Study Of Early Nutritional Assessment And Nutritional Support In Stroke Patients

Part1The Predictive Value of Nutrition Risk Screening2002(NRS2002) for Nutritional Risk in Stroke PatientsObjective:1) To evaluate the applicability of NRS2002in stroke patients.2) To investigate the incidence of nutritional risk and malnutrition in stroke patients.3) To explore the predictive value of NRS2002for nutritional risk in stroke patients.Methods:The patients admitted to our stroke unit during01/2010to06/2011and met the inclusion criteria were enrolled in this study. Nutritional status, rate of complications and the length of stay was assessed. Nutritional risk was assessed using NRS2002and the patients with a total score of>3are classified as nutritionally at risk. Malnutrition was defined as having a body mass index (BMI) of below18.5kg/m2or a serum albumin (ALB)<35g/L.Results:A total of156patients were admitted, and151patients underwent NRS2002. Overall prevalence of nutritional risk was60.3%and undernutrition was42.6%. All the nutritional indexs of the patients at nutritional risk were lower than the non-risk patients’when admitted to the hospital, but there was no significant difference between then. The nutritional indexs of the patients at nutritional risk decreased during hospital stay, and the descending levels of albumin, hemoglobin and lymphocyte count are significantly (P<0.05). But there are no significant differences were found in the triceps skinfold thickness, biceps circumference and arm muscle circumference, as well as nutritional indexs of the non-risk patients (P>0.05). Patients at nutritional risk had significantly lower higher incidence of complications (38.5%vs20.0%; P<0.05) and a significantly longer length of stay (LOS)(15.0±6.4vs12.4±6.3days; P<0.05) than non-risk patients. An ROC curve was generated for analysis of the value of NRS2002score, and the area under the ROC were0.752(95%confidence interval:0.618-0.787)(P<0.01). The optimal cut-off value for NRS2002score was3. The sensitivities, specificities, positive predictive value and negative predictive value were86%,37%,53.8%and81.6%respectively.Conclusion:The prevalence of nutritional risk and undernutrition are high in stroke patients, and NRS2002can be better for the prediction of nutritional risk in stroke patientsPart2Investigation of Sequential Enteral Nutrition Support on Patients with Severe StrokeObjective:To explore the influence of sequential enteral nutrition support on the nutritional status, complications and prognosis of severe stroke patients.Methods:The patients admitted to our stroke unit during01/2010to12/2010tow and met the inclusion criteria were enrolled in this study and randomly divided into groups. Patients of the sequential enteral nutrition group used short-peptide-based enteral nutrition support first, then gradually transferd to intacted protein enteral nutrition. Meanwhile, patients of the conventional enteral nutrition group constantly used intacted protein enteral nutrition support. The nutritional indexs, the rate of complications and prognosis were compared between the two groups.Results:Forty-nine patients met the inclusion criteria were randomly divided into sequential enteral nutrition group (n=24) and the conventional enteral nutrition group (n=25). All the nutritional indexs of the patients decreased in both groups during hospital stay, but the descending levels of hemoglobin and albumin in sequential enteral nutrition support group are significantly (P<0.05) lower than in the conventional enteral nutrition support group (0.653vs2.218,2.866vs5.904),as well as the occurrence of infectious and gastrointestinal hemorrhage complications. But there are no significant differences were found in the following nutritional indexs:body weight, BMI, triceps skinfold thickness, biceps circumference, arm muscle circumference and GCS, NIHSS, MRS (P>0.05).Conclusion:Sequential enteral nutritional support can improve the critical stroke patients’ nutritional status and decrease the occurrence of complications. It can therefore probably be ideal nutritional support method for critical stroke patients.