| BackgroundIn China, the incidence of stroke is much higher, and the number of patients increases year by year in varying degrees, and about 14%-71% of the patients suffer from dysphagia. Dysphagia will affect patients’nutrition intake and might be prone to malnutrition or aggravate the original malnourished condition, which will seriously hold back the recovery. Meanwhile, the risk of complications will increase because of the deterioration of the original nutritional status. To screen the nutritional risk, assess the nutritional status,find nutritional methods.Therefore, timely and rational enteral nutritional support can improve the nutritional status and enhance immunity in stroke patients with dysphagia, which will greatly reduce the incidence of the complications and promote the patients’ functional recovery. In this study, comprehensive assessments of nutritional status were conducted in stroke patients with dysphagia, and the impact of different nutritional interventions on patients’ objective nutritional indicators, nutritional cost and complications were analyzed, which will provide the clinical evidence for the nutritional support in non-severe stroke patients with dysphagia.Objectives1. To screen the nutritional risk, assess the nutritional status and comprehensively understand the nutritional conditions of the hospitalized stroke patients with dysphagia.2. To analyze the different roles on patients’biochemical indicators, physical indicators, nutrition cost and clinical outcomes between two methods of nutritional support.Methods1. Kubota water test was used to judge whether the patient had dysphagia, and 122 cases of stroke patients with dysphagia were admitted from the Neurology Ward 1 and 2 of the Affiliated Hospital of x Medical College from March 2015 to March 2016. All patients were diagnosed according to the diagnostic criteria of the National Conference on Cerebrovascular Disease in 2001, and corresponding to CT and MRI diagnostic criteria. All the patients in this study were without any disturbance of consciousness and able to express their conditions using language or handwriting, and all the patients’hospital stays were no less than 3 weeks. The NRS-2002 nutritional risk screening table was applied to complete the screening of patients’ nutritional risk and status in 24 hours after the patients admitted.2. According to the inclusion criteria, patients from Ward 1 were tagged as group A, which were supplied nutritional support of homogenized meal; Group B, involving patients from Ward 2, were treated with whole protein preparations. Differences of biochemical indicators, physical indicators, complications and cost of nutrition were compared between these two groups.3. Detection of biochemical indicator:fasting venous blood was collected on the second day after the patient was admitted, and total protein (TP), albumin (ALB) and hemoglobin (HB) were detected using the patients’ serum.4. Monitoring of physical indicator:body mass index (BMI) was calculated by measuring patient’s height and weight; patient’s mid-upper arm circumference (MUAC) was measured using flexible rule, and the skinfold thickness of triceps was measured with skinfold thickness gauge.Results1. Results of nutritional support:all indicators were improved in group A after the treatment with homogenized nutritional support for 21 days compared with the data before the treatment (p<0.05); The patients’ indicators revealed the same feature after the intervention with whole protein meals for 21 days in group B (p<0.05). The differences of physical indicators (weight, BMI, MUAC, skinfold thickness) and biochemical indicators(TP, HB, ALB) were no significant after nutritional intervention for 15 days and 21 days between group A and group B (p>0.05).2. The comparison of complications between the two groups treated with different nutritional intervention revealed no significant (p>0.05).3. The patient’s average nutritional cost for 3 weeks in group A was 845.12 RMB, but the same cost in group B was 1935.34 RMB. The average cost of whole protein nutritional support was 2.3 times of homogenized meal. Therefore, the costs were significantly different between the two nutritional treatments.Conclusions1. There were no significant differences in patients’complications, biological indicators and physical indicators between the treatment with homogenized meal or whole protein preparations, which suggested that both of the two different nutritional interventions are suitable for non-severe stroke patients with dysphagia.2. The cost of the two nutritional treatments were significantly different, which revealed that homogenized meal was much cheaper than whole protein preparation. Based on the consideration of economic and benefits, the homogenized meal preparation is more suitable for stroke patients with dysphagia, especially for the ecdemic patients with low reimbursement. |
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