糖尿病型肠内营养剂与匀浆膳对重症患者住院时间等的影响  

Possible effects of enteral nutrition for diabetes mellitus compared with blend diet on length of hospital stay etc of critically ill patients

作　　者：马爱勤[1] 潘玲[1] 高宗伟[2] 朱勤[1] 王曼[1] 秦环龙[3] 

机构地区：[1]上海市第六人民医院奉贤分院营养科,201400 [2]临沂市人民医院重症监护室,山东临沂276003 [3]上海市第十人民医院普外科,200072

出　　处：《中华临床营养杂志》2012年第5期285-290,共6页Chinese Journal of Clinical Nutrition

基　　金：黎介寿院士“肠道屏障”研究专项基金（LJS-201011）

摘　　要：目的观察糖尿病型肠内营养剂对高血糖状态危重患者住院时间等的影响。方法采用随机数字表法将64例高血糖状态危重患者随机分成研究组和对照组，分别给予相似热量和氮量的糖尿病型肠内营养剂和匀浆膳。从患者入住重症监护室（ICU）第3天开始肠内营养（EN），连续14d。研究期间，用胰岛素将血糖控制在6．1-8．5mmol／L，患者均未补充血浆、白蛋白以及肠外营养。分别于EN前及EN后，测定患者尿乳果糖／甘露醇比值、外周血细菌DNA阳性率、生化指标，统计累计胰岛素用量，分析近期和远期临床结局。结果最终人选患者59例，其中研究组30例，对照组29例。EN7d[0．221＋0．117比0．299＋0．154，t=-2．199，P=0．032]和14d[0．169±0．122比0．305±0．129，t=-4．191，P=0．000]后，研究组尿乳果糖／甘露醇比值显著低于对照组。EN第7天[（195＋54）比（227±60）U；t=-2．096，P=0．041]和第14天[（392±114）比（459±118）U；t=-2．221，P=0．030]，研究组的胰岛素累计用量均显著低于对照组。与对照组比较，研究组的机械通气时间[（8．00±1．75）比（6．73±2．05）d，t=-2．547，P=0．014]及ICU住院时间[（10．00±1．95）比（8．80±2．17）d，t=-2．233，P=0．030]均有所下降；住院总费用显著降低[（56238．39±17869．61）比（70395．63±20111．69）元／人，t=-2．861，P=0．006]；EN90d后日常生活活动能力[（17．59±3．21）比（35．34±8．65）分，t=10．030，P=0．000]及生存质量[（22．67±4．51）比（40．55±8．88）分，t=9．397，P=0．000]恢复较快。结论糖尿病型肠内营养剂与等热量等氮量的自制均浆膳相比，可能具有改善高血糖状态危重患者近期和远期临床情况的作用。Objective To investigate the effects of enteral nutrition （EN） for diabetes mellitus on the clinical outcomes of critically ill patients with hyperglycemia. Methods Sixty-four critically ill patients with hyper- glycemia were randomly divided into the control group and intervention group. The control group was given home- made homogenized meals and the study group was given EN for diabetes mellitus. Both were given the same total energy and nitrogen content. EN was applied 3 days after ICU admission and then lasted 14 days. Blood glucose wascontroled at 6. 1-8. 5 mmoL/L by insulin therapy. No albumin, blood plasma, or parenteral nutrition was provided to all patients. The lactulose mannitol ratio, biochemical indicators, total insulin dosage, and short-term and long- term outcomes were analyzed before and after EN support. The quality of life was evaluated using Stroke Specific Quality of Life Scale. Results Finally 59 patients were enrolled in the study, with 30 in the intervention group and 29 in the control group. The lactulose mannitol ratios in the intervenion group were significantly lower than those in the control group 7 days （0.221 ±0. 117 vs. 0.299 ±0. 154, t = -2. 199, P =0.032） and 14 days （0. 169 ± 0. 122 vs. 0. 305 ±0. 129, t = -4. 191, P =0. 000） after EN support. Meanwhile, the total insulin dosages were also significantly less in the intervention group [ 7 days, （ 195 ± 54） vs. （227 ± 60） U; t = - 2. 096, P = 0. 041 ; 14 days, （392±114） vs. （459±118） U; t= -2.221, P=0.030]. Compared with the control group, the intervention group had significantly shorter duration of mechanical ventilation [ （ 8. 00± 1.75 ） d vs. （6. 73 ± 2.05） d, t=-2.547, P=0.014] andICUstay [ （10.00±1.95） vs. （8.80±2.17） d, t=-2.233, P= 0. 0301, lower total hospitalization expanses [ （56 238.39 ± 17 869.61 ） vs. （70 395.63 ±20 111.69） Yuan, t= -2. 861, P=0.006], and faster recovery of daily activities [ （17.59 ±3.21） vs. （35.34 ±8.65） scores, t=10. 030,

关 键 词：肠内营养 高血糖 危重症 结局 

分 类 号：R459.3[医药卫生—治疗学]