Objective:To investigate the effects of The Nutritional Risk Screening 2002 (NRS-2002)-based nutritional therapy on nutritional status and rehabilitation process in hemorrhagic stroke patients with dysphagia.Methods:Eighty-eight hemorrhagic stroke patients with dysphagia who received treatment in Lishui Central Hospital, China between June 2018 and November 2020 were included in this study. They were randomly assigned to receive either routine treatment ( n = 44, control group) or routine treatment combined with NRS-2002-based nutritional therapy ( n = 44, observation group) for 4 successive weeks. The Kubota drinking test score, the National Institutes of Health Stroke Scale (NIHSS) score, clinical efficacy, and nutritional status were compared between the control and observation groups. Results:Compared with before treatment, the Kubota drinking test score and National Institutes of Health Stroke Scale score in each group were greatly decreased after treatment ( t = 9.393, 5.998, 25.851, 21.136, all P < 0.01). The Kubota drinking test score and NIHSS score in the observation group were significantly lower than those in the control group [(2.57 ± 0.30) points vs. (4.16 ± 0.49) points; (8.93 ± 1.01) points vs. (15.83 ± 2.03) points, t = 18.357, 20.186, both P < 0.01). Total effective rate in the observation group (93.18%) was significantly higher than that in the control group ( χ2 = 4.162, P < 0.05). Compared with before treatment, serum prealbumin, albumin, and hemoglobin levels in each group were significantly increased after treatment ( t = 2.551, 4.088, 2.600, 7.239, 7.540, 8.684, all P < 0.01). After treatment, serum prealbumin, albumin, and hemoglobin levels in the observation group were significantly higher than those in the control group ( t = 5.104, 3.439, 6.024, all P < 0.01). Conclusion:NRS-2002-based nutritional therapy can effectively improve the dysphagia, neurological function and nutritional status of patients with hemorrhagic stroke.

Objective To evaluate the effect of ventilation with different positive end-expiratory pressures (PEEPs) on intracranial pressure in the patients undergoing gynecological laparoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 25-55 yr,with body mass index of 18-27 kg/m2,scheduled for elective gynecological endoscopic surgery,were divided into 3 groups (n=20 each) using a random number table method:routine ventilation group (group A),4 cmH2O PEEP group (group B) and 8 cmH2O PEEP group (group C).The patients were mechanically ventilated with PEEP 4 or 8 cmH2O at 5 min of head-down tilt after start of pneumoperitoneum in group B and group C.The patients were mechanically ventilated in volume-controlled mode,with tidal volume 7 ml/kg,inspired oxygen concentration 50％ and inspiratory/expiratory ratio 1 ∶ 2.Blood samples were collected from the radial artery for measurement of PaCO2 and PaO2 at 5 min after tracheal intubation (T0),5,15 and 30 min of head-down tilt (T1-3),and 5 min of the supine position after the end of pneumoperitoneum (T4).The peak airway pressure (Ppeak) was recorded,dynamic pulmonary compliance (Cdyn)was calculated,and optic nerve sheath diameter was measured using an ultrasonic apparatus at T0-4.Cognitive function was assessed at 1 day before surgery and 7 days after surgery using Mini-Mental State Examination.Results Compared with group A,Ppeak was significantly increased at T1-4,and PaO2 was increased at T2 in group B,and Ppeak and PaO2 were increased at T1-4,and Cdyn was increased at T1,2 in group C (P＜0.05).Compared with group B,Ppeak was significantly increased at T4,and Cdyn was increased at T2 in group C (P＜0.05).There was no significant difference in optic nerve sheath diameter or Mini-Mental State Examination score at each time point among three groups (P＞0.05).No patients developed cognitive dysfunction at 7 days after surgery in three groups.Conclusion Ventilation with different PEEPs causes no increase in intracranial pressure of the patients undergoing gynecological laparoscopic surgery.

Objective To explore the nutritional risk influencing factors in stroke patients， and to discuss the formulation of rehabilitation nursing countermeasures. Methods We randomly selected 152 patients with acute hemorrhagic stroke admitted to our hospital from July 2018 to July 2020. Based on the results of the mini nutritional assessment （MNA） score， the patients were divided into normal group （49 cases）， risk group （53 cases）， and bad group （50 cases）. Single factor analysis and correlation analysis were used to analyze the nutritional risk factors， and the countermeasures for the influencing factors were discussed. Results Univariate analysis showed that stroke time， mechanical ventilation， swallowing dysfunction， ADL score， upper arm muscle circumference， serum albumin， and total lymphocyte count in risk and bad groups were different from the normal group. In comparison， the proportion of patients with mechanical ventilation and swallowing dysfunction was higher， and ADL score， upper arm muscle circumference， serum albumin level and total lymphocyte count were lower （P<0.05）. The Spearman rank correlation analysis showed that the factors with differences in the univariate analysis also showed correlation （P<0.05）. Among them， the positive correlation factors included the duration of stroke， receiving mechanical ventilation， swallowing dysfunction， NIHSS score， negatively related factors included ADL score， serum levels of albumin， transferrin， and hemoglobin. Multivariate Logistic regression analysis showed that stroke time （OR=1.739， P<0.001） and swallowing dysfunction （OR=3.966， P=0.008） were independent risk factors for malnutrition. ADL score （OR=0.687， P<0.001）， upper arm muscle circumference （OR=0.770， P=0.012）， serum albumin level （OR=0.870， P=0.003） were independent protective factors for malnutrition. Conclusion The nutritional status in stroke patients is not optimistic. Most patients have swallowing disorders， motor dysfunction， and poor self-care ability. At the same time， the body protein content in patients has decreased significantly. The clinical work is needed to deal with the patients' swallowing function recovery together with the treatment of nerve damage.