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İnmeli Hastalarda Malnütrisyon ve Disfajinin Önemi

Yıl 2022, Cilt: 17 Sayı: 2, 182 - 190, 15.07.2022
https://doi.org/10.17517/ksutfd.876155

Öz

Amaç: İnmeli hastalarda disfaji sıklığı ile inmeli hastaların beslenme durumlarının araştırılması ve malnütrisyonun tıbbi durumlara etkisini incelemek.
Gereç ve Yöntemler: Çalışma prospektif, kesitsel olarak planlanmıştır. İnme tanısı ile rehabilitasyon programına alınan 40-80 yaş aralığında 60 hasta çalışmaya dahil edilmiştir. İnmeli hastaların yaş, cinsiyet, boy, kilo, beden kitle indeksi (BKİ), inme sonrası kilo kaybı ve disfaji varlığı ve hastaların inme süresi (ay olarak) not edilmiştir. İnmeli hastaların nütrisyonel durumları; serum albümin ve lenfosit düzeyleri, hasta başı EAT-10 yutma fonksiyonu tarama testi, Nütrisyon risk indeksi (NRI), Prognostik nütrisyonel indeks (PNI), Nottingham nütrisyonel tarama testi (NTT) ile değerlendirilmiştir. Hastaların fonksiyonel durumları Brunnstrom ve FAS evrelemesi ile değerlendirilmiştir.
Bulgular: Hastalar NRI=97.5 değeri temel alınarak ‘düşük malnütrisyon’ veya ‘malnütrisyon yok’ bir grup; orta veya ağır malnütrisyon bir grup olacak şekilde ikiye ayrıldığında inme süresi (p=0.041), yaş (p<0.001), kilo kaybı (p<0.001), EAT-10 skor (p<0.001), albümin (p<0.001), NRI (P<0.001), PNI (p<0.001), üst ekstremite brunnnstrom (p=0.045), el brunnstrom (p=0.05), alt ekstremite brunnstromm (p=0.001) ve FAS (p<0.001) değerlerinde anlamlı farklılık tespit edildi. Buna göre orta ve ağır malnütrisyonlu grup inme süresi kısa, ileri yaşta, total kilo kaybı daha yüksek, disfajisi olan, albümini düşük, PNI düşük, NTT indeksi yüksek, üst ekstremite-alt ekstremite-el brunnstromları ve FAS skorları daha düşük seviyede olan hastalardan oluşmakta idi.
Sonuç: İnmeli hastaların EAT-10 yutma fonksiyonu tarama testi, NRI, PNI, NTT ile değerlendirildiği çalışmamızda literatürle uyumlu sonuçlar elde edilmiştir. Disfaji saptanan hastalarda görülen kilo kaybı, disfajinin ilerlemesine katkı sunarak malnütrisyona sebep olmaktadır. EAT-10 ölçeğine göre disfajisi saptanan hastalarda nutrisyon testleriyle yapılan taramalarda daha fazla malnütrisyon geliştiği görülmüştür. Bu durum disfajinin, malnütrisyonun önemli prekürsörü olduğunu göstermektedir.

Teşekkür

Çıkar Çatışması ve Finans Durumu: Çalışmamız bir kurum ve kuruluşca finanse edilmemiştir. Bu çalışmada yazarlar arasında herhangi bir konuda çıkar çatışması bulunmamaktadır.

