不同碳水化合物肠内营养液对应激性高血糖患者早期血糖水平与预后的影响

目的观察不同的碳水化合物肠内营养液［肠内营养乳剂（TPF-D）和肠内营养混悬液（TPF）］用于早期肠内营养对应激性高血糖患者血糖水平与预后的影响，探讨其作为应激性高血糖患者早期肠内营养制剂的临床可行性。 方法选入2020年6至10月徐州医科大学附属医院急诊ICU收治的合并应激性高血糖的患者为研究对象。根据入排标准，最终71例患者纳入研究，随机数字表法将其分为观察组（35例，鼻饲TPF-D）和对照组（36例，鼻饲TPF）。收集患者一般资料，包括性别、年龄、急性生理与慢性健康状况（APACHE Ⅱ）评分；记录患者第1、3、7天每4小时一次血糖数据，并计算平均血糖值（GLU_AVE）、平均血糖波动幅度（GLU_MAGE）；计算治疗后3、7 d胰岛素应用总量；监测患者第1、7天相关营养指标变化，如总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）；记录胃肠道并发症（如反流、呕吐、腹泻、腹胀等）、ICU住院时间及28 d病死率。 结果（1）2组性别比例、年龄、APACHE Ⅱ评分比较，差异均无统计学意义（P＞0.05）。（2）2组第1、3、7天GLU_AVE及第1、3天GLU_MAGE比较，差异均无统计学意义（P＞0.05）；观察组第7天GLU_MAGE显著低于对照组，差异有统计学意义［（0.72±0.08）mmol/L vs（1.56±0.10）mmol/L，t=6.22，P=0.02］。（3）观察组治疗3、7 d胰岛素应用总量显著低于对照组，差异均有统计学意义［（60.40±39.80）U vs（102.70±49.60）U，t=0.17，P=0.02；（110.50±43.30）U vs（202.80±56.40）U，t=2.52，P=0.01］。（4）2组第1、7天TP、PA、ALB比较，差异均无统计学意义（P＞0.05）。（5）2组胃肠道并发症、ICU住院时间、28 d病死率比较，差异均无统计学意义（P＞0.05）。 结论应激性高血糖患者早期营养中，TPF-D较TPF能更好地降低血糖变异性，控制血糖波动幅度，并减少临床中胰岛素用量，但不影响预后。

Effects of different carbohydrate enteral nutrient solutions on blood glucose level and prognosis of patients with stress hyperglycemia in early nutrition

ObjectiveTo observe the effects of enteral nutritional emulsion (TPF-D) on blood glucose level and prognosis in patients with stress hyperglycemia during early nutrition, and to explore the clinical feasibility of TPF-D as Enteral nutrition preparation in patients with stress hyperglycemia. MethodsEighty-five patients with stress hyperglycemia admitted to the Emergency ICU of the Affiliated Hospital of Xuzhou Medical University from June 2020 to October 2020 were selected as the research subjects, 71 of whom were eventually enrolled. The enrolled patients were divided into observation group and control group according to random number table method. 35 cases of nasal feeding TPF-D were the observation group, and 36 cases of nasal feeding TPF were the control group. General data of 2 groups were collected, including gender, age, acute physiology and chronic health evaluation (APACHE Ⅱ). Blood glucose data of patients admitted to ICU for days 1, 3 and 7 every 4 hours were recorded, and average blood glucose (GLUAVE) and mean amplitude of glycemic excursions (GLUMAGE) were calculated. The total amount of insulin at 3 and 7 days after treatment was calculated. The changes of related nutritional indexes of patients on day 1 and 7 were monitored, including total protein (TP), albumin (ALB) and prealbumin (PA). Gastrointestinal complications (such as regurgitation, vomiting, diarrhea, abdominal distention, etc.), length of ICU stay, and 28-day mortality were recorded as well. Results(1) Sex ratio, age, APACHE Ⅱ scores between observation group and control group, showed no significant difference (P＞0.05). (2) The GLUAVE of the observation group and the control group on days 1, 3, 7, and GLUMAGE on days 1, 3, were not significantly different (P＞0.05). GLUMAGE in the observation group was significantly lower than that in the control group on day 7 [(0.72±0.08) mmol/L vs (1.56±0.10) mmol/L, t=6.22, P=0.02]. (3) The total amount of insulin in the observation group and the control group at days 3, 7 after treatment were statistically significant [day 3: (60.40±39.80) U vs (102.70±49.60) U, t=0.17, P=0.02; day 7:(110.50±43.30) U vs (202.80±56.40) U, t=2.52, P=0.01]. (4) Compared with the control group on day 1, TP, PA and ALB had no significant changes (P＞0.05). (5) The gastrointestinal complications, length of ICU stay, 28-day mortality between two groups had no significant differences (P＞0.05). ConclusionIn the early nutrition of stress hyperglycemia patients, TPF-D can better reduce the variability of blood glucose, control the fluctuation range of blood glucose, and reduce the clinical dose of insulin, but it does not affect the prognosis.