不同营养评估指标对老年缺血性脑卒中患者抑郁的预测作用及护理启示  

Comparison of the performance of different nutritional indicators for predicting poststroke depression in older adults with ischemic stroke

作　　者：胡守娣 高茂凤 何俞 谢小华 Shoudi Hu;Maofeng Gao;Yu He;Xiaohua Xie(School of Nursing,Anhui Medical University,Hefei,China)

机构地区：[1]School of Nursing,Anhui Medical University,Hefei,China

出　　处：《International Journal of Nursing Sciences》2024年第3期349-356,I0003,共9页国际护理科学（英文）

基　　金：supported by the School of Nursing,Anhui Medical University(Project No.hlqm12023061),Hefei,China.

摘　　要：目的调查相关营养评估指标与卒中后抑郁(poststroke depression,PSD)的关系,分析营养指标预测老年缺血性脑卒中患者发生PSD的表现,为护理人员早期识别PSD高危患者,优化脑卒中管理,改善预后提供参考依据。方法于2022年9月至2023年5月在深圳市1所医院神经内科选取239例老年缺血性脑卒中患者为研究对象。采用自行设计的问卷,收集患者一般人口学资料及疾病相关信息;采用白蛋白、微型营养评定简表(Mini Nutritional Assessment Short Form,MNA-SF)、老年营养风险指数(Geriatric Nutrition Risk Index,GNRI)评估患者的营养状况;采用医院焦虑抑郁量表的抑郁分量表(Hospital Anxiety and Depression Scale-Depression,HADS-D)评估卒中后抑郁情况。采用二元逻辑回归分析,分析卒中后抑郁相关影响因素,并采用受试者工作特征曲线分析方法比较营养指标的表现。结果老年缺血性脑卒中患者平均年龄为71.10±7.41岁,男性占66.5%(159/239),PSD发生率为32.6%(78/239)。不同营养指标的低值组PSD的发生率显著大于高值组,差异均具有统计学意义(P<0.05)。二元逻辑回归分析表明白蛋白(OR,0.681;95%CI,0.508~0.913,P=0.010)、GNRI(OR,1.238;95%CI,1.034~1.483,P=0.020)、MNA-SF(OR,0.708;95%CI,0.614~0.815,P<0.001)是影响PSD的因素(P<0.05)。白蛋白、GNRI和MNA-SF 3个指标联合预测老年缺血性脑卒中患者PSD的ROC曲线下面积最大,有较高的区分度(AUC,0.738;敏感度为75.6%,特异度为60.9%)。结论由白蛋白、GNRI、MNASF联合组成的营养评价指标可作为预测老年缺血性脑卒中营养不良患者发生PSD风险的辅助工具。需要护理人员在更多样化的患者群体中进行进一步的验证,以证明预测的准确性。Objective:This study aimed to investigate the relationships between three different nutritional indicators and poststroke depression(PSD)and to analyze the performance of these nutritional indicators in predicting the occurrence of PSD in older adults with ischemic stroke to provide a reference for nurses to identify high-risk patients with PSD early,optimize stroke management,and improve patient prognosis.Methods:This cohort study prospectively included 239 older adults with ischemic stroke in the Department of Neurology of a hospital in Shenzhen from September 2022 to May 2023.The nutritional status of the patients were evaluated by laboratory indicators,the Mini Nutritional Assessment Short Form(MNA-SF),and the Geriatric Nutrition Risk Index(GNRI).The Hospital Anxiety and Depression Scale-Depression(HADS-D)was used to evaluate PSD.A self-designed questionnaire was used to collect demographic information and disease-related information.Binary logistic regression analysis was performed to analyze factors related to PSD,and receiver operating characteristic curve analysis was also used to compare the performance of these nutritional indicators.Results:A total of 239 older adults with ischemic stroke were included;the mean age was 71.10±7.41 years,and 66.5%(159/239)were males.The incidence of PSD was 32.6%(78/239).The incidence of PSD in the low-value group was significantly greater than that in the high-value group according to the different nutritional indices,and the difference was statistically significant(all P<0.05).Binary logistic regression analysis revealed that the albumin(ALB)level(OR=0.681;95%CI,0.508e0.913;P=0.010),GNRI score(OR=1.238;95%CI,1.034e1.483;P=0.020),and MNA-SF score(OR=0.708;95%CI,0.614e0.815;P<0.001)were influencing factors for PSD in this population(P<0.05).Combined with the ALB,GNRI,and MNA-SF,the area under the ROC curve for predicting the incidence of PSD in older adults with ischemic stroke was the largest and had a high degree of differentiation(AUC,0.738;sensitivity,75.6%;specific

关 键 词：老年人 抑郁 缺血性卒中 营养不良 护士 

分 类 号：R473.74[医药卫生—护理学]