患者营养状况及其影响因素分析

Analysis of nutritional status and its influencing factors in elderly patients with deglutition disorders after hypertensive intracerebral hemorrhage surgery

目的调查老年高血压脑出血术后吞咽障碍(deglutition disorders,DD)患者营养状况,并分析其主要影响因素,为制定患者营养支持和营养管理策略提供依据。方法选取2021年8月—2022年7月于空军军医大学第二附属医院行高血压脑出血手术患者88例。对患者的营养状况进行评估;采用单因素、二元多因素Logistic回归方法分析老年高血压脑出血术后吞咽障碍患者发生营养不良的影响因素。结果出现DD后,患者营养状况各指标值低于术前,差异有统计学意义(P<0.05);调查结果显示,营养不良者57例(64.77%),营养正常者31例(35.23%);单因素分析结果显示,年龄、NIHSS评分、咀嚼功能、BI评分、合并其他术后并发症、HAMD评分、吸烟史、酗酒史及早期康复锻炼是营养状况的影响因素(P<0.05);经二元Logistic回归分析显示,高年龄、咀嚼功能差、自主能力低、合并其他术后并发症及存在吸烟史是影响老年高血压脑出血术后吞咽障碍患者营养状况的独立危险因素,早期康复锻炼是其保护因素(P<0.05)。结论老年高血压脑出血患者营养不良现象较为严重,对年龄高、咀嚼功能差、自主能力低、合并其他术后并发症、有吸烟史患者,应当重视其营养补充。

Objective To investigate the nutritional status of elderly patients with deglutition disorders(DD)after hypertensive intracerebral hemorrhage surgery and analyze its main influencing factors,so as to provide basis for formulating nutritional support and nutritional management strategies.Methods A total of 88 patients undergoing hypertensive intracerebral hemorrhage surgery in Second Affiliated Hospital of Air Force Medical University between August 2021 and July 2022 were selected.Their nutritional status was evaluated.The influencing factors of malnutrition in elderly patients with DD after hypertensive intracerebral hemorrhage surgery were analyzed by univariate and binary logistic regression.Results After the occurrence of DD,the nutritional status indexes of patients were lower than those before surgery,and the differences were statistically significant(P<0.05).The investigation results showed that there were 57 cases with malnutrition(64.77%)and 31 ones without malnutrition(35.23%).The results of univariate analysis showed that age,NIHSS score,chewing function,BI score,concurrent other postoperative complications,HAMD score,smoking history,alcoholism history and early rehabilitation exercise were the influencing factors of nutritional status(P<0.05).Binary Logistic regression analysis showed that advanced age,poor chewing function,low self-care ability,concurrent other postoperative complications and smoking history were independent risk factors affecting the nutritional status of elderly patients with postoperative DD after hypertensive intracerebral hemorrhage surgery,while early rehabilitation exercise was a protective factor(P<0.05).Conclusion Malnutrition is severe in elderly patients with hypertensive cerebral hemorrhage.For patients with advanced age,poor chewing function,low self-care ability,concurrent other postoperative complications and smoking history,attention should be paid to their nutritional supplementation.