武珏瑛, 吴友红, 黄学才, 卓玉荣, 杨燕. 脑卒中患者营养不良风险评估及对康复护理的对策研究[J]. 上海预防医学, 2022, 34(1): 41-45. DOI: 10.19428/j.cnki.sjpm.2022.20826
引用本文: 武珏瑛, 吴友红, 黄学才, 卓玉荣, 杨燕. 脑卒中患者营养不良风险评估及对康复护理的对策研究[J]. 上海预防医学, 2022, 34(1): 41-45. DOI: 10.19428/j.cnki.sjpm.2022.20826
WU Jueying, WU Youhong, HUANG Xuecai, ZHUO Yurong, YANG Yan. Influencing factors of nutritional risks and rehabilitation nursing countermeasures in stroke patients[J]. Shanghai Journal of Preventive Medicine, 2022, 34(1): 41-45. DOI: 10.19428/j.cnki.sjpm.2022.20826
Citation: WU Jueying, WU Youhong, HUANG Xuecai, ZHUO Yurong, YANG Yan. Influencing factors of nutritional risks and rehabilitation nursing countermeasures in stroke patients[J]. Shanghai Journal of Preventive Medicine, 2022, 34(1): 41-45. DOI: 10.19428/j.cnki.sjpm.2022.20826

脑卒中患者营养不良风险评估及对康复护理的对策研究

Influencing factors of nutritional risks and rehabilitation nursing countermeasures in stroke patients

  • 摘要:
    目的 分析脑卒中患者营养风险影响因素,并探讨康复护理对策的制定。
    方法 随机选取2018年7月—2020年7月丽水市中心医院神经外科收治的急性出血性脑卒中患者152例,根据微型营养评估(MNA)量表评分结果,将患者分为正常组、风险组和不良组。采用单因素分析与相关性分析方法,分析患者可能存在的营养风险影响因素,并针对影响因素给出康复护理对策。
    结果 单因素分析结果显示:卒中患病时间、机械通气、吞咽功能障碍、日常生活能力(ADL)评分、上臂肌围、血清白蛋白、总淋巴细胞计数统计结果表现出了差异,与正常组相比,机械通气、吞咽功能障碍患者比例更高,ADL评分、上臂肌围、血清白蛋白、总淋巴细胞计数水平更低(P<0.05)。Spearman等级相关性分析结果显示:单因素分析中具有差异的因素,采用Spearman等级相关方法分析后同样表现出了相关性(P<0.05),其中,正相关因素包括卒中患病时间、接受机械通气、吞咽功能障碍、格拉斯哥昏迷评分(GCS),负相关因素包括ADL评分、血清白蛋白、转铁蛋白、血红蛋白。多因素logistic回归分析显示:卒中患病时间(OR=1.739,P<0.001)、吞咽功能障碍(OR=3.966,P=0.008)是影响患者营养状况的独立危险因素;ADL评分(OR=0.687,P<0.001)、上臂肌围(OR=0.770,P=0.012)、血清白蛋白(OR=0.870, P=0.003)是影响患者营养状况的独立保护因素。
    结论 脑卒中部分患者存在吞咽障碍、运动功能障碍、自理能力差等现象,同时,患者蛋白质含量减少明显,营养状态有待改善。临床工作可从患者吞咽功能恢复,神经损伤的治疗、功能恢复,以及社会家庭支持度恢复等方面展开。

     

    Abstract:
    Objective To explore the nutritional risk influencing factors in stroke patients, and to discuss the formulation of rehabilitation nursing countermeasures.
    Methods We randomly selected 152 patients with acute hemorrhagic stroke admitted to our hospital from July 2018 to July 2020. Based on the results of the mini nutritional assessment (MNA) score, the patients were divided into normal group (49 cases), risk group (53 cases), and bad group (50 cases). Single factor analysis and correlation analysis were used to analyze the nutritional risk factors, and the countermeasures for the influencing factors were discussed.
    Results Univariate analysis showed that stroke time, mechanical ventilation, swallowing dysfunction, ADL score, upper arm muscle circumference, serum albumin, and total lymphocyte count in risk and bad groups were different from the normal group. In comparison, the proportion of patients with mechanical ventilation and swallowing dysfunction was higher, and ADL score, upper arm muscle circumference, serum albumin level and total lymphocyte count were lower (P<0.05). The Spearman rank correlation analysis showed that the factors with differences in the univariate analysis also showed correlation (P<0.05). Among them, the positive correlation factors included the duration of stroke, receiving mechanical ventilation, swallowing dysfunction, NIHSS score, negatively related factors included ADL score, serum levels of albumin, transferrin, and hemoglobin. Multivariate Logistic regression analysis showed that stroke time (OR=1.739, P<0.001) and swallowing dysfunction (OR=3.966, P=0.008) were independent risk factors for malnutrition. ADL score (OR=0.687, P<0.001), upper arm muscle circumference (OR=0.770, P=0.012), serum albumin level (OR=0.870, P=0.003) were independent protective factors for malnutrition.
    Conclusion The nutritional status in stroke patients is not optimistic. Most patients have swallowing disorders, motor dysfunction, and poor self-care ability. At the same time, the body protein content in patients has decreased significantly. The clinical work is needed to deal with the patients' swallowing function recovery together with the treatment of nerve damage.

     

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