Dávalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, Suñer R, Genís D
Department of Neurology, Hospital Doctor Josep Trueta, Girona, Spain.
Stroke. 1996 Jun;27(6):1028-32. doi: 10.1161/01.str.27.6.1028.
Malnutrition has received little attention in acute stroke, although it represents a risk of decreased immunity and nosocomial infections. Our objectives were to determine the prevalence of malnutrition after 1 week of hospitalization in acute stroke and to establish its relation to the stress response and neurological outcome.
The study included 104 patients with an acute stroke of less than 24 hours' duration. Nutritional parameters (triceps skinfold thickness, midarm muscle circumference, serum albumin, and calorimetry) were evaluated at admission and after 1 week. Stress response (free urinary cortisol) was measured daily during the first week. Neurological deficit was evaluated by the Canadian Stroke Scale. Clinical outcome was estimated by the Barthel Index 1 month after the acute stroke. Patients received an oral standard diet or polymeric enteral nutrition when they had swallowing difficulties.
Protein-energy malnutrition was observed in 16.3% of patients at inclusion and in 26.4% after the first week, with a significant decrease in fat (P = .002) and visceral protein compartments (P = .049). Malnourished patients showed higher stress reaction and increased frequency of infections and bedsores in comparison with the appropriately nourished group. Multiple logistic regression analysis showed that malnutrition after 1 week (odds ratio, 3.5; 95% confidence interval, 1.2 to 10.2) and elevated free urinary cortisol (odds ratio, 3.3; confidence interval, 1.05 to 10.2) increased the risk of poor outcome (death or Barthel Index < or = 50 on the 30th day of follow-up) independently of age and nutritional status at admission.
Our findings suggest that protein-energy malnutrition after acute stroke is a risk factor for poor outcome. Early appropriate enteral caloric feeding did not prevent malnutrition during the first week of hospitalization.
营养不良在急性卒中中很少受到关注，尽管它会导致免疫力下降和医院感染风险增加。我们的目标是确定急性卒中患者住院1周后营养不良的患病率，并确定其与应激反应和神经功能结局的关系。
该研究纳入了104例病程小于24小时的急性卒中患者。在入院时和1周后评估营养参数（三头肌皮褶厚度、上臂中部肌肉周长、血清白蛋白和热量测定）。在第一周每天测量应激反应（尿游离皮质醇）。通过加拿大卒中量表评估神经功能缺损。急性卒中1个月后通过巴氏指数评估临床结局。当患者有吞咽困难时，给予口服标准饮食或聚合型肠内营养。
纳入时16.3%的患者存在蛋白质-能量营养不良，第一周后为26.4%，脂肪（P = 0.002）和内脏蛋白部分显著减少（P = 0.049）。与营养状况良好的组相比，营养不良的患者表现出更高的应激反应，感染和褥疮的发生率增加。多因素logistic回归分析显示，1周后营养不良（比值比，3.5；95%置信区间，1.2至10.2）和尿游离皮质醇升高（比值比，3.3；置信区间，1.05至10.2）独立于年龄和入院时的营养状况增加了不良结局（死亡或随访第30天巴氏指数≤50）的风险。
我们的研究结果表明，急性卒中后的蛋白质-能量营养不良是不良结局的危险因素。早期适当的肠内热量喂养并不能预防住院第一周的营养不良。
