早期肠内营养治疗对急性卒中近期预后的影响  

The impact of early alimentary nutrition on short-term prognosis after acute stroke

作　　者：王少石[1] 郑天衡[2] 陈真理[1] 杨建道[1] 周晓宇[1] 刘春风[2] 

机构地区：[1]上海交通大学附属第一人民医院分院神经内科,200081 [2]苏州大学附属第二医院神经内科

出　　处：《中华内科杂志》2007年第5期366-369,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨早期肠内营养治疗能否改善急性卒中的近期预后。方法采用前瞻性非随机对照研究,146例急性卒中伴吞咽障碍患者中;研究组(肠内营养)75例,对照组(家庭喂养饮食)71例。观察21d 两组患者营养状态、病死率、感染发生率,比较21d 的神经功能缺损评分[美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力(BI)指数和残障程度评分(mRS)]。结果住院21d,研究组营养指标显著优于对照组、营养不良发生率、感染发生率及病死率显著低于对照组;研究组的 NIHSS 显著优于对照组;两组的 BI 指数和90dmRS 比较差异无统计学意义。结论早期肠内营养治疗能够改善急性卒中神经功能的近期预后,但神经功能缺损评分未能获益。Objective To discuss the short-term effects of early naso-gastric nutrition after acute stroke. Methods In a prospective non-randomized controlled design, 146 stroke patients with dysphagia were included. 75 patients in the intervention group received standard naso-gastric nutrition and 71 patients in the control group and received feeding supervised by family members. We observed the nutrition status, infective complications and mortality between the two groups for 21 days. Neurological deficit was evaluated with NIH stroke scale, Barthel index and the modificied of Rankin Scale, the latter scale being calculated for 90 days. Results After 21 days, the nutritional parameters （triceps skin thickness, arm muscle circumference, haemoglobin, serum albumin, and triglycerides） in the intervention group were significantly better than those in the control group. Malnutrition was observed in 27. 1% of the intervention group and 48. 3% of the control group （P = 0. 014）. The incidence of infective complications was 33.3% in the intervention group and 52. 1% in the control group（P =0. 022）. Mortality rate was 6. 7% in the intervention group and 18. 1% in the control group（P = 0. 032）. The score of NIH stroke scale on the 21st day in the intervention group was also significantly better than that in the control group （P = 0. 008 ）. However, the Barthel index on the 21st day and the score of the medificied Rankin Scale on the 90th day of follow-up were not statistically different between the two groups. Conclusions It is suggested that standardized naso-gastric nutrition is helpful for improving short-term neurological function following acute stroke. However, improvement of Barthel index and the score of the modificied Rankin Scale needs more therapeutic measures besides nutritional support.

关 键 词：脑血管意外 肠营养 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]