Zheng Tianheng, Zhu Xinpu, Liang Huazheng, Huang Haixia, Yang Jiandao, Wang Shaoshi
Department of Neurology, Branch of the People's First Hospital, 1878 North Sichuan Road, Hongkou District, Shanghai 200081, China.
Department of Neurology, Branch of the People's First Hospital, 1878 North Sichuan Road, Hongkou District, Shanghai 200081, China; Neuroscience Research Australia, Randwick, NSW, Australia.
J Clin Neurosci. 2015 Sep;22(9):1473-6. doi: 10.1016/j.jocn.2015.03.028. Epub 2015 Jul 14.
We hypothesized that early enteral nutritional support would improve the short term prognosis of acute stroke patients with dysphagia, demonstrated by lower malnutrition rates, lower complication rates, and lower National Institutes of Health Stroke Scale (NIHSS) scores at 90 days post stroke. Nutrition support is an essential element in the care of stroke patients and many studies have investigated the effect of specific nutritional elements on stroke patients. However, few studies have looked at the impact of complete enteral nutrition on Chinese patients with acute stroke. To investigate this, we conducted a randomized controlled trial of 146 patients with acute stroke and dysphagia, among whom 75 were supported with nasogastric nutrition and 71 received family managed nutrition after randomization. Nutritional status, nosocomial infection and mortality rates were recorded on day 21 of hospitalization. Neurological deficits were evaluated by the NIHSS activities of daily living Barthel index (ADLBI) and the modified Rankin scale (mRS) and compared between the two groups. We found that the nasogastric nutrition group had a better nutritional status and reduced nosocomial infection and mortality rates after 21 days compared with patients in the family managed nutrition group. In addition, the nasogastric nutrition group showed a lower score on the NIHSS than the control group. However, the differences in the scores of the ADLBI and the 90 day mRS between the groups were not significant. Taken together, the present study shows that early enteral nutrition support improves the short term prognosis of acute stroke patients with dysphagia.
我们假设，早期肠内营养支持能够改善急性吞咽困难中风患者的短期预后，表现为较低的营养不良率、较低的并发症发生率以及中风后90天时较低的美国国立卫生研究院卒中量表（NIHSS）评分。营养支持是中风患者护理的重要组成部分，许多研究探讨了特定营养元素对中风患者的影响。然而，很少有研究关注完全肠内营养对中国急性中风患者的影响。为了对此进行研究，我们对146例急性中风伴吞咽困难患者进行了一项随机对照试验，其中75例接受鼻饲营养支持，71例在随机分组后接受家庭管理营养。在住院第21天记录营养状况、医院感染率和死亡率。通过NIHSS、日常生活活动巴氏指数（ADLBI）和改良Rankin量表（mRS）评估神经功能缺损，并在两组之间进行比较。我们发现，与家庭管理营养组患者相比，鼻饲营养组在21天后营养状况更好，医院感染率和死亡率更低。此外，鼻饲营养组的NIHSS评分低于对照组。然而，两组之间ADLBI评分和90天mRS评分的差异并不显著。综上所述，本研究表明早期肠内营养支持可改善急性吞咽困难中风患者的短期预后。
