RESUMEN
BACKGROUND & AIMS: Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. METHODS: We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. RESULTS: Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change. CONCLUSION: Severe malnutrition risk independently predicts the achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.
Asunto(s)
Trastornos de Deglución/terapia , Ingestión de Alimentos , Fenómenos Fisiológicos Nutricionales del Anciano , Ingestión de Energía , Nutrición Enteral , Desnutrición/prevención & control , Rehabilitación de Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Convalecencia , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Estudios de Seguimiento , Evaluación Geriátrica , Humanos , Incidencia , Japón/epidemiología , Masculino , Desnutrición/epidemiología , Desnutrición/etiología , Evaluación Nutricional , Encuestas Nutricionales , Neumonía/epidemiología , Neumonía/etiología , Neumonía por Aspiración/epidemiología , Neumonía por Aspiración/etiología , Prevalencia , Estudios Retrospectivos , RiesgoRESUMEN
A 41-year-old man was referred to our department for surgical treatment for aortic stenosis 7 years after renal transplantation. He had been diagnosed with aortic stenosis by echocardiography a year before. He had syncopal attack during exercise 2 months before and surgical treatment had been indicated. We successfully performed aortic valve replacement via right mini-thoracotomy in the 4th intercostal space. Cardiac surgery after renal transplantation is rare and many complications may happen. Minimally invasive cardiac surgery is considerated to be useful in minimizing mediastinitis in patients on immune suppressants.