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1、卒中患者肠内营养的实施北京天坛医院卒中单元NICU杨中华卒中后营养的重要性卒中患者营养不良的发生率N（%）1week31(35)5weeks29(33)3months18(20)6months20(22)theJournalofNutrition,Health&Aging2007;11:75-79Page低热卡摄入与血液感染CritCareMed2004;32:350–357DaysSinceMICUAdmissionP<0.05>50%<75%<25%>75%>=25%<50%1.000.750.500.250.00
2、02040ProportionWithoutFirstICUBSIPageFood试验的基线特征NormalOverweightUndernourishedProportionaliveTimesincerandomisation(months)123456780.00.10.20.30.40.50.60.70.80.91.0Stroke.2003;34:1450-1456.Page营养不良是急性缺血性卒中并发症的独立危险因素ArchNeurol.2008;65(1):39-43Page急性卒中后营养不良对临床结局的影
3、响Stroke.1996;27:1028-1032Scoreat1moMalnourishedNonmalnourishedNo.%No.%PCSS≤51666.71522.40.0001BI0.012≥95416.72841.855-90312.51522.4≤501770.82435.8Page吞咽困难是卒中后营养不良 的最重要的机制卒中后吞咽障碍的发生率（筛查）Stroke.2005;36:2756-2763Page卒中相关性肺炎的发生频率-吞咽困难vs无吞咽困难Page卒中相关性肺炎的发生频率-误吸vs无误吸R
4、eview:ArticleComparison:01IncidenceofPneumoniaReview:02Figure2-IncidenceofPneumoniainStrokePatients-AspiratorsvsNon-AspiratorsStudyAspiratorsNon-AspiratorsRR(Random)WeightRR(Random)Orsub-categoryn/Nn/N95%CL%95%CLHolasetal,19948/611/537.366.95[0.90,53.78]Schmidte
5、tal,19945/261/337.186.35[0.79,51.03]Kiddetal,199517/252/3511.5411.90[3.02,46.94]Smithardetal,19967/2012/7416.742.16[0.98,4.76]Teaselletal,199610/842/35710.5821.25[4.74,95.18]Reynoldsetal,199812/349/6817.032.67[1.25,5.70]Ding&Logeman,200060/18540/19320.441.56[1.1
6、1,2.21]Mengetal,20003/70/134.5912.25[0.72,208.21]Limetal,20015/260/244.5610.19[0.59,174.94]Total(95%CL)4688501004.45[2.25,8.81]Totalevents:127(Aspirators),67(Non-Aspirators)Testforheterogeneity:Chi2=24.70,df=8(P=0.002),I2=67.6%TestforOveralleffect:Z=4.28(P<0.000
7、1)0.10.20.512510Non-AspiratorsAspiratorsPageASPIRATIONPNEUMONITISANDASPIRATIONPNEUMONIA右肺下叶局部形成空洞（箭头所指）NEnglJMed,2001,344(9):665-671Page吞咽筛选试验任意程度的意识水平下降；饮水之后声音变化；自主咳嗽减弱；饮一定量的水时发生咳嗽；限时饮水实验有阳性表现。有一种异常即认为有吞咽困难存在。Page正规吞咽筛查对肺炎的影响Stroke2005;36:1972-1976Page正规吞咽筛查对肺炎
8、的影响-卒中严重程度Stroke2005;36:1972-1976Page选择肠内还是肠外营养国内肠内营养的现状18k1.8k200235k6k2007PN:EN=10:1PN:EN=6:1Page国外肠内营养概况IntensiveCareMed.2003Jun;29(6):867-9PageENvsPN-死亡率Nutrition
