腦中風急性後期住院病人營養攝取與復健復原相關性之探討

A Study on the Correlation Between Nutritional Intake and Physical Recovery of Post-Acute Care for Stroke Inpatients

李玉珍(Yu-Jen Li) ； 潘柏榮(Po-Jung Pan) ； 蕭淳仁(Chun-Jen Hsiao) ； 沈靈(Ling Shen) ； 林育芬(Yu-Fen Lin)

《臺灣膳食營養學雜誌》 13卷2期 (2021/12) Pp. 43-55

https://doi.org/10.6709/TJD.202112_13(2).0004

摘要

本研究藉由「腦中風急性後期照顧計畫」（Post acute care-Cerebrovascular Diseases），簡稱PAC-CVD的病人，在積極營養介入及高強度復健下，探討體能復原與營養攝取的相關性。研究收集本院參加PAC-CVD計畫患者，在住院前3日、住院每隔3週及出院前分別收集營養狀況（血液白蛋白、熱量攝取、蛋白質攝取及迷你營養評估量表）及體能復原（巴氏量表分數、工具性日常生活活動量表分數、伯格氏平衡量表、患側握力公斤數、健側握力公斤數及步行速度）表現，做前後比較，熱量建議目標30 kcal/kgBW、蛋白質1.2 g/kgBW。依住院時間分2組，第一組（住院3～4週）及第二組（住院5～6週），營養狀況中，血液白蛋白僅第一組在結案時明顯增加（p ＜ 0.05）。熱量、蛋白質攝取及迷你營養評估量表在兩組結案時都有顯著增加（p ＜ 0.05）。體能復原表現部分，雖然在工具性日常生活活動量表只有第二組結案時有明顯進步（p ＜ 0.05），其餘項目兩組在結案時皆有顯著進步（p ＜ 0.05）。進一步探討營養狀況與體能復原表現的相關性，熱量攝取與巴氏量表（r = 0.355, p = 0.037）及蛋白質攝取與健側的握力（r =0.386, p = 0.022）皆呈現顯著正相關。本研究兩組病人在結案時，可維持良好的營養狀態及促進體能恢復。依據實際熱量攝取28.5～34.0 kcal/kgBW，蛋白質1.2g/kgBW，可作為針對腦中風急性後期復能營養建議。

關鍵字

腦中風急性後期照顧計畫 ； 營養狀況 ； 功能復原 ； 復健

並列摘要

This study was conducted to investigate the correlation between nutritional intake and physical recovery of patients in the Post acute care-Cerebrovascular Diseases (PAC-CVD) program under active nutritional intervention and high intensity rehabilitation. Data regarding nutritional status (blood albumin, energy intake, protein intake and mini nutritional assessment [MNA] score) and physical recovery performance (Barthel Index, Berg Balance test, gait speed, patient health examination, and hand grip strength) of patients were collected and recorded as patients enrolled in the PAC-CVD program during the first 3 days of hospitalization, at 3-weeks intervals during hospitalization, and before discharge. Energy requirement was set at 30 kcal/kgBW/day, and protein need was set at 1.2 g/kgBW/day. Patients were divided into 2 groups, including group1 (3 ~ 4 weeks of hospitalization) and group 2 (5 ~ 6 weeks of hospitalization) based on length of stay in the program. Regarding nutritional status, only group 1 had a significant increase in blood albumin after participating in the PAC-CVD program (p ＜ 0.05). Subjects of both groups showed significant increases in caloric intakes, protein intakes and score of MNA after the program (p ＜ 0.05). In terms of physical recovery performance, Barthel Index, Berg Balance test, gait speed, patient health examination, and hand grip strength on the affected side were improved significantly after the program in both groups (p ＜ 0.05); group 2 also had significant improvement in instrumental activities of daily living (IADL) scores (p ＜ 0.05). The Spearman's rank correlation was used to further analyze the associations between nutritional parameters and physical recovery performance. Significant positive correlations were found between caloric intakes and Barthel Index (r = 0.355, p = 0.037) and between protein intakes and grip strength on the healthy side (r = 0.386, p = 0.022). We found that both groups of subjects participating in this PAC-CVD program were able to maintain fair nutritional status and progressive improvement in physical recovery. Actual energy intakes at 28.5 ~ 34 kcal/ kgBW/day and protein at 1.2 g/kgBW/day observed from this study may serve as references to facilitate physical recovery of post-acute care for patients with stroke.

並列關鍵字

post-acute care for stroke ； nutritional status ； functional recovery ； rehabilitation