Mora Mendoza Alejandra, Pereyra-García Castro Francisca, Oliva García José Gregorio, Suárez Llanos José Pablo, Medina Rodriguez Antonio, Caracena Castellanos Nieves, García Nuñez María Aracelí, Palacio Abizanda José Enrique
Servicio de Endocrinología y Nutrición. Hospital Universitario Nuestra Señora de Candelaria.
Servicio de Neurología. Hospital Universitario Nuestra Señora de Candelaria.
Nutr Hosp. 2020 Apr 16;37(2):233-237. doi: 10.20960/nh.02742.
Introduction: the data in the medical literature are conflicting regarding the nutritional support of patients with stroke and the most appropriate time to start it. Objective: to analyze the effect of a nutritional intervention and of nutritional parameters on the clinical evolution of patients with stroke. Material and methods: this was an observational, retrospective study in 43 patients. The following baseline data were collected: tricipital skinfold (TS), mid-upper arm circumference (MUAC), muscular arm circumference (MAC), albumin, prealbumin, total cholesterol, lymphocytes, diabetes mellitus (DM), nutritional support onset, duration and type of supplementation, nutrition care plan, neurological dysfunction according to the National Institute of Health Stroke Scale (NIHSS) both at baseline and discharge, and mortality. Mortality within the first month and neurological deficit at discharge are identified as poor prognostic factors, and are related to nutritional parameters. Results: age 67.2 ± 12.5 years; 53.5% males and 34.9% females. Presence of DM: 34.88%. Nutritional parameters: TS: 18.7 ± 7.8 mm; MUAC: 30.2 ± 3 cm; MAC: 24.4 ± 3.1 cm; serum albumin 3.39 ± 0.3 g/dl; prealbumin: 22.3 ± 6.9 mg/dl; total cholesterol: 177.1 ± 46.4 mg/dL; lymphocytes: 1742 ± 885/mm3. Enteral nutritional support was started at 4.3 ± 5.8 days after the acute event, with a duration of 17.8 ± 23.2 days. Fifty percent of patients had severe neurological deficits at discharge. As markers of worse prognosis we identified a delay in the start of nutritional support of over 7 days, and the presence of DM. Conclusions: the late start of nutritional support was related to worse clinical prognosis. DM is a marker of poor prognosis in patients with stroke.
医学文献中关于中风患者的营养支持及其最适宜的开始时间的数据存在矛盾。目的：分析营养干预及营养参数对中风患者临床转归的影响。材料与方法：这是一项对43例患者的观察性回顾性研究。收集了以下基线数据：三头肌皮褶厚度（TS）、上臂中部周长（MUAC）、上臂肌肉周长（MAC）、白蛋白、前白蛋白、总胆固醇、淋巴细胞、糖尿病（DM）、营养支持开始时间、持续时间及补充类型、营养护理计划、根据美国国立卫生研究院卒中量表（NIHSS）在基线和出院时评估的神经功能障碍以及死亡率。将首月内的死亡率和出院时的神经功能缺损确定为不良预后因素，并与营养参数相关联。结果：年龄67.2±12.5岁；男性占53.5%，女性占34.9%。DM的发生率为34.88%。营养参数：TS：18.7±7.8毫米；MUAC：30.2±3厘米；MAC：24.4±3.1厘米；血清白蛋白3.39±0.3克/分升；前白蛋白：22.3±6.9毫克/分升；总胆固醇：177.1±46.4毫克/分升；淋巴细胞：1742±885/立方毫米。肠内营养支持在急性事件发生后4.3±5.8天开始，持续时间为17.8±23.2天。50%的患者出院时存在严重神经功能缺损。作为预后较差的指标，我们确定营养支持开始延迟超过7天以及存在DM。结论：营养支持开始较晚与较差的临床预后相关。DM是中风患者预后不良的一个指标。
