The Impact Of Ultra-early Enteral Nutrition On The Clinical Prognosis Of Patients With Severe Cerebrovascular Disease

Objective: This study aims to investigate the impact of ultra-early enteral nutrition(UEEN)on the clinical prognosis of patients with severe cerebrovascular disease(SCVD),to clarify whether enteral nutrition timing is an independent risk factor for death outcome,so as to provide a basis for the selection of enteral nutrition timing in patients with severe cerebrovascular diseases.Methods: 216 patients with acute cerebral diseases who met the study criteria in the neurologic intensive care unit of The Second Affiliated Hospital of Dalian Medical University from August 2017 to November 2019 were collected retrospectively.According to the time of enteral nutrition,the patients were divided into two groups: the ultra-early enteral nutrition group(patients with enteral nutrition within 24 hours from onset of diseases)and the delayed enteral nutrition group(patients with enteral nutrition after 24 hours from onset of diseases).Collecting patients' basic information(age,gender,height,weight,diabetes mellitus,daily energy,NIHSS score for admission(National Institute of Health Stroke Scale),liver function,renal function,heart function,total protein(total protein,TP),albumin(albumin,ALB),hemoglobin(hemoglobin,Hb)] and clinical observation index [the incidence of complications,hospitalization time,mechanical ventilation time,use of antibiotics,NIHSS score,hospital discharge mortality],analyzing difference between two groups,to assess the clinical prognosis of two groups of patients,and to investigate the effect of ultra-early enteral nutrition on the prognosis of patients with severe cerebrovascular disease.According to the clinical outcomes of patients with divided the patients into death group and alive group,contrast and analyze in two groups of patients age,gender,height,weight,NIHSS score for admission,diabetes,liver function,renal function,heart function,timing of enteral nutrition,and daily energy intake,total protein,albumin,hemoglobin.Further,Logistic regression was used to analyze the independent risk factors affecting the death outcome of patients with severe cerebrovascular diseases.Results: 1.Demographic characteristics:This study included in the standard of 216 patients with severe cerebrovascular,the median age was 74 years old,male 111 cases(51.4%),NIHSS score for admission median 16 points.According to the time away from the disease start time is divided into ultra-early enteral nutrition 121 cases(56%),the median age was 74 years old,male 61 cases(50.4%),NIHSS score for admission median 16 points.Delayed enteral nutrition 95 cases(44%),the median age was 73 years old,male 50 cases(52.6%),NIHSS score for admission median 16 points.2.Differences in basic datas: There were no statistically significant differences in the basic information of age,gender,height,weight,diabetes,daily intake of energy,NIHSS score,liver function,kidney function,heart function,total protein,albumin,and hemoglobin between the patients in the ultra-early enteral nutrition group and the delayed enteral nutrition group at the time of admission(P > 0.05).3.The difference of clinical prognosis: In terms of clinical prognosis,the hospital stay,ventilator use time and antibiotic use time of the ultra-early enteral nutrition group were shorter than those of the delayed enteral nutrition group,and the incidence of gastrointestinal bleeding,stroke-associated pneumonia and hospital mortality were less than those of the delayed enteral nutrition group,with statistically significant differences between the two groups(P < 0.05).Through the comparison of the changes of nutritional indicators between the two groups,it was found that the total protein,albumin and hemoglobin in the delayed enteral nutrition group after enteral nutrition decreased more significantly than that in the ultra-early enteral nutrition group,and the difference between the two groups was statistically significant(P < 0.05).However,there was no statistically significant difference between the two groups in discharge NIHSS score,incidence of liver dysfunction,incidence of renal dysfunction,incidence of reflux and incidence of diarrhea(P > 0.05).4.Risk factors: According to the clinical prognosis is divided into survival group and death group,and comparing the two groups of patients in age,gender,height,weight,NIHSS score for admission,diabetes,liver function,renal function,cardiac insufficiency,timing of enteral nutrition,and daily energy intake,total protein,albumin on admission,on admission to hospital when differences between hemoglobin,Logistic regression analysis for the further application,admission NIHSS score and enteral nutrition in patients with the timing for the independent risk factors influencing the prognosis of severe cerebrovascular disease clinical.Conclusion: 1.Enteral nutrition should be given to patients with severe cerebrovascular disease as soon as possible.Enteral nutrition at an early stage can significantly shorten the duration of hospitalization,ventilator use time and antibiotic use time,reduce the incidence of gastrointestinal bleeding,stroke-related pneumonia and mortality in hospital,and provide better nutritional support to patients.However,there was no significant improvement in the occurrence of liver dysfunction,renal insufficiency,reflux,diarrhea and discharge NIHSS score.2.By comparing and analyzing the risk factors of death outcome in patients with severe cerebrovascular disease,it was concluded that enteral nutrition timing and admission NIHSS score were independent risk factors affecting death outcome in patients with severe cerebrovascular disease.For patients with severe cerebrovascular disease,severe early enteral nutrition can reduce mortality.