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目的通过观察经康复治疗的老年脑梗死患者从发病1周至6个月的营养状况,探讨营养不良的发生率及特点,营养不良与吞咽障碍、认知障碍、抑郁、日常生活能力(BI)、住院时间、感染并发症、独居的关系。方法前瞻性连续登记我院神经内科住院并经康复治疗的老年脑梗死患者128例,于梗死后1周、5周、3个月、6个月分别测体质量、体质量指数(BMI)、三头肌皮褶厚度(TSF)、上臂肌围(AMC)、血清白蛋白、血清转铁蛋白等营养指标,测量同期健康者128例的体质量、BMI、AC、TSF,计算AMC,以平均值的90%可信区间作为正常值范围,有两项及两项以上指标下降者为营养不良。记录脑梗死患者住院时间感染并发症、是否独居、评定神经功能、包括吞咽功能、认知功能、抑郁状况、BI。结果脑梗死组5周至6个月体质量及BMI显著降低(P<0.01);1周至6个月血清白蛋白浓度显著增高(P<0.01),5周至6个月转铁蛋白浓度显著增高(P<0.01);1周至6个月TSF,AMC呈下降趋势,但差异无统计学意义(P>0.05);营养不良发生率由1周48例(37.5%)下降至6个月35例(27.3%);脑梗死后1周营养不良亚组与营养正常组神经功能(吞咽障碍、认知障碍及BI<50)及独居率比较差异有统计学意义(P<0.01),感染并发症,住院天数及抑郁差异无统计学意义(P>0.05)。结论经康复治疗的老年脑梗死患者发病后1周,营养不良发生率为37.5%,主要为血清白蛋白、转铁蛋白、TSH、AMC、体质量及BMI下降,脑梗死后6个月,血清白蛋白浓度及转铁蛋白浓度上升,TSH、AMC、体质量及BMI仍下降,营养不良发生率为27.3%,营养不良患者脑梗死后1周独居、吞咽障碍、认知障碍及BI<50发性率高于营养正常患者,但住院时间、感染并发症、抑郁两组差异无统计学意义。
Objective To observe the nutritional status of patients with senile cerebral infarction who have undergone rehabilitation from 1 week to 6 months after onset of illness and to investigate the incidence and characteristics of malnutrition, malnutrition and dysphagia, cognitive impairment, depression, daily living ability (BI) Inpatient time, infection complications, solitary relationship. Methods A total of 128 elderly patients with cerebral infarction were enrolled and prospectively enrolled in our department of neurology. The body mass index (BMI), body mass index (BMI) Triceps skinfold fold (TSF), upper arm muscle circumference (AMC), serum albumin, serum transferrin and other nutritional indicators, body mass, BMI, AC, TSF were measured in 128 cases of healthy subjects, AMC, 90% confidence interval as the normal range of values, two or more indicators of the decline of malnutrition. Record the hospital stay of patients with cerebral infarction infection complications, whether living alone, assessment of neurological function, including swallowing function, cognitive function, depression, BI. Results The body mass and BMI of cerebral infarction group were significantly decreased from 5 weeks to 6 months (P <0.01). Serum albumin concentration was significantly increased from 1 week to 6 months (P <0.01), and the concentration of transferrin was significantly increased from 5 weeks to 6 months (P> 0.05). The incidence of malnutrition decreased from 48 (37.5%) in one week to 35 in 6 months (P <0.01) 27.3%). There was significant difference in neurological function (dysphagia, cognitive impairment and BI <50) and solitary death rate in malnutrition subgroup 1 week after cerebral infarction and normal nutrition group (P <0.01) The days of hospitalization and depression had no significant difference (P> 0.05). Conclusions The incidence of malnutrition was 37.5% in the elderly patients with cerebral infarction 1 week after the onset of rehabilitation. The main malnutrition rates were serum albumin, transferrin, TSH, AMC, body mass and BMI. Serum Albumin and transferrin levels increased, TSH, AMC, body mass and BMI still decreased, the incidence of malnutrition was 27.3%, malnutrition patients living alone one week after cerebral infarction, dysphagia, cognitive impairment and BI <50 Sex ratio higher than normal nutrition patients, but hospital stay, infection complications, depression was no significant difference between the two groups.