中风后口咽吞咽困难住院患者的个体化营养支持：一项随机对照试验
Individualized Nutritional Support for Hospitalized Patients With Oropharyngeal Dysphagia After Stroke: A Randomized Controlled Trial.
作者信息
Yan Xiu-Li, Liu Zhuo, Sun Ye, Zhang Peng, Lu Xue-Yan, Mu Fei, Du Juan, Yang Yi, Guo Zhen-Ni
机构信息
Department of Neurology, The First Hospital of Jilin University, Changchun, China.
School of Nursing, The Fourth Military Medical University, Xi'an, China.
出版信息
Front Nutr. 2022 Apr 13;9:843945. doi: 10.3389/fnut.2022.843945. eCollection 2022.
OBJECTIVES
Post-stroke dysphagia may cause aspiration pneumonia, malnutrition, dehydration, and other complications. However, data on the effects of nutritional supplementation and its value after stroke are insufficient. We aimed to evaluate the effect of an individualized 1-week nutrition intervention program on swallowing function and nutritional status in stroke patients with oropharyngeal dysphagia.
METHODS
This study comprised the control group receiving oral nutritional support and continuous nasogastric tube feeding according to the results of the water swallow test (WST). The intervention group additionally underwent a volume-viscosity swallowing test (V-VST) and intermittent oroesophageal tube feeding based on WST. The outcomes were measured after 7 days of intervention, including the improvement of swallowing function assessment by WST, biochemical parameters, such as total serum protein, serum albumin, hemoglobin levels and body composition. This trial was registered with the Chinese Clinical Trial Registry, identifier ChiCTR 2100054054.
RESULTS
In total, 173 participants completed the study between September 1, 2020, and April 30, 2021. Patients receiving individualized nutritional support showed a more significant improvement in the total effective rate of swallowing function (95.3% vs. 85.1%, < 0.05). After the intervention, the total serum protein level (0.97 ± 0.41 vs. -0.83 ± 0.47 g/L; < 0.05), serum albumin level (0.33 ± 0.28 vs. -1.39 ± 0.36 g/L; < 0.001) and lean tissue mass (0.13 ± 0.35 vs. -1.00 ± 0.40 g/L; < 0.05) increased in the intervention group. The decrease of hemoglobin levels in the control group was more evident (-6.17 ± 1.63 vs. -0.64 ± 1.40 g/L; 95%CI, -9.78 to -1.28; = 0.001). The difference of phase angle between the two groups was statistically significant (5.93 ± 0.88° vs. 5.77 ± 0.78°; = 0.035), but not in body fat mass.
CONCLUSIONS
In stroke patients with oropharyngeal dysphagia, the use of individualized nutritional support based on V-VST and intermittent oroesophageal tube feeding during the first week of hospitalization improved swallowing function and maintained nutritional status.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/, identifier: ChiCTR 2100054054.
目的
中风后吞咽困难可能导致吸入性肺炎、营养不良、脱水及其他并发症。然而，关于营养补充剂在中风后的作用及其价值的数据并不充分。我们旨在评估一项为期1周的个体化营养干预方案对患有口咽吞咽困难的中风患者吞咽功能和营养状况的影响。
方法
本研究包括根据饮水试验（WST）结果接受口服营养支持和持续鼻饲管喂养的对照组。干预组另外还进行了容量 - 黏度吞咽试验（V - VST），并根据WST结果进行间歇性经食管管饲。在干预7天后测量结果，包括通过WST评估吞咽功能的改善情况、生化参数，如总血清蛋白、血清白蛋白、血红蛋白水平和身体成分。本试验已在中国临床试验注册中心注册，标识符为ChiCTR 2100054054。
结果
共有173名参与者在2020年9月1日至2021年4月30日期间完成了研究。接受个体化营养支持的患者在吞咽功能总有效率方面有更显著的改善（95.3%对85.1%，P<0.05）。干预后，干预组的总血清蛋白水平（0.97±0.41对 - 0.83±0.47 g/L；P<0.05）、血清白蛋白水平（0.33±0.28对 - 1.39±0.36 g/L；P<0.001）和瘦组织质量（0.13±0.35对 - 1.00±0.40 g/L；P<0.05）有所增加。对照组血红蛋白水平的下降更为明显（ - 6.17±1.63对 - 0.64±1.40 g/L；95%CI， - 9.78至 - 1.28；P = 0.001）。两组之间的相位角差异具有统计学意义（5.93±0.88°对5.77±0.78°；P = 0.035），但在体脂质量方面无差异。
结论
在患有口咽吞咽困难的中风患者中，在住院第一周使用基于V - VST的个体化营养支持和间歇性经食管管饲可改善吞咽功能并维持营养状况。
临床试验注册
https://clinicaltrials.gov/，标识符：ChiCTR 2100054054。
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