脑卒中吞咽障碍患者营养状况的影响因素及间歇经口食管管饲的应用效果分析  

Analysis of influencing factors of nutritional status in stroke patients with dysphagia and the effect of intermittent oro-esophageal tube feeding

作　　者：陈梦丽 胡敏[1] CHEN Mengi;HU Min(Department of Neurology,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006,China)

机构地区：[1]南昌大学第二附属医院神经内科,江西南昌330006

出　　处：《当代医学》2024年第3期60-63,共4页Contemporary Medicine

基　　金：江西省卫生健康委科技计划项目(202210664)。

摘　　要：目的探讨脑卒中吞咽障碍患者营养状况的影响因素及间歇经口食管管饲(IOE)的应用效果。方法选取2020年1月至2022年1月于南昌大学第二附属医院接受治疗的113例脑卒中吞咽障碍合并营养不良患者作为研究对象,依据患者入院后1个月体质量的丢失情况分为中度营养不良组(中度组,n=63)与重度营养不良组(重度组,n=50),比较两组临床资料,并采用多因素Logistics回归分析探讨营养不良的影响因素。另依据营养支持方法的不同分为鼻饲组(NG组,n=57)与间歇经口食管管饲组(IOE组,n=56),比较管饲前后两组营养状况。结果重度组高血压、感染、脑出血占比高于中度组,洼田饮水分级4级与5级总占比高于中度组,心理状态抑郁自评量表(SDS)评分高于中度组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压、合并脑出血、洼田饮水试验分级5级及SDS评分高是发生重度营养不良的独立危险因素(P<0.05)。基于SDS评分绘制ROC曲线,在60分处截断,诊断的灵敏度为82.00%,特异度为88.89%。营养支持前,IOE组与NG组血红蛋白(Hb)、白蛋白(ALB)及总蛋白(TP)水平比较差异无统计学意义;营养支持后,IOE组Hb、ALB、TP水平均高于NG组,差异有统计学意义(P<0.05)。结论高血压、合并脑出血、洼田饮水试验分级5级及SDS评分高是脑卒中吞咽障碍患者发生重度营养不良的独立危险因素,采用IOE的营养支持方式可更有效改善患者营养不良状况。Objective To investigate the influencing factors of nutritional status in stroke patients with dysphagia and the effect of intermittent oro-esophageal tube feeding(IOE).Methods 113 stroke patients with dysphagia combined with malnutrition were selected as the study objects from January 2020 to January 2022 in the Second Affiliated Hospital of Nanchang University,and they were divided into the moderate malnutrition group(moderate group,n=63)and the severe malnutrition group(severe group,n=50)according to their body mass loss one month after admission,clini-cal data between the two groups were compared,and multivariate Logistic regression analysis was aused to explore the influencing factors of malnu-trition.In addition,according to different nutritional support methods,the patients were divided into the nasogastric gavage group(NG group,n=57)and the intermittent oro-esophageal tube feeding group(IOE group,n=56),and the nutritional status of the two groups before and after tube feeding was compared.Results The proportion of hypertension,infection and cerebral hemorrhage in the severe group were higher than those in the moder-ate group,the total proportion of grade 4 and grade 5 was higher than that in the moderate group,and the score of self-rating mental state depression scale(SDS)was significantly higher than that in the moderate group,the differences were statistically significant(P<0.05).The results of multivari-ate Logistics regression analysis showed that hypertension,intracerebral hemorrhage,grade 5 of water swallow test and high SDS score were indepen-dent risk factors for severe malnutrition(P<0.05).The receiver operating characteristic(ROC)curve was drawn based on SDS score and truncated at 60 scores,the diagnostic sensitivity was 82.00%and the specificity was 88.89%.Before nutritional support,there were no significant differences in he-moglobin(Hb),albumin(ALB)and total protein(TP)levels between the IOE group and the NG group;after nutritional support,the levels of Hb,ALB and TP in the IOE group were hig

关 键 词：脑卒中 吞咽障碍 营养状况 影响因素 间歇经口食管管饲 

分 类 号：R473.74[医药卫生—护理学]