胃肠术后应激性高血糖患者实施早期低能量肠内营养支持的临床研究  

Clinical trial of early hypocaloric enteral nutrition in postoperative patients with stress hyperglycemia after gastrointestinal operation

作　　者：王梅子[1] 陈耿臻[1] 谢舜峰[1] 许建衡[1] 

机构地区：[1]汕头大学医学院第一附属医院普外科,515041

出　　处：《实用医学杂志》2008年第18期3147-3150,共4页The Journal of Practical Medicine

摘　　要：目的:研究胃肠切除术后出现应激性高血糖患者实施早期肠内营养支持对血糖控制、胃肠道功能恢复、营养状况改善、并发症预防等方面的效果。方法:将40例胃肠切除术后出现应激性高血糖患者分成标准肠外营养支持组[30 kcal/(kg.d)]、标准肠内营养支持组[30 kcal/(kg.d)]、允许性低热量肠外营养支持组[20 kcal/(kg.d)]及允许性低热量肠内营养支持组[20 kcal/(kg.d)],监测各组术前、术后血常规、肝肾功能、IgA等,并观察有无感染现象发生。结果:4个营养组清晨空腹血糖和血清白蛋白在手术前后的变化差异无统计学意义(P>0.05);两肠外营养组前白蛋白、IgA、淋巴细胞计数在手术前后的变化差异无统计学意义(P>0.05),而两肠内营养组前白蛋白、IgA及标准肠内营养支持组淋巴细胞计数在手术前后的变化差异有统计学意义(P<0.01);胰岛素干预量的差异在标准肠外营养支持组[(168.60±35.24)U]和标准肠内营养支持组[(148.54±36.80)U]]间、允许性低热量肠外营养支持组[(62.63±40.20)U]和允许性低热量肠内营养支持组[(63.42±36.81)U]间无统计学意义(P>0.05),但在标准组与低热量组间两两比较则有统计学意义(P<0.01);肠道排气时间的差异在两肠外营养支持组[(62.35±12.32)h和(61.68±16.21)h]间无统计学意义(P>0.05),两肠内营养支持组[(45.62±10.37)h]和[(46.18±11.51)h]间亦无统计学意义(P>0.05),但在肠外与肠内组间两两比较则有统计学意义(P<0.01)。结论:术后早期实施允许性低能量肠内营养支持对患者肠功能、营养状况、免疫功能等的恢复及改善有着积极的临床意义。Objective To evaluate early hypocaloric enteral nutrition in postoperative patients with stress hyperglycemia after gastrointestinal operation. Methods Forty postoperative patients were randomly assigned into four groups, standard parenteral nutrition group [30 kcal/（kg·d）], standard enteral nutrition group [30 kcal/（kg·d）], permissive hypocaloric parenteral nutrition group [20 kcal/（kg·d）], permissive hypocaloric enteral nutrition group [20 kcal/（kg·d） ]. Blood routine, hepatic and renal function and IgA were measured preoperatively and postoperatively, and infection and other complications were investigated. Results Comparing with the index preoperatively, there were no significant changes （P 〉 0.05） in fasting blood glucose and albumin postoperatively for each group. As compared to preoperation, there were significant changes of prealbumin, IgA after the operatrion in the two enteral nutrition groups, so as to lymphocytes in the standar enteral nutrition group, but not for the parenteral nutrition groups. The changes of interference quantity of insulin have also reached a positive result （P 〈 0.01 ） between the standard groups and the hypocaloric groups. And the recovery of gastrointestinal was faster in the enteral nutrition groups rather than the parenteral nutrition groups. Conclusion Permissive hypocaloric enteral nutrition shortly after operation is of great significance to the recovery of gastrointestinal function, nutrition status, immune function and so on.

关 键 词：高血糖症 消化系统外科手术 肠道营养 允许性低能量摄入 

分 类 号：R656.6[医药卫生—外科学] R459.3[医药卫生—临床医学]