2011年 · 第44卷第11期

Neurological diseases are associated with nutritional problems for a long time. Whether the neurological diseases occur suddenly or slowly, the neurological impairment is limited or extensive, the disease is mild or critical, all patients with consciousness disorders, mental disorders, cognitive disorders, neurogenic dysphagia, neurogenic vomiting, neurogenic gastrointestinal dysfunction, neurogenic respiratory failure and serious complications can increase the nutritional risk or undernutrition. Insufficient nutrition can also aggravate the primary disease, increase complications, prolong hospital stay, increase medical expenses and increase mortality rate, thus affecting prognosis or outcome.

Background and evidence: Patients with neurological diseases and dysphagia eat less or can't eat, patients with critical neurological diseases have more catabolism than anabolism, and some patients with neurological diseases already have nutritional deficiency or nutritional risk before illness. Therefore, nutrition risk screening (NRS,Table 1) to identify further nutritional assessment and nutritional support programmes. 2003 Kondrup et al.^[2]A systematic analysis of 128 randomized controlled studies on nutritional support showed that among the 8944 patients screened by NRS2002, the proportion of favorable outcomes was significantly higher in those who received nutritional support with a total score of ≥3 (P=0.000, Grade IA evidence). European Society for Parenteral and Enteral Nutrition (ESPEN) in 2003, Chinese Society of Parenteral and Enteral Nutrition (CSPEN) in 2006, and American Society for Parenteral and Enteral Nutrition (ASPEN) in 2011 All recommended the use of nutritional risk screening tools for hospitalized patients^[3,4,5]。 Due to the ease of use of NRS2002 and evidence-based medical evidence, from 2005 to 2006, NRS2002 was used to screen the inpatients for nutritional risk in the neurology departments of three tertiary hospitals in Beijing. Among 753 inpatients, 461 (61.2%) completed the screening. The incidence of nutritional deficiency and nutritional risk was 4.2% and 21.2%, respectively. Only 14.4% of patients with nutritional risk received nutritional support^[6](Level IIIB Evidence). This shows that even big hospitals in big cities have the current situation of high nutritional risk rate and low nutritional support rate. Therefore, it is necessary to incorporate nutritional risk screening into the practice of nutritional support for neurological diseases to strengthen the management of nutritional support in hospitalized patients.