Clinical observation of short term prognosis of acute severe stroke patients with early enteral and parenteral nutrition

Abstract

Objective To investigate the short-term prognosis of acute severe stroke patients treated with early partly of enteral nutrition followed by parenteral nutrition, only early enteral nutrition or only conventional family feeding. Methods According to stratified random method, 97 severe acute stroke patients were divided into three groups, including early partly enteral nutrition and parenteral nutrition therapy group (study group，33 cases), only early enteral nutrition group (32 cases), and only conventional family feeding group (32 cases). The nutritional status, mortality, and incidence of infection were observed in the three groups at 21 days; NIH Stroke Scale (NIHSS) and Barthel Index at 21 days were compared among the three groups, and Modificied Rankin Scale (mRS) were compared at 90 days. Results At 21 days, the nutritional parameters including triceps skinfold thickness，mid-arm muscular circumference, hemoglobin, serum albumin, serum prealbumin and triglycerides in the study group were better than that in the other two groups. The incidence of malnutrition(10.0%（3/30）, 37.5%（9/24）, 12/19) and infection (18.2%（6/33）, 40.6%（13/32）, 56.3%（18/32）) among the three groups were significantly different(χ2=15.2417，P=0.0005；χ2=10.1030, P=0.0064). The mortality（9.1% (3/33), 25.0%(8/32), 40.6%(13/32); χ2=8.6777, P=0.0131） and the NIHSS score (11.51±2.68, 13.22±2.71, 14.48±2.55；F=7.86，P=0.0008) in the intervention group were lower than that in the other two groups. However, the Barthel Index had no significant difference among the three groups. At 90 days, the mRS grade 0 to 1 and the mRS grade 2 to 3 had no significant difference among the three groups; However, the mRS grade 4 to 5 among the three groups were statistical difference. Conclusion The early partly enteral nutrition combined with the stage of parenteral nutrition therapy can improve the short-term prognosis of severe acute stroke, though it cannot improve the Barthel Index on the 21th day. Key words: Critical illness; Stroke; Enteral nutrition; Parenteral nutrition; Prognosis