Hsieh Dong-Yi, Hung Jen-Wen, Chang Ku-Chou, Huang Yu-Ching, Lee Tsong-Hai, Chen Hsiu-Min
Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Acta Neurol Taiwan. 2017 Sep 15;26(3):120-127.
Stroke results in high mortality with tremendous health care burden. Malnutrition is frequently observed in patients after stroke. This study was designed to explore the nutritional status in the acute stage of stroke aiming at exploring factors related to malnutrition after stroke.
This was a hospital based, prospective, observational study recruiting cerebrovascular diseases patients hospitalized for acute management. Patients suffered from all kinds of cerebrovascular diseases hospitalized for management within 30 days after onset were consecutively recruited in the study hospitals. Stroke severity was evaluated by National Institutes of Health Stroke Scale, functional status by Barthel index, and global outcome by modified Rankin Scale. Cognitive function was evaluated by Mini-Mental State Examination. Nutritional status was assessed by Mini Nutritional Assessment (MNA), stratified by 1) adequate nutritional status, MNA ≥ 24; 2) protein-calorie malnutrition, MNA less than 17; 3) at risk of malnutrition, MNA between 17 and 23.5.
There were 231 cerebral infarction patients recruited at 13.5 days (25-75%: 5.0-17.0) after stroke onset with mild stroke severity 71.4% and severe 10.4% with nasogastric tube insertion in 14%. Malnutrition was identified in 12.1% with 54.1% at risk of malnutrition. Factor related to malnutrition was severe stroke severity with dependency. Patients with old age, hypertension, and diabetes mellitus tended to have malnutrition or risk of malnutrition.
Nutritional status was poor in stroke patients across all stroke severities within weeks. Further longitudinal outcome studies to identify the poor outcome and the evolution of nutritional status are warranted.
中风导致高死亡率，带来巨大的医疗负担。中风患者中经常观察到营养不良。本研究旨在探讨中风急性期的营养状况，以探寻与中风后营养不良相关的因素。
这是一项基于医院的前瞻性观察性研究，招募因急性治疗而住院的脑血管疾病患者。在发病后30天内住院接受治疗的各类脑血管疾病患者被连续纳入研究医院。中风严重程度通过美国国立卫生研究院卒中量表评估，功能状态通过巴氏指数评估，总体预后通过改良Rankin量表评估。认知功能通过简易精神状态检查表评估。营养状况通过微型营养评定法（MNA）进行评估，分为以下几类：1）营养状况良好，MNA≥24；2）蛋白质 - 热量营养不良，MNA小于17；3）营养不良风险，MNA在17至23.5之间。
共招募了231例脑梗死患者，中风发病后13.5天（四分位间距：5.0 - 17.0天）纳入研究，其中轻度中风严重程度患者占71.4%，重度患者占10.4%，14%的患者插入了鼻胃管。12.1%的患者被确定为营养不良，54.1%的患者有营养不良风险。与营养不良相关的因素是严重中风严重程度且伴有依赖。老年、高血压和糖尿病患者往往存在营养不良或有营养不良风险。
数周内，所有中风严重程度的患者营养状况均较差。有必要进行进一步的纵向结局研究，以确定不良结局以及营养状况的演变情况。
