The Effects Of Different Dose Of Enteral Nutrition On Nutritional Status And Prognosis Of Patients With Severe Stroke

Objective Monitor the VO₂?minute volume of O₂ consumed?,VCO₂?minute volume of CO₂ generated?and Respiratory Quotient?RQ?of patients with severe stroke through a ventilator,calculate the energy consumption of patients,provide accurate predictions for energy consumption of patients with severe stroke,and study the effect of different doses of enteral nutrition on the nutritional status and prognosis of patients with severe stroke.It provides a theoretical basis to guide the selection of early nutrition support programs for patients with severe stroke.Method Severe stroke patients admitted to the emergency ICU of the affiliated hospital of Qinghai University within 24 hours of onset from November 2018 to December 2019 were collected and monitored by a respiratory therapist using the CARESCAPE R860 ventilator and energy monitoring module produced by Datex-Ohmeda,Inc.Patients' VO₂,VCO₂,and respiratory quotient were calculated according to the modified Weir's formula,according to the dosage of enteral nutrition?enteral nutrition,EN?as a proportion of the actual energy consumption,it was divided into three groups: the 40%-55% dose group?n=51?,the 55%-70% dose group?n=33?and the full dose group?80%-100%??n=31?.All three groups were given conventional treatment,all were given enteral nutrition within 24 hours,and were administered by nasogastric tube or nasal jejunal tube,enteral nutrition was increased to total after 3 days in 40%-55% dose group and 55%-70% dose group.Compare the three groups of patients admitted to hospital and 3,7,15,28 days after admission of APACHEII score,GCS score,and neurological impairment score-NIHSS score,NRS2002 score,prognostic indicators [ICU stay days,organ support?mechanical ventilation,etc.?days,feeding interruption rate,lung infection rate,the proportion of gastrointestinal bleeding and Refeeding Syndrome,MRS score,etc.].Result 1.Atotal of 115 cases were collected during the study,51 in the 40%-55% dose group,and 33 in the 55%-70% dose group,and 31 cases in the full-dose group.The general data of patients at admission were height,weight,BMI,age,stroke type,etc,and indicators of disease severity at admission?APACHEII score,GCS score,NRS2002 score,NIHSS score,etc.?factors were analyzed statistically,and the difference was not statistically significant?P>0.05?,which was comparable.2.The three groups of patients were followed up for APACHEII score,GCS score,NIHSS score,NRS-2002 score,?1?Comparison between groups: The three groups' APACHEII score and GCS score were compared on the 3rd,7th,and 28 th days of admission.There was no statistical significance?P>0.05?.On the 15 th day,the APACHEII score of the 40%-55%dose group was lower than the other two groups,and the GCS score was higher than the other two groups with statistically significant differences?P<0.05?.NIHSS score comparison showed no significant difference between the three groups on the 3rd day of admission?P>0.05?.On the 7th,15 th,and 28 th days of admission,the 45%-55% dose group score was lower than the 55%-70% dose group and the full dose group,the difference was statistically significant?P<0.05?;there was no significant difference in NRS2002 score between the three groups on the 3rd,7th,15 th,and 28 th days of admission?P>0.05?.?2?Comparison within the group: The APACHEII score and NIHSS score were lower than before,and the GCS score and NRS2002 score were higher than before,and the differences were statistically significant?P<0.05?.3.The prognosis comparison of the three groups of patients: incidence of Refeeding Syndrome?RFS?and MRS score,the difference was not statistically significant?P>0.05?,although there was no significant difference in the incidence of RFS among the three groups,the 40%-55% dose group was significantly lower than the 55%-70% dose group and the full dose group.The outcome,the incidence of pulmonary infection,feeding interruption and gastrointestinal bleeding,days of ICU stay,days of mechanical ventilation in 40%-55% dose group were lower than that in 55%-70% dose group and full dose group,the difference was statistically significant?P<0.05?.Conclusion 1.Malnutrition or malnutrition risk is prevalent in patients with severe stroke.2.Early enteral nutrition treatment has a positive effect on the improvement of disease severity in patients with severe stroke.3.40%-55% dose of enteral nutrition can reduce the incidence of pulmonary infection,feeding interruption,gastrointestinal bleeding and refeeding syndrome in patients with severe stroke,as well as ICU retention time and mechanical ventilation time.