RESUMEN
Objective:To explore the risk factors for malnutrition after a tracheotomy and to construct a predictive model useful for its prevention through early intervention.Methods:Clinical data describing 440 tracheotomy patients were subjected to a retrospective analysis. The variables examined were age, sex, etiology, Glasgow Coma Score (GCS), activities of daily living (ADL) score, age-corrected Charlson comorbidity index (aCCI), food intake, swallowing function, incidence of infections, as well as any history of diabetes mellitus, hypertension, smoking or alcohol consumption. Patients identified as being at risk of malnutrition (NRS-2002≥3) were screened using the Nutritional Risk Screening tool (NRS-2002) and the European Society of Clinical Nutrition and Metabolism′s ESPEN2015 criteria. The subjects were thus categorized into a malnutrition group of 343 and a control group of 97. Unifactorial and multifactorial logistic regression analyses were performed, and stepwise regression was applied to include the factors found significant in the unifactorial analysis into the multifactorial logistic regression analysis, and to construct a column-line graph prediction model. The clinical utility of the model was assessed by applying the receiver operator characteristics (ROC) curves, calibration plots and decision curve analysis (DCA).Results:Of the 440 persons studied, 343 (78%) were malnourished. The multivariate logistic regression analysis showed that pulmonary infection, dysphagia, low GCS score and high aCCI score were significant risk factors for malnutrition after a tracheotomy. A prediction nomograph was constructed. After fitting and correcting, the area under the curve (AUC) of the prediction model′s ROC curve was 0.911, the specificity was 80.4%, and the sensitivity was 91.3%. That was significantly higher than the AUCs for pulmonary infection (0.809), dysphagia (0.697), aCCI (0.721) and GCS (0.802). Bootstrap self-sampling was used to verify the model internally. After 1000 samples the average absolute error between the predicted risk and the actual risk was 0.013, indicating good prediction ability. The DCA results demonstrated that the model has substantial clinical applicability across a range of nutritional interventions, particularly for threshold probability values ranging from 0 to 0.96.Conclusion:Pulmonary infection, dysphagia, low GCS score, and high aCCI score are risk factors for malnutrition among tracheotomy patients. The nomogram model constructed in this study has good predictive value for the occurrence of malnutrition among such patients.
RESUMEN
Objective:To analyze the risk factors for malnutrition among disabled stroke survivors and devise a prediction model.Methods:A total of 373 disabled stroke survivors treated in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University in 2021 formed a control group ( n=102) and a malnutrition group ( n=271) according to their nutritional status. Univariate correlation analysis and multivariate logistic regression were used to analyze the risk factors for malnutrition and their predictive value. Results:Age, dysphagia, pulmonary infection, disability score and feeding style were found to be related significantly to the occurrence of malnutrition. Multivariate logistic regression confirmed that age, pulmonary infection, dysphagia, low total intake and a low Barthel index were useful predictors of malnutrition in such persons. Moreover, patients who had received nasogastric tube feeding were at much higher risk of malnutrition than those with intermittent oroesophageal tube feeding. The area under the receiver operating characteristics curve of the Barthel index combined with dysphagia to predict malnutrition was 0.84. The critical value was 0.67 with a sensitivity of 88% and a specificity of 72.5%.Conclusions:Age, pulmonary infection, dysphagia, feeding method, total intake and disability score are risk factors for malnutrition in disabled stroke survivors. The Barthel index combined with dysphagia has good predictive power for the occurrence of malnutrition in such persons.
RESUMEN
Objective:To investigate the value of applying B+ M type and shear-wave elastic ultrasound in determining the parameters of the geniohyoid muscles of stroke survivors with dysphagia.Methods:Forty stroke survivors with dysphagia formed an observation group, while 20 healthy counterparts were chosen as the control group. The thickness of the geniohyoid muscle, as well as the movement distance, time, rate and shear wave velocity were measured using B+ M ultrasound and shear wave elastic ultrasound when swallowing nothing or 5ml of water, respectively.Results:The average thickness of the geniohyoid muscle and the average shear wave velocity of the observation group were significantly smaller than among the controls. When swallowing either nothing or water, the geniohyoid muscle in the observation group tended to move farther than among the controls, acting more slowly and taking significantly more time.Conclusion:Ultrasound can quantify the thickness of the geniohyoid muscle and its motor parameters and stiffness. It can be used to evaluate the swallowing function of stroke survivors with dysphagia.
