| Objectives To investigate the influence of different calorie and protein nutrition regiments on the nutritional status,gastrointestinal complications,blood glucose and prognosis of patients with acute ischemic stroke.Methods A total of 161 patients with acute ischemic stroke requiring enteral nutrition were selected from Department of Neurology,Affiliated Hospital of North China University of Science and Technology from October 2018 to October 2020.They were randomly divided into four groups and given different enteral nutrition regimens:EN1group(energy target 25Kcal/kg/d,protein target 1.2g/kg/d)and EN2 group(energy target17Kcal/kg/d,protein target 1.2g/kg/d);EN3 group(energy target 25kcal/kg/d,protein target 1.8g/kg/d);EN4 group(energy target 17Kcal/kg/d,protein target 1.8g/kg/d),nutrition support for 7 days.The levels of albumin(ALB),total protein(TP),pre-albumin(PA)and hemoglobin(HGB)in 4 groups before and after feeding were observed.The incidence of feeding complications in four groups was observed.Fasting blood glucose of the four groups of diabetic patients from day 4 to 7 was monitored,and blood glucose values at different time points on day 7 were monitored to calculate the mean blood glucose,standard deviation of blood glucose level and range of blood glucose.The incidence of pulmonary infection and mechanical ventilation,duration of antibiotics and ventilator use,length of hospital stay and other prognostic indicators were recorded in the four groups.NIHSS score was used to evaluate the neurological recovery of patients at discharge.Results 1 After feeding for 7 days,there were statistically significant differences in the nutritional indexes of ALB,TP,PA and HGB among the four groups(F=9.781,P<0.001;F=7.667,P<0.001;F=17.108,P<0.001;F=11.127,P<0.001),and by LSD test,the above nutritional indexes in EN3 and EN4 groups were significantly higher than those in EN1and EN2 groups(P<0.05),and there was no significant difference between EN1 and EN2groups,EN3 and EN4 groups(P>0.05).2 Within 7 days of nutritional support,the incidence of gastric retention,diarrhea and gastric mucosal bleeding in the four groups was statistically significant(χ~2=21.317,P<0.001;χ~2=18.612,P<0.001;χ~2=22.106,P<0.001);By chi-square segmentation,the incidence of gastric retention,diarrhea and gastric mucosal hemorrhage in EN2 and EN4 groups were significantly lower than those in EN1 and EN3groups(P<0.00833),while there was no statistically significant difference between EN1and EN3 groups,EN2 and EN4 groups(P>0.00833).3 There were significant differences in average blood glucose,standard deviation of blood glucose level and range of blood glucose among the four groups on the 7th day of enteral nutrition support(F=6.542,P=0.001;F=5.605,P=0.002;F=7.880,P<0.001)by one-way analysis of variance(ANOVA),by LSD test,the above blood glucose fluctuation indexes in EN2 and EN4groups were significantly lower than those in EN1 and EN3 groups(P<0.05),and there was no statistical significance between EN1 group and EN3 group,EN2 group and EN4 group(P>0.05).4 The incidence of lung infection among the four groups was statistically significant(χ~2=20.707,P<0.001),and the comparison by chi-square segmentation showed that EN3 and EN4 groups were significantly lower than EN1 and EN2 groups(P<0.00833),while there was no statistically significant difference between EN1 and EN2 groups or EN3 and EN4 groups(P>0.00833);Kruskall-Wallis H test showed statistically significant differences in antibiotic use time and hospitalization time among the four groups(H=29.126,P<0.001;H=18.317,P<0.001),the Dunn-Bonferroni test showed that groups EN3 and EN4 were significantly lower than groups EN1 and EN2(adjusted for P<0.05),there was no statistically significant difference between EN1 and EN2 groups or EN3 and EN4 groups(adjusted for P>0.05).5 Comparison of NIHSS evaluation among groups after discharge showed statistically significant difference between groups(F=4.428,P=0.005).Pair comparison by LSD test showed that EN3 and EN4 groups were significantly lower than EN1 and EN2 groups(P<0.05),there was no statistically significant difference between EN1 and EN2 groups,EN3 and EN4 groups(P>0.05).Conclusions 1 In enteral nutrition support for patients with acute ischemic stroke,1.8g/kg/d of protein is more beneficial to the nutritional status and recovery of patients than 1.2g/kg/d of protein,which is generally recommended,and does not increase gastrointestinal complications,blood glucose fluctuations and other adverse events.2 In enteral nutrition support for patients with acute ischemic stroke,compared with increasing protein intake,sufficient calories or calorie restriction alone has no significant effect on the nutrition and prognosis of patients,but reducing calorie intake can improve gastrointestinal intolerance and reduce blood glucose fluctuations.3 Calorie-restricted and high-protein nutrition scheme is a more appropriate choice for patients with acute ischemic stroke.Figure 8;Table 12;Reference 92... |
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