Nishioka Shinta, Yamasaki Kazumi, Ogawa Kenji, Oishi Kana, Yano Yoko, Okazaki Yuka, Nakashima Ryusei, Kurihara Masaki
Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan.
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
Nutr Diet. 2020 Sep;77(4):456-466. doi: 10.1111/1747-0080.12579. Epub 2019 Sep 9.
To clarify the correlation between malnutrition, muscle mass and oral status, and swallowing function recovery in stroke patients receiving enteral nutrition.
Patients with stroke and dysphagia receiving any amount of enteral nutrition in rehabilitation wards from 2012 to 2016 were eligible for inclusion in this retrospective study. On admission, body composition by bioimpedance analysis, malnutrition confirmed by the European Society for Clinical Nutrition and Metabolism criteria, oral status, functional independence measure and demographic data were collected. Characteristics were compared between "oral intake alone" and "artificial nutrition" groups based on the discharge status. Kaplan-Meier methods and the Cox proportional hazards model were used to determine explanatory factors for the probability of full oral intake.
Among 174 patients, 113 were analysed (55 women; median age, 77 years). Overall, 61% and 39% were classified as "oral intake alone" and "artificial nutrition," respectively. Days from onset to admission to rehabilitation wards and motor Functional Independence Measure were higher in the "oral intake alone" group. Kaplan-Meier analysis demonstrated that patients with lower muscle mass exhibited lower probability of full oral intake (P = .009). The Cox proportional hazards model suggested that lower muscle mass (hazard ratio, 0.493; 95% CI, 0.286-0.850) and poor oral hygiene (hazard ratio, 0.573; 95% CI, 0.333-0.987) were independently correlated with "oral intake alone" status. Malnutrition and other oral status are not related to achieving full oral intake.
Skeletal muscle mass and oral hygiene are independently correlated with full oral intake among stroke patients receiving enteral nutrition during the rehabilitation phase.
阐明接受肠内营养的中风患者营养不良、肌肉量与口腔状况及吞咽功能恢复之间的相关性。
2012年至2016年在康复病房接受任何量肠内营养的中风及吞咽困难患者符合纳入本回顾性研究的条件。入院时，通过生物电阻抗分析测量身体成分，根据欧洲临床营养与代谢学会标准确认营养不良情况，收集口腔状况、功能独立性测量结果及人口统计学数据。根据出院状态比较“仅经口摄入”和“人工营养”组之间的特征。采用Kaplan-Meier方法和Cox比例风险模型确定完全经口摄入概率的解释因素。
174例患者中，113例进行了分析（55例女性；中位年龄77岁）。总体而言，分别有61%和39%被归类为“仅经口摄入”和“人工营养”。“仅经口摄入”组从发病到入住康复病房的天数和运动功能独立性测量得分更高。Kaplan-Meier分析表明，肌肉量较低的患者完全经口摄入的概率较低（P = 0.009）。Cox比例风险模型表明，较低的肌肉量（风险比，0.493；95%置信区间，0.286 - 0.850）和较差的口腔卫生状况（风险比，0.573；95%置信区间，0.333 - 0.987）与“仅经口摄入”状态独立相关。营养不良和其他口腔状况与完全经口摄入无关。
在康复阶段接受肠内营养的中风患者中，骨骼肌量和口腔卫生状况与完全经口摄入独立相关。
