OBJECTIVE
To study the severity of systemic metabolic dysfunction in various types of stroke and determine the parameters of optimal energy and protein supply for this category of patients in the presence of severe neurological deficit (National Institutes of Health Stroke Scale — NIHSS score of 15 points or more) during different periods of the disease.
MATERIAL AND METHODS
The retrospective study included 512 patients with acute cerebrovascular accident (ACVA) who received nutritional support (NS) for 10 days or more: 367 (71.7%) people with ischemic stroke (IS) and 145 (28.3%) — with hemorrhagic stroke (HS). The course of stroke in all patients included in the study was accompanied by severe and extremely severe neurological disorders (15 points or more on the NIHSS scale). Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic assessment of indirect calorimetry indicators and actual nitrogen losses.
RESULTS
More than 99% of patients received tube feeding. Using the method of indirect calorimetry, the ranges of energy expenditure during stroke were determined: for IS — 1600—2100 kcal/day (24—26 kcal/kg/day), for HS — 1900—2600 kcal/day (26-30 kcal/kg/day) in depending on the period of the disease. The average nitrogen losses at all stages of the disease in patients with IS and HS were comparable. In IS, these amounts were 19 g/day (0.25 g/kg/day), which corresponds to 119 g/day of protein (1.56 g/kg/day of protein), and in HS patients lost an average of 18.9 g/day of nitrogen (0.24 g/kg/day) or 118 g/day of protein (1.5 g/kg/day of protein). The maximum nitrogen losses were observed in the period from 10 to 20 days of illness and amounted to 24.7 g/day in patients with HS (0.31 g/kg/day or 1.93 g/kg/day protein), and in patients with IS — 24.5 g/day (0.29 g/kg/day or 1.81 g/kg/day protein).
CONCLUSION
An identified trend towards a decrease in mortality in patients with acute stroke with energy supply in the amount of 27—28 kcal/kg/day and protein consumption in the amount of 1.3—1.4 g/kg/day compared with patients receiving 20—21 kcal/kg /day and 1—1.2 g/kg/day of protein requires further prospective randomized studies.
