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目的分析收住NICU重症老年脑卒中患者的蛋白代谢、血脂代谢、免疫功能变化与并发症的发生,探讨营养状况、营养支持与疾病预后的相关性。方法选择30例收住NICU的重症老年脑卒中患者,检测入院第1天、第14天血红蛋白、血清总蛋白、白蛋白、前白蛋白、总胆固醇、甘油三酯、IgA、IgM、IgG的含量。分析第1天、第14天血红蛋白、蛋白代谢、脂代谢及部分血清免疫的变化。比较并发感染组(n=20)和非感染组(n=10)的第1天、第14天血清白蛋白、血红蛋白的水平。分析营养支持前后并发症。结果重症老年脑卒中患者住院14天后血红蛋白、前白蛋白、白蛋白、甘油三酯、总胆固醇、IgG水平均有明显下降(P<0.05),合并感染率达67%,死亡率7%。第1天、14天感染组及非感染组血清白蛋白、血红蛋白的水平下降,组间无显著差异(P>0.05)。结论重症老年脑卒中后营养状况呈恶化趋势,以2周内白蛋白和血红蛋白的下降最为明显。营养状况的恶化,延缓脑卒中患者的神经功能康复,增加合并症发生和住院成本。肠内营养治疗虽可延缓营养状况的恶化,但老年患者卒中后神经内分泌代谢改变、营养成分消化吸收摄入能力下降与高消耗等多因素阻碍营养障碍改善,寻找更加符合老年重症患者吸收的营养支持,包括营养制剂、营养途径与方法,有益于改善老年重症卒中患者营养状况,降低住院成本,提高生存质量。
OBJECTIVE: To analyze the protein metabolism, blood lipid metabolism, immune function changes and complications in patients with severe elderly stroke in NICU. To investigate the correlation between nutritional status, nutrition support and disease prognosis. Methods Thirty patients with severe elderly stroke receiving NICU were enrolled in this study. The levels of hemoglobin, serum total protein, albumin, prealbumin, total cholesterol, triglyceride, IgA, IgM and IgG on the first day and the 14th day after admission . Analyze the changes of hemoglobin, protein metabolism, lipid metabolism and partial serum immunity on the first day and the fourteenth day. Serum albumin and hemoglobin levels were compared between day 1 and day 14 of the concurrent infection (n = 20) and noninfected (n = 10) groups. Analysis of nutritional support before and after complications. Results Severe senile stroke patients had significant reduction in hemoglobin, prealbumin, albumin, triglyceride, total cholesterol and IgG levels after hospitalization for 14 days (P <0.05). The combined infection rate was 67% and the mortality rate was 7%. The levels of serum albumin and hemoglobin in infected and noninfected groups decreased on day 1 and 14, with no significant difference between the two groups (P> 0.05). Conclusion The nutritional status of severe elderly patients showed a worsening trend after stroke, and the decrease of albumin and hemoglobin was the most obvious in 2 weeks. Degradation of nutritional status, delaying the recovery of neurological function in patients with stroke, increase the incidence of complications and hospitalization costs. Although enteral nutrition therapy can delay the deterioration of nutritional status, but elderly patients with neuroendocrine metabolism after stroke, nutrient intake and loss of digestion and absorption of nutrients and high consumption and other factors hinder the improvement of nutritional disorders, to find more in line with the elderly patients with severe nutrition absorption Support, including nutrition preparations, nutrition approaches and methods, is beneficial to improve nutritional status of elderly patients with severe stroke, reduce hospitalization costs and improve quality of life.