Wang Shao-Shi, Zheng Tian-Heng, Chen Zhen-Li, Yang Jian-Dao, Zhou Xiao-Yu, Liu Chun-Feng
Department of Neurology, First Municipal Hospital of Shanghai, Jiaotong University, Shanghai 200081, China.
Zhonghua Nei Ke Za Zhi. 2007 May;46(5):366-9.
To discuss the short-term effects of early naso-gastric nutrition after acute stroke.
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 modified of Rankin Scale, the latter scale being calculated for 90 days.
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 modified Rankin Scale on the 90th day of follow-up were not statistically different between the two groups.
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 modified Rankin Scale needs more therapeutic measures besides nutritional support.
探讨急性脑卒中后早期鼻饲营养的短期效果。
采用前瞻性非随机对照设计，纳入146例吞咽困难的脑卒中患者。干预组75例患者接受标准鼻饲营养，对照组71例患者接受家属监督下的喂食。观察两组患者21天内的营养状况、感染并发症及死亡率。采用美国国立卫生院卒中量表（NIH卒中量表）、巴氏指数及改良Rankin量表评估神经功能缺损，改良Rankin量表在随访90天时计算。
21天后，干预组的营养参数（肱三头肌皮褶厚度、上臂肌肉周长、血红蛋白、血清白蛋白和甘油三酯）显著优于对照组。干预组27.1%的患者出现营养不良，对照组为48.3%（P = 0.014）。干预组感染并发症发生率为33.3%，对照组为52.1%（P = 0.022）。干预组死亡率为6.7%，对照组为18.1%（P = 0.032）。干预组第21天的NIH卒中量表评分也显著优于对照组（P = 0.008）。然而，两组在第21天的巴氏指数及随访90天时的改良Rankin量表评分无统计学差异。
标准化鼻饲营养有助于改善急性脑卒中后的短期神经功能。然而，除营养支持外，改善巴氏指数及改良Rankin量表评分还需要更多治疗措施。