RESUMEN
Objective:To explore the prevalence of malnutrition among stroke survivors with bulbar palsy and the risk factors involved, and to construct a prediction model.Methods:This was a retrospective study of 325 stroke survivors. The nutritional status of those with and without bulbar palsy was compared. Univariate and multivariate logistic regressions were evaluated to highlight risk factors. A risk prediction model was constructed and a receiver operating characteristics (ROC) curve was drawn.Results:The prevalence of malnutrition among the stroke survivors with bulbar palsy was 66%, significantly greater than among all patients (52%). Among the stroke survivors with bulbar palsy there were significant differences between the normal nutrition group and the malnutrition group in terms of age, National Institutes of Health Stroke Scale (NIHSS) scores, hemoglobin, daily activities and pulmonary infection. The multivariate logistic regressions showed that pulmonary infection, a higher NIHSS score and lower hemoglobin were independent risk factors predicting malnutrition among stroke survivors with bulbar palsy. A risk prediction model for malnutrition was constructed based on the 3 major indicators and the area under the ROC curve was 0.86, with sensitivity of 0.79 and specificity of 0.83. A Hosmer-Lemeshow test indicated that the model was well calibrated, indicating that it would have good predictive value.Conclusions:Malnutrition is prevalent among stroke survivors with bulbar palsy. Pulmonary infection, a high NIHSS score and low hemoglobin are independent risk factors. They should be treated as important by medical staff.
RESUMEN
Objective:To explore the factors influencing the extubation time of patients in a persistent vegetative state (PVS) after tracheotomy so as to provide a theoretical basis for early extubation for such patients.Methods:Clinical data were collected on PVS patients after a tracheotomy. The cases were divided into an extubation group and a difficult extubation group according to whether the extubation was successful or not. Version 22.0 of the SPSS software was used to evaluate univariate and multivariate logistic regressions analyzing the factors influencing the success of extubation.Results:The single-factor analysis revealed significant differences between the groups in terms of average age, nursing level, nutrition, swallowing function, hypoalbuminemia and incubation time. Gender, brain injury, stroke, ischemic anoxic encephalopathy and lung infection were not, however, significant predictors. The multivariate logistic regression analysis highlighted nutritional mode, swallowing function, intubation time, pulmonary infection, full-time care and age as independent predictors of extubation success.Conclusions:Intermittent oral to esophageal tube feeding and full-time care are protective factors for extubation of patients in a PVS after a tracheotomy. Swallowing disorders, intubation for more than 30 days, pulmonary infection and greater age are risk factors for unsuccessful extubation. Nutritional support, swallowing function training and intensive nursing can effectively improve the success rate of extubation.
RESUMEN
Objective:To explore the effects of intermittent oral-esophageal tube feeding (IOE) on cerebral hemorrhage (CH) survivors receiving a tracheotomy.Methods:A total of 126 CH patients undergoing tracheotomy were randomly divided into an IOE group ( n=65) and a nasogastric tube feeding (NGT) group ( n=61). The feeding continued for 4 weeks along with medication and thorough rehabilitation interventions (including hemiplegic limb training, swallowing training, and pulmonary function training). Before and after the treatment, the body mass index, hemoglobin, albumin, proalbumin, creatinine height index, extubation rate and intubation time of the tracheotomy, as well as the incidence of complications were evaluated for both groups. Both groups were also assessed using the clinical pulmonary infection scale (CPIS) and National Institutes of Health stroke scale (NIHSS). Results:After the 4 weeks the nutrition indexes, average extubation rate (90.76%) and intubation time [(15.96±3.86)d], CPIS score (3.00±1.69), NIHSS score (11.86±4.08) and the overall incidence of complications in the IOE group were all significantly better than the NGT group′s averages.Conclusions:Where feasible, intermittent oro-esophageal tube feeding is superior to nasogastric tube feeding of cerebral hemorrhage patients undergoing tracheotomy. It reduces the risk of pulmonary infection and other complications, resulting in early removal of the tracheotomy cannula and quicker recovery.
RESUMEN
Objective:To explore the effect of intermittent oro-esphageal tube feeding (IOE) on functional recovery from severe brain injury complicated by tracheotomy.Methods:A total of 98 patients with severe brain injury and tracheotomy were randomly divided into an observation group and a control group. All received neurotrophic and anti-infection medication, physical therapy, acupuncture and exercise. The observation group was also given intermittent oro-esophageal tube feeding, while the control group was given nasogastric tube feeding for 4 weeks. Before and after the treatment, each patient′s nutritional status, extubation time and extubation rate of the tracheotomy, and Glasgow Coma Scale score was evaluated as well as the incidence of complications.Results:After the 4 weeks the average hemoglobin, albumin and pre-albumin levels of the observation group and its average body mass index were all significantly better than the control group′s averages. It also had a significantly better overall incidence of complications, average extubation rate, average extubation duration and average GCS score.Conclusions:Where feasible, intermittent oro-esphageal tube feeding is superior to nasogastric tube feeding for improving the nutritional status and consciousness level of patients with severe brain injury. It promotes early removal of the tracheotomy cannula, which inhibits complications.
