İnmeli Hastalarda Malnütrisyon ve Disfajinin Önemi

Nurbanu Güçmen; Burhan Güçmen; Tuba Tülay Koca

doi:10.17517/ksutfd.876155

EN TR

The Importance of Malnutrition and Dysphage in Patient With Stroke

Abstract

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.

Keywords

Dysphagia , Malnutrition , Rehabilitation , Stroke

İnmeli Hastalarda Malnütrisyon ve Disfajinin Önemi

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.

Anahtar Kelimeler

Disfaji , İnme , Malnütrisyon , Rehabilitasyon

Kaynakça

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