低热量高蛋白肠内营养对急性脑梗死病人营养指标及并发症的影响
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摘要
目的:探讨低热量高蛋白肠内营养对急性脑梗死病人营养指标及并发症发生的影响。方法:选择2018年3月1日至2018年9月31日收治的符合入组标准的146例急性脑梗死病人为研究对象。随机分为标准热量组和低热量组,两组供给的肠内营养热量不同,蛋白质摄入均为1.2～1.5g/(kg·d)。标准热量组在入院3日内达到全量,低热量组在一周内给予低热量高蛋白营养治疗,第二周给到全量,对比两组病人营养指标、并发症发生率、住院天数及费用情况。结果:营养支持第14天时,低热量组病人的总蛋白、白蛋白水平显著高于标准热量组;血糖值显著低于标准热量组。低热量组病人腹泻及胃潴留的发生率显著低于标准热量组;住院天数及住院费用显著低于标准热量组,均具有统计学差异(P <0.05)。结论:短期应用低热量高蛋白肠内营养不仅能提高急性脑梗死病人的营养状况,而且能减少并发症的发生,缩短住院天数,减少住院费用,在临床应用上具有重要意义。
Objective: To investigate the effects of low-calorie and high-protein enteral nutrition on nutritional indicators and complications in patients with acute cerebral infarction. Methods: A total of 146 qualified patients with acute cerebral infarction from March 1 st2018 to September 31 th2018 were randomly divided into standard calorie group and low calorie group. The two groups were supplied with different calories, and the protein intake was 1.2～1.5 g/(kg.d).The standard calorie group reached the full amount within 3 days after admission. The low-calorie group received lowcalorie and high-protein nutrition therapy in the first week and whole amount in the second week. The nutritional indicators, complication rate, hospitalization days and expenses between groups were compared. Results: On the 14 th day of nutritional support, the total protein and albumin levels in low-calorie group were significantly higher while the blood glucose level was significantly lower than those in standard calorie group. The incidence of diarrhea and gastric retention in low-calorie group was significantly lower than that in the standard calorie group; the hospitalization days and expenses were significantly lower than those in standard calorie group(P<0.05). Conclusion: Short-term application of low-calorie and high-protein enteral nutrition can improve nutritional status, reduce incidence of complications and cost as well as shorten length of hospital stay in patients with acute cerebral infarction.
Objective: To investigate the effects of low-calorie and high-protein enteral nutrition on nutritional indicators and complications in patients with acute cerebral infarction. Methods: A total of 146 qualified patients with acute cerebral infarction from March 1 st2018 to September 31 th2018 were randomly divided into standard calorie group and low calorie group. The two groups were supplied with different calories, and the protein intake was 1.2～1.5 g/(kg.d).The standard calorie group reached the full amount within 3 days after admission. The low-calorie group received lowcalorie and high-protein nutrition therapy in the first week and whole amount in the second week. The nutritional indicators, complication rate, hospitalization days and expenses between groups were compared. Results: On the 14 th day of nutritional support, the total protein and albumin levels in low-calorie group were significantly higher while the blood glucose level was significantly lower than those in standard calorie group. The incidence of diarrhea and gastric retention in low-calorie group was significantly lower than that in the standard calorie group; the hospitalization days and expenses were significantly lower than those in standard calorie group(P<0.05). Conclusion: Short-term application of low-calorie and high-protein enteral nutrition can improve nutritional status, reduce incidence of complications and cost as well as shorten length of hospital stay in patients with acute cerebral infarction.
引文
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[15]Krezalek MA, et al. Influence of nutrition therapy on the intestinal microbiome, Curr Opin Clin Nutr Metab Care, 2017Mar, 20(2):131-137.
[16]安友仲.补不足损有余无监测慎营养再谈危重症病人的营养治疗.肠外与肠内营养,2017,5(24):129-131.
[17]张瑛,戴启荷,陈立.急性脑梗死患者神经功能恢复情况与炎症因子水平的相关性分析.安徽医学,2016,37(05):578-581.
