Rabadi M H, Coar P L, Lukin M, Lesser M, Blass J P
VA Medical Center, 921 NE 13th Street, Oklahoma City, OK 73104, USA.
Neurology. 2008 Dec 2;71(23):1856-61. doi: 10.1212/01.wnl.0000327092.39422.3c. Epub 2008 Oct 22.
Poor nutrition is a common complication of strokes severe enough to require inpatient rehabilitation. We therefore tested whether intensive nutritional supplements given to undernourished patients from the time of their admission to a specialized stroke rehabilitation service would improve patient outcomes.
Randomized, prospective, double-blind, single center study comparing intensive nutritional supplementation to routine nutritional supplementation in 116 undernourished patients admitted to a stroke service. The analysis included the 90% of patients who were not lost to follow-up due to acute or subacute hospitalization (n = 102; 51 in each group). The nutritional supplements are commercially available and Food and Drug Administration approved. The primary outcome variable was change in total score on the Functional Independence Measure (FIM). The secondary outcome measurements included the FIM motor and cognitive subscores, length of stay (taken from day of admission), 2-minute and 6-minute timed walk tests measured at admission and on discharge, and discharge disposition (home/not home).
Patients receiving intensive nutritional supplementation improved more than those on standard nutritional supplements on measures of motor function (total FIM, FIM motor subscore, 2-minute and 6-minute timed walk tests, all significant at p < 0.002). They did not, however, improve on measures of cognition (FIM cognition score). A higher proportion of patients who received the intensive nutritional supplementation went home compared to those on standard supplementation (p = 0.05).
Intensive nutritional supplementation, using readily available commercial preparations, improves motor recovery in previously undernourished patients receiving intensive in-patient rehabilitation after stroke.
营养不良是严重到需要住院康复治疗的中风常见并发症。因此，我们测试了从营养不良患者入院到专门的中风康复服务机构时给予强化营养补充剂是否会改善患者的预后。
一项随机、前瞻性、双盲、单中心研究，比较了116名入住中风服务机构的营养不良患者强化营养补充与常规营养补充的效果。分析纳入了90%未因急性或亚急性住院而失访的患者（n = 102；每组51人）。营养补充剂为市售且经美国食品药品监督管理局批准。主要结局变量是功能独立性测量量表（FIM）总分的变化。次要结局测量包括FIM运动和认知子分数、住院时间（从入院日起算）、入院时和出院时测量的2分钟和6分钟定时步行测试，以及出院处置情况（回家/未回家）。
在运动功能测量方面（FIM总分、FIM运动子分数、2分钟和6分钟定时步行测试，p均<0.002，差异均有统计学意义），接受强化营养补充的患者比接受标准营养补充的患者改善更大。然而，在认知测量方面（FIM认知分数）他们并没有改善。与接受标准营养补充的患者相比，接受强化营养补充的患者回家的比例更高（p = 0.05）。
使用现成的商业制剂进行强化营养补充，可改善中风后接受强化住院康复治疗的既往营养不良患者的运动恢复情况。
