NUTRITIONAL SUPPORT IN STROKE PATIENTS

Nutritivna potpora u bolesnika s moždanim udarom je važan dio u liječenju moždanoga udara. Procjena disfagije u akutnom zbrinjavanju bolesnika diktira daljnji plan nutritivne potpore u bolesnika s moždanim udarom. Ako bolesnik nema disfagiju, poremećaj svijesti ili ne postoji potreba za mehaničkom ventilacijom, u bolesnika je indicirana peroralna prehrana. Za vrijeme hospitalizacije preporuča se najmanje jednom tjedno provjeriti nutritivni status bolesnika – koncentracijom albumina u seruma ili jednim od testova procjene nutritivnoga statusa. Ako bolesnik ima blagu ili umjerenu disfagiju, moguća je modifikacija prehrane promjenom konzistencije hrane ili postavljanje nazogastrične sonde, tj. enteralna prehrana. Iako je postavljena nazogastrična sonda, ne treba odustati od peroralne prehrane ako bolesnikovo stanje to dopušta. U slučaju teške disfagije koja narušava nutritivni status bolesnika, indicirano je što ranije postavljanje nazogastrične sonde ili PEG-a u bolesnika s teškim poremećajem svijesti i/ili mehaničkom ventilacijom. Prednost se uvijek daje peroralnoj prehrani pred enteralnom i enteralnoj prehrani pred parenteralnom. Osim disfagije, smanjena kognitivna funkcija, hiposmija, anosmija, hipogeuzija i depresija mogu biti uzroci malnutricije u bolesnika s moždanim udarom. Cilj pravilne nutritivne potpore u bolesnika s moždanim udarom je spriječiti malnutriciju čija je incidencija u bolesnika s moždanim udarom oko 24 %. Nutritivna potpora i potreba za promjenom vrste prehrane je individualna, a ovisi o fizičkom i psihičkom stanju bolesnika. Malnutricija je nepoželjna u bolesnika s moždanim udarom jer je povezana s povećanom stopom smrtnosti.Nutritional support in patients suffering from a cerebral stroke has a significant role in their treatment. Dysphagia evaluation during initial patient care is essential to adequately estimate nutrition in all patients with stroke. The absence of dysphagia, altered consciousness and the need for mechanical ventilation indicates oral nutrition. Determination of nutritional status in hospitalized patients is highly recommended and should be done once a week by serum albumin test or one of the nutritional status evaluation tests. Modifying food consistency and the insertion of a nasogastric tube, i.e. enteral nutrition are options for patients with mild to moderate dysphagia. Even after nasogastric tube placement, oral nutrition should be encouraged in patients whose condition is stable. All patients with severe dysphagia require early nasogastric tube placement. PEG should be inserted in patients with altered level of consciousness and/or those on mechanical ventilation. Oral nutrition is preferred to enteral nutrition and enteral nutrition is preferred to parenteral nutririon. Apart from dysphagia, causes of malnutrition in stroke patients include lower cognitive ability, hyposmia, anosmia, hypogeusia and depression. Malnutrition is present in about 24% of stroke patients, and it should be prevented by adequate nutritional support. Treatment needs to be individualized, depending on both patients' physical and mental health status. Malnutrition must be avoided in all patients with cerebral stroke, as it is assocciated with higher mortality rate