[18]Yilmaz G, Arumujgam TV, Karen Y et al. Role of T lymphocytes and interferon in ischemic stroke. Circulation,2006,113(5):2105-2112.
[19]González O, Tobia C, Ebersole J, et al. Caloric restriction and chronic inflammatory diseases. Oral Dis,2012,18(1):16-31.
[20]胡雯,于康,周春凌.医疗膳食学.北京:人民卫生出版社,2017:171-172.
[21]李艳玲,齐玉梅.添加薏苡仁的肠内营养对脑卒中患者肠屏障功能的影响.卫生研究,2011,40(4):503-504.
[22]王新颖. 2016年成人危重症病人营养支持治疗实施与评价指南解读.肠外与肠内营养,2016,23(5):263-269.
[2]Wang D, Liu J, Liu M, et al. Patterns of Stroke Between University Hospitals and Nonuniversity Hospitals in Mainland China:Prospective Multicenter Hospital-Based Registry Study.World Neurosurg, 2017, 98:258. 265.
[3]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018.中华神经科杂志,2018,51(9):666-682.
[4]Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia:a review and design considerations for future trials. Int J Stroke,2016,11(4):399-411.
[5]Kampman MT, Eltoft A, Karaliute M, et al. Full implementation of screening for nutritional risk and dysphagia in an acute stroke unit:a clinical audit. Neurohospitalist, 2015,5(4):205-211.
[6]Nishioka S, Okamoto T, Takayama M, et al. Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition:Secondary analysis of a multicentre survey(the APPLE study). Clin Nutr, 2017, 36(4):1089-1096.
[7]Arabi YM, Haddad SH, Aldawood AS, et al. Permissive underfeeding versus target enteral feeding in adult critically ill patients(Permi T Trial):a study protocol of a multicenter randomized controlled trial.Trials,2012,13:191.
[8]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志, 2015, 48(4):246-257.
[9]脑卒中患者膳食指导:WS/T 558-2017,2017.
[10]Arabi YM, Aldawood AS, Haddad SH, et al. Permissive underfeeding or standard enteral feeding in critically Ill adults. N Engl J Med,2015,372(25):2398-2408.
[11]赵晓瑞,周清安,李同静,等.早期个体化肠内营养支持治疗在危重症脑卒中患者中的应用研究.中国医药指南,2011,9(31):345-346.
[12]Burgos R, Bretón I, Cereda E, et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr,2018,37(1):354-396.
[13]Zaloga G, Roberts P. Permissive underfeeding. New Horizons,1994;292:257.
[14]Mc Clave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(ASPEN). JPEN, 2016,40(2):159-211.
[15]Krezalek MA, et al. Influence of nutrition therapy on the intestinal microbiome, Curr Opin Clin Nutr Metab Care, 2017Mar, 20(2):131-137.
[16]安友仲.补不足损有余无监测慎营养再谈危重症病人的营养治疗.肠外与肠内营养,2017,5(24):129-131.
[17]张瑛,戴启荷,陈立.急性脑梗死患者神经功能恢复情况与炎症因子水平的相关性分析.安徽医学,2016,37(05):578-581.
[18]Yilmaz G, Arumujgam TV, Karen Y et al. Role of T lymphocytes and interferon in ischemic stroke. Circulation,2006,113(5):2105-2112.
[19]González O, Tobia C, Ebersole J, et al. Caloric restriction and chronic inflammatory diseases. Oral Dis,2012,18(1):16-31.
[20]胡雯,于康,周春凌.医疗膳食学.北京:人民卫生出版社,2017:171-172.
[21]李艳玲,齐玉梅.添加薏苡仁的肠内营养对脑卒中患者肠屏障功能的影响.卫生研究,2011,40(4):503-504.
[22]王新颖. 2016年成人危重症病人营养支持治疗实施与评价指南解读.肠外与肠内营养,2016,23(5):263-269.