Dynamic Nutrition Evaluation And Therapeutic Strategy For Severe Stroke Patients At Early Stage

Objective:To explore rules of early dystrophia in patients with severe stroke and compare the impact of early eternal feeding versus eternal nutrition combined with parenteral nutrition(EN+PN) on the nutritive index, metabolic status and infection incidence of patients with severe stroke, thereby putting forward an appropriate strategy for nutrition treatment.Methods:45 patients with severe stroke placed in the intensive care unit of neurology are chose from a number of major hospitals in Shanxi province from May, 2014 to February,2015, which conforms with the GCS ≤ the Watian drinking water test assessment ≥level 3 neurologic function by the European Stroke Scale(ESS). Patients are divided into two groups: EN group and EN+PN group. Calories that meet nutritional objectives are25Kcal/(kg?d). The two groups shall be given the indwelling nasal-stomach tube within24 hours of admission and the supporting treatment of tube feeding nutrition. The EN+PN group shall be given the central venous catheter(CVC) within 24 hours and according to patients’ weight and caloric requirement, extra calories needed will be offered by parenteral nutrition. To monitor nutritive indexes of the first, the third, the fifth, the seventh, the ninth, the eleventh and the thirteenth day respectively after admission to the hospital: TP, Alb, PA and urinary nitrogen after 24 hours; also,endocrine indexes: cortisol and thyroid function in 8:00am; body immune indexes: TLC.Total Incidence of Hospital Infection, case fatality rate and coma scale shall be monitored regularly as well. Statistics concerned will be analyzed by a software calledSPSS13.0 and measurement data shall be made bysx ±. Intra-group comparison is tested by t whereas comparison among groups use variance analysis and is tested by x2.Enumeration data is denoted by case number and rate. It has statistical significance to use P<0.05 to show the difference.Results:1. Patients in the EN group and EN+PN group showed no distinct difference in terms of their age, diseases, serum protein indicators and Neurological Deficit Scale(NDS) when they are hospitalized.2. The Alb of patients in the EN group decreased to the lowest five days after their admission to the hospital while that of patients in the EN+PN group, the seventh day.3. The number of PA reduced earlier than that of Alb.4. In the intra-group comparison of the two groups, after the observation, the number of Alb and PA has increased compared with the minimum level. The difference has statistical significance(P<0.05).5. In the comparison among groups, after the observation, the number of Alb and PA in the EN+PN group is higher than that of the EN group. The difference has statistical significance(P<0.05).6. In the acute phase, T3 has reduced. In the intra-group comparison of the two groups, the difference between results after the observation and the first day in the hospital has no statistical significance(P>0.05).7. In the comparison among groups, there is no statistical significance(P>0.05) after the observation. TSH increased in the acute phase. Patients with severe stroke has their corisol increased in the 8 o’closk two days after the admission to the hospital.8. Patients in the two groups have apparent performance of negative nitrogen balance during the fifth to ninth day but EN+PN group is better in terms of nitrogen loss.The difference has statistical significance(P<0.05).9. In the intra-group comparison of the two groups, the number of blood lymphocytes have increased compared with the first day in hospital. The difference hasstatistical significance(P<0.05). In the comparison among groups, the number of blood lymphocytes in the EN+PN group is higher than that of blood lymphocytes in the EN group. The difference has statistical significance(P<0.05).10. Total Incidence of Hospital Infection in the EN+PN group is lower than that of EP. The difference has statistical significance(P<0.05). Case fatality rate shows no difference between the two groups and that difference has no statistical significance(P>0.05).11. Glasgow Coma Scale is applied to the comparison among groups and the result shows that coma scale has increased after the observation comparing with the first day.The difference has statistical significance(P<0.05). But there is no statistical significance after the observation in the intra-group comparison(P>0.05).Conclusions:1. Though patients with severe stroke are treated with positive nutrition support,malnutrition still existed.2. Eternal nutrition combined with parenteral nutrition(EN+PN) performs better in improving various of nutrition indicators than eternal nutrition(EN).3. There is no significant difference of the impact of both enteral and parenteral nutrition on thyroid related hormones.4. EN+PN can reduce the total incidence of infection compared with EN.5. There is no significant difference of the impact of both enteral and parenteral nutrition on the recent consciousness of patients.