老年脑卒中后患者营养风险筛查研究

doi:10.16150/j.1671-2870.2022.06.10

摘要/Abstract

摘要：

目的：探讨老年脑卒中患者中营养风险发生率及营养筛查意义。方法：选取2019年7月至2020年6月上海市徐汇区中心医院康复科收治的490例老年（>60岁）脑卒中患者，患者病程均在在6个月内，入院后24 h内用营养风险筛查2002（nutrition risk screening 2002，NRS 2002）评估表进行营养风险评估，调查该群患者营养风险发生率，并将患者分为营养风险组与正常组。所有患者出院前24 h内用Barthel指数评估其出院时日常生活活动能力（activities of daily living，ADL），并分析所有患者入院时的营养风险、血红蛋白、白蛋白、前白蛋白、肌酐水平与出院时ADL间的关系；同时比较营养风险组与正常组间出院时ADL的差异。结果：490例老年脑卒中患者的营养风险发生率为69.18%，所有患者营养风险评分、前白蛋白、肌酐水平与出院时ADL呈显著负相关，即使在医院经过对症治疗，入院营养风险组ADL在出院时依然显著低于正常组[（47.45±22.35）分比（54.10±22.14）分]（P<0.05）。结果：老年卒中患者中，营养风险发生率高达69.18%，在院康复老年脑卒中患者存在营养风险评分高者，其出院时ADL较低，提示对于入院时筛查有营养风险的老年患者需采取更积极的措施。

关键词: 脑卒中后, 营养风险, 日常生活活动能力

Abstract:

Objective: To explore the incidence of nutritional risk in elderly stroke patients and the significance of nutritional screening. Methods: A total of 490 elderly stroke patients admitted to the Rehabilitation Department of Xuhui District Central Hospital in Shanghai from July 2019 to June 2020 were enrolled. All the patients were more than 60 years old， with the duration after stroke less than 6 months. Nutrition risk assessment was conducted in the patients within 24 hours after admission using the Nutrition Risk Screening 2002 (NRS 2002) assessment form，and incidence of nutrition risk was investigated. The patients were divided into nutrition risk group and normal group. Barthel index was used to assess the activities of daily living(ADL) of patients within 24 hours before discharge, and correlation of the nutritional risk, hemoglobin, albumin, prealbumin, creatinine levels with ADL at discharge were analyzed. At the same time, the difference in ADL between the nutrition risk group and the normal group at discharge as compared. Results: The incidence of nutritional risk in 490 elderly stroke patients was 69.18%. The nutritional risk score, prealbumin and creatinine levels of the patients were significantly negatively correlated with ADL at discharge. Even given symptomatic treatment in the hospital, patients in the nutrition risk group had a lower ADL than those of the normal group at discharge(P<0.05). Conclusions: Among the elderly stroke patients, the incidence of nutritional risk is as high as 69.18%. Patients with higher nutritional risk scores in hospital rehabilitation may have lower ADL scores at discharge, indicating that more active measures should be taken to deal with elderly patients having nutritional risk at admission.

Key words: Post-stroke, Nutritional risk, Activities of daily living

中图分类号:

R473.5

崔岩, 葛海萍. 老年脑卒中后患者营养风险筛查研究[J]. 诊断学理论与实践, 2022, 21(06): 726-729.

CUI Yan, GE Haiping. Study on nutritional risk screening in elderly post-stroke patients[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(06): 726-729.

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参考文献 12

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项目	人数（n）	百分比（%）
性别
男	287	58.57
女	203	41.43
年龄（岁）
60~69	205	41.84
70~79	191	38.98
80~89	87	17.75
≥90	7	1.43
病程（d）
≤8周	250	51.02
>8周	240	48.98
既往疾病
无	39	7.96
高血压	166	33.88
糖尿病	15	3.06
高血压+糖尿病	169	34.49
高血压+糖尿病+其他慢病	23	4.69
高血压或糖尿病+其他慢病	51	10.41
其他	27	5.51
吞咽困难
有	315	64.29
无	175	35.71

变量	营养风险评分			ADL（入院时）			ADL（出院前）
变量	r值	95%置信区间		r值	95%置信区间		r值	95%置信区间
营养风险评分血红蛋白（g/L）血清白蛋白（g/L）前白蛋白（g/L）肌酐（mm/mmol） ADL（入院时） ADL（出院前）	-0.063 -0.075 -0.170^ -0.148^ -0.125^ -0.138^	-0.149~0.029 -0.154~0.004 -0.253~-0.087 -0.240~-0.060 -0.213~-0.049 -0.221~-0.062		-0.125^** 0.113^* 0.371^ 0.298^ 0.306^ 0.945^	-0.213~-0.049 0.014~0.202 0.297~0.456 0.218~0.384 0.226~0.389 0.929~0.958		-0.138^ 0.135^ 0.388^ 0.309^ 0.299^ 0.945^	-0.221~-0.062 0.036~0.222 0.312~0.462 0.225~0.392 0.220~0.379 0.929~0.958