RESUMEN
Objective:To observe the effect of intermittent oro-esophageal tube feeding (IOE) on dysphagia patients with cerebral small vessel disease.Methods:Sixty such patients were randomly divided into an experimental group ( n=30) and a control group ( n=30). In addition to the routine basic treatment and swallowing function training, the control group was given nasogastric tube feeding, while the experimental group was provided with IOE. Before and after two weeks of the treatment the swallowing function and nutritional status of both groups were evaluated along with the incidence of pneumonia, ability in the activities of daily living and general quality of life. Results:Before the intervention, there were no significant differences between the two groups in any of the measurements. Afterward significant improvements were observed in all of the measurements in both groups, but the experimental group had improved significantly more than the control group in terms of each measure.Conclusions:IOE is superior to NG in improving the nutrition and swallowing function of patients with dysphagia and cerebral small vessel disease. It betters their ability in daily life activities and their quality of life.
RESUMEN
Objective:To observe the clinical effect of intermittent oro-esophageal tube feeding (IOE) in the treatment of swallowing disorder caused by Wallenberg syndrome dorsal lateral syndrome,and to find new treatment for this kind of patients.Methods:60 cases of Wallenberg syndrome dorsal lateral syndrome were selected and randomly divided into the IOE group and the NGT group.All the patients were given swallowing function training based on controlling of the primary diseases,intervene modifiable risk factors and stroke prevention.The nutrition index and swallowing function were evaluated and compared in 24h after admission and 6 weeks after treatment.Results:Compared with the NGT group,the nutrition and swallowing function in IOE group were better.The differences were statistically significant (P ＜ 0.05).Conclusion:Intermittent oro-esophageal tube feeding is more conducive to the improvement of nutrition and swallowing function in patients with Wallenberg syndrome than NGT.
RESUMEN
Objective To observe the stellate ganglion block (SGB) on obstructive sleep apnea syndrome (OSAS) combined the curative effect of sleep respiration and blood pressure control in patients with hypertension.Methods Incorporating meets the criteria for the OSAS patients with high blood pressure in hospital order randomly assigned into normal group and experimental group and routine group was given antihypertension drugs,adjustment in lifestyle,continuous positive airway pressure (CPAP) treatment,the experimental group on the basis of conventional treatment at the same time give SGB to intervene.Using t test on admission and intervention were compared after a period of treatment in patients with sleep apnea and blood pressure control,using 2 test comparison blood pressure control rates of two groups patients.Results Compared with normal group,the experimental group after intervention in a course of apnea hypoventilation index (AHI),SaO2 and 24 h mean arterial pressure were obviously improved,the difference was statistically significant (P＜0.05).Conclusion SGB as a new treatment method,not only can improve clinical symptoms in patients with OSAS,but also make the patients get better control of blood pressure.
RESUMEN
Objective To investigate the effects of treadmill exercise on spatial learning,memory and the expression of hippocampal brain-derived neurotrophic factor(BDNF) in rats after mild traumatic brain injury (TBI).Methods Thirty Sprague-Dawley rats were randomly divided into group T (n =10,undergoing TBI modelling operation and 4 weeks' treadmill exercise training beginning at 48 h after the operation),group C (n =10,undergoing TBI modelling operation and no exercise training) and group N (n =10,undergoing sham operation and no exercise training).Morris water maze(MWM)was used to test rats' abilities of spatial learning and memory.The number of BDNF-positive cells in the hippocampus was measured with immunohistochemistry.Results In the orientational navigation test,the escape latency period was gradually shortened for rats in all groups.At the second training week,the average time of group T(88.54 ±5.73 s) became shorter than that in group C (91.45 ± 8.91 s).At the fourth week,however,the difference [(55.33 ± 6.77 s) vs (74.53 ± 6.85 s)] was significant(P ＜ 0.01).Group N (88.44 ±7.79 s,79.52 ± 8.02 s,69.54 ± 10.14 s and 62.49 ± 7.22 s respectively) also improved significantly more than group C (98.99 ± 6.84 s,91.45 ± 8.91 s,79.65 ± 12.47 s and 74.53 ± 6.85 s respectively) from week 1 to 4 (P ＜ 0.01).The average number of times of passing through the platform area of group N in four weeks (3.00 ± 0.54,3.38 ± 0.74,4.38 ± 1.06 and 6.00 ± 0.76 respectively) and group T from the second week on(3.25 ± 1.28,5.00 ± 0.93 and 5.88 ± 0.99 respectively) were significantly higher than that of group C (1.25 ± 0.71,1.50 ± 0.54,2.13 ± 1.25 and 3.00 ± 0.54 respectively) accordingly (P ＜ 0.01).At the week four,the average number of BDNF-positive cells in group T(128.56 ± 7.93) were significantly larger than that in group C and group N (P ＜ 0.05),with no significant difference was noted between group N and group C (P ＞0.05).Conclusions Treadmill exercise could improve the spatial learning and memory of rats after mild traumatic brain injury.This may be related with the up-regulation of expression of BDNF in the hippocampus.