АКТУАЛЬНОСТЬ: Острое нарушение мозгового кровообращения (ОНМК) характеризует высокая распространенность и летальность. Белково-энергетическая недостаточность является распространенным синдромом у данной категории пациентов, влияющим на течение и исходы церебрального инсульта. ЦЕЛЬ ИССЛЕДОВАНИЯ: Провести анализ распространенности и влияния на осложнения и исход тяжелого церебрального инсульта белково-энергетической недостаточности. МАТЕРИАЛЫ И МЕТОДЫ: Под эгидой Федерации анестезиологов и реаниматологов России проведено многоцентровое обсервационное клиническое исследование «Регистр респираторной терапии у пациентов с ОНМК (RETAS)». В исследовании участвовало 14 центров, включено 1289 пациентов с ОНМК, которым проводили респираторную поддержку. РЕЗУЛЬТАТЫ: Белково-энергетическая недостаточность у пациентов с ОНМК при осуществлении искусственной вентиляции легких (ИВЛ) ассоциировалась с тенденцией к большему риску развития летального исхода (р = 0,0003). Отсутствие белково-энергетической недостаточности у пациентов с ОНМК с тяжестью по Шкале тяжести инсульта Национальных институтов здоровья (National Institutes of Health Stroke Scale, NIHSS) менее 14 баллов при осуществлении ИВЛ ассоциировалось с большей вероятностью позитивного клинического исхода (по Шкале исходов Глазго [Glasgow Outcome Scale, GOS] 4 и 5) в сравнении с пациентами, имеющими признаки недостаточности питания (р = 0,000002). Белково-энергетическая недостаточность ассоциируется с более длительным пребыванием пациентов с ОНМК на ИВЛ (р < 0,0001). При этом для группы пациентов с длительной ИВЛ были характерны большая распространенность пролежней (р < 0,0001), гипопротеинемии, гипоальбуминемии (р = 0,0001) и снижение массы тела на 10 и более процентов (р < 0,0001). Наличие белково-энергетической недостаточности сопровождалось повышенным риском развития вентилятор-ассоциированного трахеобронхита у пациентов с ОНМК (р < 0,0001). ВЫВОДЫ: Белково-энергетическая недостаточность оказывает существенное влияние на течение и основные показатели клинического исхода тяжелого церебрального инсульта у пациентов при проведении искусственной вентиляции легких (ИВЛ).

INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.

Objective : to determine prognostic characteristics of the restoration of swallowing function in patients with ischemic stroke (IS) of various pathogenetic subtypes. Material and methods . The study included 110 patients (64 men and 46 women aged 44–89 years) with dysphagia in the acute period of IS. The SSS-TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding depending on the severity of dysphagia, a non-linear regression method was used using the least squares method. Results. Patients with cardioembolic stroke subtype were initially characterized by a greater degree of dysphagia in comparison with patients with atherothrombotic stroke subtype in groups comparable in severity (p<0.05). In the cardioembolic subtype of IS, the probability of switching patients to self-feeding on the 21st day in groups with dysphagia severity from 105 to 135 points on the MASA scale was lower than in the atherothrombotic subtype of IS (p<0.05). Conclusion. Patients with cardioembolic strokes are characterized by more severe initial dysphagia and a worse prognosis for recovery of swallowing function compared to patients with atherothrombotic strokes.

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p < 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.