Kaynakça

  • Demir H. Nörojenik Yutma Bozuklukları. Beyazova M, Gökçe Kutsal Y. Fiziksel Tıp ve Rehabilitasyon, 3. Baskı, Cilt 2, Ankara, Güneş Tıp Kitabevleri, 2016, s:1177-1189.
  • Smith EE, Kent DM, Bulsara KR. Effect of dysphagia screening strategies on clinical outcomes after stroke: A systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018;49(3):123-128.
  • López Espuela F, Portilla Cuenca JC, Holguín Mohedas M, Párraga Sánchez JM, Cordovilla-Guardia S, Casado Naranjo I. Nutritional status and the relationship regarding functional status after stroke. Nutr Hosp. 2017;34(5):1353-1360.
  • Corrigan ML, Escuro AA, Celestin J, Kirby DF. Nutrition in the stroke patient. Nutr Clin Pract. 2011;26(3):242-252.
  • Chen N, Li Y, Fang J, Lu Q, He L. Risk factors for malnutrition in stroke patients: A meta-analysis. Clin Nutr. 2019;38(1):127-135.
  • Çevikol A, Çakcı A. İnme Rehabilitasyonu. Oğuz H, Çakırbay H, Yanık B. Tıbbı Rehabilitasyon, 3. Baskı, İstanbul, Nobel Tıp Kitabevleri, 2015, s:419-448.
  • Sato M, Ido Y, Yoshimura Y, Mutai H. Relationship of malnutrition during hospitalization with functional recovery and postdischarge destination in elderly stroke Patients. J Stroke Cerebrovasc Dis. 2019;28(7):1866-1872.
  • Maruyama K, Nakagawa N, Koyama S, Maruyama JI, Hasebe N. Malnutrition increases the incidence of death, cardiovascular events, and infections in patients with stroke after rehabilitation. J Stroke Cerebrovasc Dis. 2018;27(3):716-723.
  • Andrade PA, dos Santos CA, Firmino HH, Rosa C de OB. The importance of dysphagia screening and nutritional assessment in hospitalized patients. Einstein (Sao Paulo). 2018;16(2): eAO4189.
  • Luo H, Yang H, Huang B, Yuan D, Zhu J, Zhao J. Geriatric nutritional risk index (GNRI) independently predicts amputation in chronic critical limb ischemia (CLI). PLoS One. 2016;11(3): e0152111.
  • Cheng Y, Li H, Li D, Liang L, Jia Y, Zou L et. al. Prognostic nutritional index may not be a good prognostic indicator for acute myocardial infarction. Sci Rep. 2019;11;9(1):14717.
  • Castro-Vega I, Veses Martín S, Cantero Llorca J, Salom Vendrell C, Bañuls C, Hernández Mijares A. Validation of nutritional screening Malnutrition Screening Tool compared to other screening tools and the nutritional assessment in different social and health areas. Nutr Hosp. 2018;35(2):351-358.
  • Isenring EA, Bauer JD, Banks M, Gaskill D. The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care. J Hum Nutr Diet. 2009;22(6):545-550.
  • Akdeniz D, Em S, Çağlayan M, Bozkurt M, Oktayoğlu P, Karakoç M et.al. İnmeli hastalarda uyku kalitesi ve ilişkili faktörlerin değerlendirilmesi. Fırat Tıp Dergisi.2015;20(2):86-91.
  • Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012;7:287-297.
  • Sa A, By J. Dysphagia following acute stroke and its effect on short-term outcome. The Nigerian Postgraduate Medical Journal, 2017;24(3):182-186
  • Toscano M, Viganò A, Piero VD. Commentary: Early Screening Parameters for Dysphagia in Acute Ischemic Stroke. Frontiers in Neurology. 2018;9:148.
  • Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One. 2016;10;11(2): e0148424.
  • Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Serra-Prat M et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr. 2015;34(3):436-442.
  • Kim S, Byeon Y. Comparison of nutritional status indicators according to feeding methods in patients with acute stroke. Nutr Neurosci. 2014;17(3):138-144.
  • Obara H, Tomite Y, Doi M. Serum trace elements in tube-fed neurological dysphagia patients correlate with nutritional indices but do not correlate with trace element intakes: case of patients receiving enough trace elements intake. Clin Nutr. 2008;27(4):587-593.

The Importance of Malnutrition and Dysphage in Patient With Stroke

Yıl 2022, Cilt: 17 Sayı: 2, 182 - 190, 15.07.2022
https://doi.org/10.17517/ksutfd.876155

Öz

Objective: To investigate the frequency of dysphagia in stroke patients and nutritional status of stroke patients and to examine the effects of malnutrition on medical conditions.
Material and Methods: The study was planned prospectively and cross-sectionally. Sixty patients between the ages of 40-80 who were taken to the rehabilitation program with a diagnosis of stroke were included in the study. Age, gender, height, weight, body mass index (BMI), post-stroke weight loss and presence of dysphagia and duration of stroke (in months) of patients with stroke were noted. Nutritional status of stroke patients; serum albumin and lymphocyte levels were evaluated by bedside EAT-10 swallowing function screening test, Nutrition risk index (NRI), Prognostic nutritional index (PNI), Nottingham nutritional screening test (NTT). The functional status of the patients was evaluated by Brunnstrom and FAS staging.
Results: The patients are a group of “low malnutrition” or “no malnutrition” based on NRI = 97.5; When we divided them into two groups as a medium or severe malnutrition group, stroke duration (p=0.041), age (p<0.001), weight loss (p<0.001), EAT-10 score (p<0.001), albumin (p<0.001) Significant difference
in NRI (P<0.001), PNI (p<0.001), upper extremity brunnnstrom (p=0.045), hand brunnstrom (p=0.05), lower extremity brunnstrom (p=0.001) and FAS (p<0.001) detected. Accordingly, the group with moderate and severe malnutrition consists of patients with a short stroke duration, advanced age, higher total
weight loss, dysphagia, low albumin, low PNI, high NTT index, lower upper extremity-lower extremity-hand brunnstrom and FAS scores.
Conclusion: In our study, in which stroke patients were evaluated using EAT-10 swallowing function screening test, NRI, PNI, and NTT, results consistent with the literature were obtained. Weight loss seen in patients with dysphagia contributes to the progression of dysphagia and causes malnutrition. It was
observed that patients with dysphagia according to the EAT-10 scale developed more malnutrition in screening performed with nutritional tests. This indicates that dysphagia is an important precursor of malnutrition.

