目的 观察住院脑卒中康复期患者的身体成分组成情况和膳食营养状况。 方法 2015年11月至2018年12月，顺序入组100例住院脑卒中康复患者，进行身体成分测定和膳食调查，并进行相关性分析。 结果 患者骨骼肌含量小于目标含量(t = -2.605, P < 0.05)，患侧上肢骨骼肌百分比小于健侧(t = -1.984, P < 0.05)；体质量、体质量指数、体脂百分比、腹部肥胖程度均显著高于目标值(t > 10.715, P < 0.001)。患者每日能量、碳水化合物、维生素B1、维生素B2、维生素E、钙、钾、锌、镁、硒的实际摄入量低于推荐量(|t| > 4.427, P < 0.05)；每日蛋白质、脂肪、胆固醇、烟酸、铁、磷、铜的实际摄入量高于推荐量(t > 2.122, P < 0.05)。身体成分指标与膳食中蛋白质、脂肪和康复时间相关(P < 0.05)。 结论 为住院脑卒中康复期患者提供营养干预计划时，要考虑其身体成分分布特点，适当降低脂肪摄入量，保证碳水化合物、蛋白质等营养素的充足摄入。
Objective To investigate the body composition and the nutrition of diet of the stroke inpatients during rehabilitation. Methods From November, 2015 to December, 2018, 100 stroke inpatients were sequentially recruited and measured the body composition, and the diets were investigated. The correlations among their body composition, dietary nutrition and rehabilitation time were analyzed. Results The skeletal muscle mass was less than the target quantity (t = -2.605, P < 0.05), the percentage of skeletal muscle of upper limbs was less in the affected side than in the unaffected side (t = -1.984, P < 0.05). The body mass, body mass index, body fat percentage and abdominal obesity were all significantly higher than the target quantity (t > 10.715, P < 0.001). The daily intake of energy, carbohydrates, vitamin B1, vitamin B2, vitamin E, calcium, potassium, zinc, magnesium and selenium were lower than the recommendation (|t| > 4.427, P < 0.05), but the daily intake of protein, fat, cholesterol, niacin, iron, phosphorus and copper were higher (t > 2.122, P < 0.05). There were correlation between body composition index and dietary protein, fat and rehabilitation time (P < 0.05). Conclusion It is necessary to reduce the fat intake and promote sufficient intake of carbohydrate, protein and so on, in nutritional intervention plans for hospitalized stroke rehabilitation patients.
1 FeiginV L, ForouzanfarM H, KrishnamurthiR, et al. Group global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010 [J]. Lancet, 2014, 383(9913): 245-254.
2 国家卫生计生委脑卒中防治工程委员会. 中国卒中流行报告2015[M]. 北京:中国协和医科大学出版社, 2015.
3 ThorsénA M, HolmqvistL W, Pedro-CuestaJ, et al. A randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke: five-year follow-up of patient outcome [J]. Stroke, 2005, 36(2): 297-303.
4 OstwaldS K, DavisS, HerschG, et al. Evidence-based educational guidelines for stroke survivors after discharge home [J]. J Neurosci Nurs, 2008, 40(3): 173-191.
5 D'EliaL, IannottaC, SabinoP, et al. Potassium-rich diet and risk of stroke: updated meta-analysis [J]. Nutr Metab Cardiovasc Dis, 2014, 24(6): 585-587.
6 ShenH C, ChenH F, PengL N, et al. Impact of nutritional status on long-term functional outcomes of post-acute stroke patients in Taiwan [J]. Arch Gerontol Geriatr, 2011, 53(2): e149-e152.
7 NipW F, PerryL, McLarenS, et al. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital [J]. J Hum NutrDiet, 2011, 24(5): 460-469.
8 López EspuelaF, Portilla CuencaJ C, Holguín MohedasM, et al. Nutritional status and the relationship regarding functional status after stroke [J]. Nutr Hosp, 2017, 34(5): 1353-1360.
9 倪伟光,赵辉. 肠内营养支持对高龄吞咽困难卒中患者的临床研究[J]. 实用医学杂志, 2009, 25(8): 1236-1238.
10 NorthcottS, MossB, HarrisonK, et al. A systematic review of the impact of stroke on social support and social networks: associated factors and patterns of change [J]. Clin Rehabil, 2016, 30(8): 811-831.
11 郭镭,潘利伟,范录平,等. 肠内和肠外营养支持对于早期重症脑卒中的效果分析[J]. 中国慢性病预防和控制, 2015, 23(4): 303-304.
12 LydenP. Using the National Institutes of Health Stroke Scale: a cautionary tale [J]. Stroke, 2017, 48(2): 513-519.
13 徐卉,张颖敏,沈志强,等. 不同营养模式对老年脑卒中营养不良患者营养状态与免疫功能的影响[J]. 浙江医学, 2019, 41(3): 272-274.
14 WakabayashiH, SakumaK J. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management [J]. J Cachexia Sarcopenia Muscle, 2014, 5(4): 269-277.
15 MitchellC J, MilanA M, MitchellS M, et al. The effects of dietary protein intake on appendicular lean mass and muscle function in elderly men: a 10-wk randomized controlled trial [J]. Am J Clin Nutr, 2017, 106(6): 1375-1383.
16 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志, 2015, 48(4): 246-255.
17 朱毅,朱黎婷,张燕,等. 不同体重指数对卒中后功能恢复影响的分析[J]. 中国康复医学杂志, 2012, 27(8): 747-749.
18 JorgensenL, JacobsenB K. Changes in muscle mass, fat mass and bone mineral content in the legs after stroke: a 1 year prospective study [J]. Bone, 2001, 28(6): 655-659.
19 SistoI R, HauckM, PlentzR D M. Muscular atrophy in cardiovascular disease [J]. Adv Exp Med Biol, 2018, 1088: 369-391.
20 ThomasD R. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia [J]. Clin Nutr, 2007, 26(4): 389-399.
21 郭战刚,张志华,王文柱,等. 肌力练习与平衡训练对卒中偏瘫患者下肢功能恢复的影响[J]. 临床合理用药杂志, 2015, 8(3): 176-177.
22 孙建琴,张坚,常翠青,等. 肌肉衰减综合征营养与运动干预中国专家共识[J]. 营养学报, 2015, 37(4): 320-322.
23 李建标,何锦照,江震钦. 不良生活方式、负性情绪与脑卒中的相关性研究[J]. 临床医学工程, 2017, 24(11): 1531-1533.
24 GariballaS E, ParkerS G, TaubN, et al. A randomized, controlled, single-blind trial of nutritional supplementation after acute stroke [J]. J Parenter Enteral Nutr, 1998, 22(5): 315-319.
25 AquilaniR, ScocchiM, IadarolaP, et al. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischemic stroke [J]. Clin Rehabil, 2008, 22(12): 1042-1050.
26 吴畏,冯波,黄东雅,等. 脑卒中患者偏瘫肢体骨量丢失与肌肉萎缩程度的关系[J]. 中国骨质疏松杂志, 2011, 17(17): 568-569.
27 杨戈,杨丽华,杨弋,等. 代谢综合征与脑血管疾病[J]. 中国老年学杂志, 2009, 29(22): 2993-2994.
