背景:受COVID-19疾病影响的患者的表型在大流行的各波之间发生了变化。我们评估了口咽部吞咽困难(OD)的患病率,营养不良(MN),和综合医院前三波COVID-19患者的死亡率。
方法:一项2020年4月至2021年5月的前瞻性观察性研究。用体积-粘度吞咽试验进行OD的临床评估;按照GLIM标准进行营养评估。在第二波和第三波中实施了多模式干预,包括(a)质构饮食-叉子可混搭(1900千卡+90克蛋白质)或泥(1700千卡+75克蛋白质),(b)口服营养补充剂(500-600千卡+25-30克蛋白质),和(c)流体增稠(250mPa·s或800mPa·s)。
结果:我们纳入了205名患者(69.3±17.6岁),200(66.4±17.5年)在第二次,和200(72.0±16.3年;)在第三波中(p=0.004)。一入场,OD的患病率为51.7%,31.3%和35.1%,MN,45.9%,36.8%和34.7%,死亡率分别为10.7%,13.6%和19.1%。OD与年龄独立相关,谵妄,和MN;MN,随着年龄,OD,腹泻和ICU入院;死亡率,随着年龄,OD和MN。(4)结论:OD患病率,COVID-19患者的MN和死亡率非常高。OD与MN和死亡率独立相关。早期和主动的多模式营养干预改善了患者的营养状况。
BACKGROUND: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital.
METHODS: a prospective observational
study between April 2020-May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets-fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500-600 kcal + 25-30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s).
RESULTS: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients\' nutritional status.