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全球营养不良领导倡议-营养不良定义的营养不良预测与吞咽困难相关的中风患者的预后。

The Global Leadership Initiative on Malnutrition-Defined Malnutrition Predicts Prognosis in Persons With Stroke-Related Dysphagia.

机构信息

Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.

Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.

出版信息

J Am Med Dir Assoc. 2019 Dec;20(12):1628-1633. doi: 10.1016/j.jamda.2019.07.008. Epub 2019 Aug 26.

Abstract

OBJECTIVE

This study aimed to clarify the association between malnutrition and improvement of swallowing ability during rehabilitation of stroke patients.

DESIGN

This was a retrospective cohort study.

SETTING AND PARTICIPANTS

One hundred eighty-eight older adults with oropharyngeal dysphagia after stroke who were admitted to a rehabilitation hospital.

METHODS

The International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) was used to assess swallowing ability. The Global Leadership Initiative on Malnutrition (GLIM) definition was used to diagnose malnutrition. The primary outcome was IDDSI-FDS score at discharge.

RESULTS

The mean age of the patients was 78.9 ± 7.7 years, and 36.7% were women. A total of 122 (64.8%) patients were diagnosed with malnutrition. Compared with those without malnutrition, malnourished patients had more severe dysphagia on admission. After adjusting for confounders, malnutrition was an independent contributor to the IDDSI-FDS scores at discharge (standardized coefficient: -0.165, P = .011).

CONCLUSION AND IMPLICATIONS

In patients with oropharyngeal dysphagia after stroke, malnutrition at admission inversely affected their swallowing ability at discharge. Dysphagia rehabilitation, including early nutritional intervention, may be effective in the recovery of swallowing ability.

摘要

目的

本研究旨在阐明脑卒中患者康复过程中营养不良与吞咽能力改善之间的关系。

设计

这是一项回顾性队列研究。

地点和参与者

188 名在脑卒中后出现口咽吞咽困难的老年人,他们被收治在一家康复医院。

方法

使用国际吞咽障碍饮食标准化倡议功能性饮食量表(IDDSI-FDS)评估吞咽能力。采用全球营养领导倡议(GLIM)定义诊断营养不良。主要结局是出院时的 IDDSI-FDS 评分。

结果

患者的平均年龄为 78.9 ± 7.7 岁,36.7%为女性。共有 122 名(64.8%)患者被诊断为营养不良。与无营养不良的患者相比,营养不良的患者入院时吞咽困难更为严重。在校正混杂因素后,营养不良是出院时 IDDSI-FDS 评分的独立影响因素(标准化系数:-0.165,P =.011)。

结论和意义

在脑卒中后出现口咽吞咽困难的患者中,入院时的营养不良会对出院时的吞咽能力产生负面影响。吞咽障碍康复,包括早期营养干预,可能对吞咽能力的恢复有效。

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