Oleh Admin Kalbe Medical pada March 09, 2017 07:30

Pemberian Nutrisi Enteral pada Stroke

Setengah dari pasien yang masuk ke dalam pelayanan rehabilitasi stroke dilaporkan mengalami gizi kurang. Banyak faktor yang mempengaruhi nutrisi tidak adekuat setelah serangan stroke sedang sampai berat, seperti kesulitan menelan, depresi, kesulitan dalam menerima makanan (ketergantungan), meningkatnya kebutuhan energi selama pemulihan, dan status nutrisi yang buruk sebelum pasien terkena stroke.

Nutrisi yang buruk dianggap berpengaruh terhadap outcome pada pasien stroke. Beberapa penelitian menunjukkan bahwa dukungan nutrisi pada pasien stroke dapat memperbaiki outcome. Namun, penelitian Cochrane terbaru melaporkan bahwa suplementasi energi dan protein pada pasien lansia malnutrisi terjadi peningkatan berat badan yang kecil tetapi konsisten dan disertai dengan penurunan mortalitas, namun tidak ditemukan efek terhadap outcome fungsional atau lamanya perawatan.

Sebaliknya pada penelitian multisenter besar dengan subjek sebanyak 4023 yang disebut dengan Feed or Ordinary Diet (FOOD) studi, menyimpulkan bahwa suplementasi  nutrisi setelah serangan stroke tidak memberikan efek terhadap lamanya perawatan. Hal ini disebabkan karena banyaknya keterbatasan pada penelitian tersebut. Pertama, hampir 92% subjeknya adalah pasien dengan status nutrisi yang baik, sehingga suplementasi nutrisi menjadi tidak bermanfaat. Kedua, pada penelitian ini tidak mengukur beratnya derajat stroke berdasarkan NIH Stroke Scale (NIHSS). Oleh karena itu, dilakukan penelitian ulang untuk menilai efek pemberian nutrisi modern pada perbaikan outcome fungsional pasien stroke dengan gizi kurang.

Desain dan metodenya adalah penelitian acak, prospektif, tersamar ganda, yang membandingkan pemberian nutrisi secara intensif (komersial) dengan nutrisi standar. Subjek sebanyak 102 pasien stroke dengan gizi kurang kemudian dibagi menjadi 2 kelompok, yaitu kelompok perlakuan mendapatkan nutrisi enteral komersial yang mengandung kalori 240 Kkal dan protein 11 gram (n=51), sedangkan kelompok kontrol mendapatkan nutrisi standar yang mengandung kalori 127 Kkal dan protein 5 gram (n=51). Parameter pertama diukur dengan menghitung skor total dari functional independence measure (FIM). Parameter kedua meliputi subskor dari FIM untuk motorik dan kognitif, serta lama perawatan. Hasilnya menunjukkan adanya perbaikan pada kelompok perlakuan yang ditandai dengan peningkatan skor total FIM dibandingkan dengan kontrol (p<0,002).  (LAI)

Image : Ilustrasi
Referensi:
1.Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology. 2008;71(23):1856-61. doi: 10.1212/01.wnl.0000327092.39422.3c.  
2.Dennis MS, Lewis SC, Warlow C, FOOD Trial Collaboration. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): A multicentre randomized control trial. Lancet 2005;365:755–63.

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