Kaynakça

  • Demir H. Nörojenik Yutma Bozuklukları. Beyazova M, Gökçe Kutsal Y. Fiziksel Tıp ve Rehabilitasyon, 3. Baskı, Cilt 2, Ankara, Güneş Tıp Kitabevleri, 2016, s:1177-1189.
  • Smith EE, Kent DM, Bulsara KR. Effect of dysphagia screening strategies on clinical outcomes after stroke: A systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018;49(3):123-128.
  • López Espuela F, Portilla Cuenca JC, Holguín Mohedas M, Párraga Sánchez JM, Cordovilla-Guardia S, Casado Naranjo I. Nutritional status and the relationship regarding functional status after stroke. Nutr Hosp. 2017;34(5):1353-1360.
  • Corrigan ML, Escuro AA, Celestin J, Kirby DF. Nutrition in the stroke patient. Nutr Clin Pract. 2011;26(3):242-252.
  • Chen N, Li Y, Fang J, Lu Q, He L. Risk factors for malnutrition in stroke patients: A meta-analysis. Clin Nutr. 2019;38(1):127-135.
  • Çevikol A, Çakcı A. İnme Rehabilitasyonu. Oğuz H, Çakırbay H, Yanık B. Tıbbı Rehabilitasyon, 3. Baskı, İstanbul, Nobel Tıp Kitabevleri, 2015, s:419-448.
  • Sato M, Ido Y, Yoshimura Y, Mutai H. Relationship of malnutrition during hospitalization with functional recovery and postdischarge destination in elderly stroke Patients. J Stroke Cerebrovasc Dis. 2019;28(7):1866-1872.
  • Maruyama K, Nakagawa N, Koyama S, Maruyama JI, Hasebe N. Malnutrition increases the incidence of death, cardiovascular events, and infections in patients with stroke after rehabilitation. J Stroke Cerebrovasc Dis. 2018;27(3):716-723.
  • Andrade PA, dos Santos CA, Firmino HH, Rosa C de OB. The importance of dysphagia screening and nutritional assessment in hospitalized patients. Einstein (Sao Paulo). 2018;16(2): eAO4189.
  • Luo H, Yang H, Huang B, Yuan D, Zhu J, Zhao J. Geriatric nutritional risk index (GNRI) independently predicts amputation in chronic critical limb ischemia (CLI). PLoS One. 2016;11(3): e0152111.
  • Cheng Y, Li H, Li D, Liang L, Jia Y, Zou L et. al. Prognostic nutritional index may not be a good prognostic indicator for acute myocardial infarction. Sci Rep. 2019;11;9(1):14717.
  • Castro-Vega I, Veses Martín S, Cantero Llorca J, Salom Vendrell C, Bañuls C, Hernández Mijares A. Validation of nutritional screening Malnutrition Screening Tool compared to other screening tools and the nutritional assessment in different social and health areas. Nutr Hosp. 2018;35(2):351-358.
  • Isenring EA, Bauer JD, Banks M, Gaskill D. The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care. J Hum Nutr Diet. 2009;22(6):545-550.
  • Akdeniz D, Em S, Çağlayan M, Bozkurt M, Oktayoğlu P, Karakoç M et.al. İnmeli hastalarda uyku kalitesi ve ilişkili faktörlerin değerlendirilmesi. Fırat Tıp Dergisi.2015;20(2):86-91.
  • Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012;7:287-297.
  • Sa A, By J. Dysphagia following acute stroke and its effect on short-term outcome. The Nigerian Postgraduate Medical Journal, 2017;24(3):182-186
  • Toscano M, Viganò A, Piero VD. Commentary: Early Screening Parameters for Dysphagia in Acute Ischemic Stroke. Frontiers in Neurology. 2018;9:148.
  • Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One. 2016;10;11(2): e0148424.
  • Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Serra-Prat M et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr. 2015;34(3):436-442.
  • Kim S, Byeon Y. Comparison of nutritional status indicators according to feeding methods in patients with acute stroke. Nutr Neurosci. 2014;17(3):138-144.
  • Obara H, Tomite Y, Doi M. Serum trace elements in tube-fed neurological dysphagia patients correlate with nutritional indices but do not correlate with trace element intakes: case of patients receiving enough trace elements intake. Clin Nutr. 2008;27(4):587-593.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Nurbanu Güçmen 0000-0003-3153-0138

Burhan Güçmen 0000-0002-1932-2128

Tuba Tülay Koca

Erken Görünüm Tarihi 11 Temmuz 2022
Yayımlanma Tarihi 15 Temmuz 2022
Gönderilme Tarihi 7 Şubat 2021
Kabul Tarihi 7 Haziran 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 17 Sayı: 2

Kaynak Göster

AMA Güçmen N, Güçmen B, Koca TT. İnmeli Hastalarda Malnütrisyon ve Disfajinin Önemi. KSÜ Tıp Fak Der. Temmuz 2022;17(2):182-190. doi:10.17517/ksutfd.876155