Nutrition Risk Assessment And Nutritional Support For Critical Nervous System Patients

ObjectiveNutritional support-based neurological critically ill patients were assessed for nutritional status,including anthropometric,biochemical and nutritional subscale scores,on the first day and on the seventh day after admission to the intensive care unit,along with the clinical outcome of critically ill patients.The importance of nutritional support for the clinical management of critically ill patients with neurological disorders was demonstrated by observing and analyzing nutritional status,nutritional indicators,and clinical outcomes,and assessing the importance of critical nutrition analysis scores for early nutritional support and for assessing clinical outcomes.MethodsFifty-nine critically ill patients with neurological disorders who were unable to eat orally or under nutritional support due to various conditions were divided into high-grade group and low-grade group according to the nutritional risk score of critical illness,and the clinical treatment required for all patients was maintained,According to the needs of the disease,give reasonable nutritional support and treatment.The indexes of nutrition,including body mass index(BMI),triceps skinfold thickness(TSF),Mid-upper arm circumference(MAC)and mid-upper arm muscle circumference(MAMC),serum albumin(ALB),pre-albumin(PA),hemoglobin(HB),lymphocyte(TLC)levels,Serum potassium(K),Numerical Aperture(NA),Serum creatinine(Scr),Blood ureanitrogen(BUN)and Blood lipids were observed.The changes of related indexes were observed.At the same time,the case fatality rate was recorded within 28 days.Observe and analyze the following questions:1.According to critical nutrition risk score,divided into high-grade group and low-grade group,compare the two groups of patients with the indicators;2.According to the Nutritional methods,the patients were divided into EN group and EN+PN group.The biochemical indexes of the two groups were compared on the 1st day and the 7th day after ICU admission.3.Differences in age,APACHEII score,Nutric score,ALB,PA and CRP on Day 1 after ICU admission were compared between patients who underwent different outcomes.ResultsThe study showed:1.According to the Nutric rating scale,all patients were divided into low-score group(0-4 points)and high-score group(5-9 points).There was no significant difference in age and gender between the two groups(P>0.05)On the first day after ICU admission,there were no significant differences in TSF,MAC and MAMC between the two groups(all P>0.05).On the 7th day after ICU admission,TSF,MAC and MAMC were significantly lower in the high-grade group than in the low-grade group(t=2.090,3.672,3.223,all P<0.05).On the first day after ICU admission,serum albumin and hemoglobin in the high-grade group were significantly lower than those in the low-grade group(t=2.466 and 4.168,all P<0.05)The absolute numbers of albumin,preprotein,hemoglobin and lymphocyte were significantly lower than those of low group.The levels of serum albumin and hemoglobin in the high and low groups at 7 days were significantly lower than those at the first day after entering the ICU(t=2.29,2.042,5.817,3.286,all P<0.05).Compared with the first day after ICU admission,there was no significant difference in low protein preprotein level within 7days after ICU admission,while the high protein level decreased significantly on the 7th day after ICU admission(P<0.05),the difference was statistically significant(t=2.024,P<0.05).On the 7th day after ICU admission,the total number of lymphocytes in patients with high scores was lower than that of patients with low scores(t=2.109,P<0.039).After ICU admission,BUN?K and TG levels of low score group increased on the 7th day.High-density lipoprotein was higher in the high-score group than in the low-score group on the 7th day.On the 7th day after admission,the high-fatality rate(32.14%)was significantly higher than that of the low-score group(6.45%Statistical significance(?~2=6.402,P<0.05).2.For all enrolled patients,EN group and EN+PN group were divided according to different nutritional support methods.There was no significant difference in albumin,preprotein and hemoglobin between the two groups on the first day of ICU admission(P>0.05).There was no significant difference in preprotein and hemoglobin on the 7th day after ICU admission(P>0.05).The level of albumin in EN+PN group was significantly higher than that in EN group(t=2.214,P=0.035).The level of urea nitrogen in patients with ICU showed an upward trend after the admission of ICU,the difference was statistically significant(t=-3.037,-3.083,P=0.005,0.004).On day 1 and day 7 of ICU admission,There was no significant difference in CRP and total lymphocyte count between EN and EN+PN group after ICU admission(P>0.05),but the CRP in EN+PN group was decreased,The difference was statistically significant(t=2.557,P=0.015).The total number of lymphocytes showed an upward trend with a significant difference(t=-4.076,P<0.01).On the 7th day after ICU admission,The level of TC was significantly lower than the EN+PN group,the difference was statistically significant(t=2.109,P=0.039).3.According to the patients outcome,analyze related indicators found APACHRII score,Nutric score,CRP is a poor clinical outcome in critically ill patients with risk factors,which Nutric score and CRP is an independent risk factor.Conclusion1.Nutric score for judging the clinical prognosis and early enteral nutrition support is of great significance;2.Enteral parenteral early nutritional support for patients with neurological disorders in patients with nutritional status and immune function better than simple enteral nutrition Support;3.CRP,Nutric score and APACHEII score for determining the prognosis of great significance.