Gariballa S E, Sinclair A J
Academic Department of Geriatric Medicine, University of Birmingham, Selly Oak Hospital, UK.
Postgrad Med J. 1998 Jul;74(873):395-9. doi: 10.1136/pgmj.74.873.395.
Stroke illness imposes a heavy and costly work load on hospital and community care services, and life after stroke can be a miserable affair for stroke patients and their carers. Nutritional factors may have an important role in acute stroke and its outcome. From the limited amount of research undertaken it has been shown that a significant number of patients with stroke are undernourished on admission and their nutritional status deteriorates further as an in-patient. This is especially so for those who are most dependent, in whom undernutrition is also associated with increasing morbidity and mortality. There is some evidence that nutritional supplementation may improve nutritional status and reduce morbidity and mortality. However most clinically available nutrition screening instruments lack sensitivity and specificity, and abnormal nutritional indicators may simply reflect effects of age, functional disability, or severe underlying disease. Therefore, causal relationship cannot be assumed without a sufficiently powerful intervention study which adequately adjusts for the effects of non-nutritional factors, such as the number and severity of comorbid conditions on clinical outcome. Meanwhile, doctors, nurses and members of the multidisciplinary team looking after stroke patients should be made aware of the likely impact of poor nutritional status on clinical outcome.
中风疾病给医院和社区护理服务带来了沉重且代价高昂的工作负担，中风后的生活对于中风患者及其护理人员而言可能是痛苦的。营养因素在急性中风及其预后中可能起着重要作用。从已开展的有限研究来看，大量中风患者入院时存在营养不良，且其营养状况在住院期间会进一步恶化。对于那些依赖性最强的患者尤其如此，在这类患者中，营养不良还与发病率和死亡率的增加相关。有证据表明营养补充可能改善营养状况并降低发病率和死亡率。然而，大多数临床可用的营养筛查工具缺乏敏感性和特异性，异常的营养指标可能仅仅反映了年龄、功能残疾或严重基础疾病的影响。因此，在没有充分有力的干预研究对非营养因素（如合并症的数量和严重程度对临床结局的影响）进行充分校正的情况下，不能假定存在因果关系。与此同时，照顾中风患者的医生、护士和多学科团队成员应意识到营养状况不佳对临床结局可能产生的影响。
