Kovács Andrea, Szabó Tamás Pál, Folyovich András
Semmelweis Egyetem, Egészségtudományi Doktori Iskola, Budapest.
Észak-Közép-budai Centrum Új Szent János Kórház és Szakrendelô, Neurológiai Osztály, Stroke Centrum, Budapest.
Ideggyogy Sz. 2021 Nov 30;74(11-12):367-378. doi: 10.18071/isz.74.0367.
The new coronavirus, SARS-CoV-2, which causes the COVID-19 disease can lead to severe acute respiratory distress syndrome (ARDS). It poses a serious challenge to the health care system, especially intensive care. Neurological patients, usually of advanced age and with a myriad of comorbidities, are at particular risk through the impact of the new coronavirus on their condition and nutritional capacity. Stroke is a leader in morbidity and mortality data, with a focus on dysphagia and its complications due to COVID-19 disease and acute cerebrovascular accident. In the acute phase of stroke, 30-50% of patients suffer from dysphagia, which still shows a prevalence of 10% six months later. Dysphagia results in decreased or insufficient fluid and nutrient uptake, supp-lemented by inactivity, leading to malnutrition and sarcopenia, which worsens overall condition, outcome, and rehabilitation efficiency. Screening and early detection of swallowing disorders is a fundamental issue in order to develop a personalized and timely-initiated nutritional therapy strategy. Nutritional therapy plays a key role in frequent intensive care due to COVID-19 disease, where it increases the chances of recovery and reduces the length of stay in the intensive care unit and mortality. This is especially true in critically ill patients requiring prolonged ventilation. In COVID-19 diagnosed patients, screening for dysphagia, bedside assessment, and instrumental examination, followed by swallowing rehabilitation, are of paramount importance. Stroke can also be a complication of the COVID-19 infection. Care for cerebrovascular patients has also adapted to the pandemic, "triazination" has become systemic, and dysphagia screening for stroke patients and nutritional therapy adapted to it have also shed new light.
导致新冠肺炎疾病的新型冠状病毒SARS-CoV-2可引发严重急性呼吸窘迫综合征(ARDS)。它对医疗系统,尤其是重症监护构成了严峻挑战。神经系统疾病患者通常年龄较大且伴有多种合并症,由于新型冠状病毒对其病情和营养能力的影响,他们面临着特别的风险。中风在发病率和死亡率数据方面位居前列,重点关注因新冠肺炎疾病和急性脑血管意外导致的吞咽困难及其并发症。在中风急性期,30%-50%的患者存在吞咽困难,六个月后患病率仍为10%。吞咽困难导致液体和营养物质摄入减少或不足,再加上缺乏活动,会导致营养不良和肌肉减少症,从而使整体病情、预后和康复效率恶化。筛查和早期发现吞咽障碍是制定个性化和及时启动的营养治疗策略的根本问题。由于新冠肺炎疾病,营养治疗在频繁的重症监护中起着关键作用,它能增加康复机会,缩短重症监护病房的住院时间并降低死亡率。对于需要长时间通气的重症患者尤其如此。在新冠肺炎确诊患者中,吞咽困难筛查、床边评估和仪器检查,随后进行吞咽康复,至关重要。中风也可能是新冠肺炎感染的并发症。对脑血管疾病患者的护理也已适应了这一疫情,“三嗪化”已成为系统性的,对中风患者的吞咽困难筛查以及与之相适应的营养治疗也有了新的认识。