不同肠内营养制剂对老年糖尿病机械通气患者的影响研究  

Clinical study of enteral nutrition in elderly patients with type 2 diabetes mellitus treated with Mechanical Ventilation

作　　者：李娟[1] 李曙平[1] 姜辉[1] 

机构地区：[1]广州军区武汉总医院,湖北武汉430070

出　　处：《现代中西医结合杂志》2016年第7期719-721,776,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：全军保健专项科研课题(13BJZ14)

摘　　要：目的探讨适合老年糖尿病机械通气患者的肠内营养治疗方案。方法根据所用肠内营养制剂不同,将86例老年糖尿病机械通气患者分为2组,康全力组40例给予糖尿病适用型配方康全力,能全力组46例给予标准型配方能全力。观察2组治疗前及治疗第15,29天血清白蛋白、前白蛋白、淋巴细胞计数、空腹血糖、餐后2 h血糖、血浆氨基末端B型利钠肽原(NT-pro BNP)水平和胰岛素用量。结果治疗第15天,康全力组血清白蛋白、前白蛋白、淋巴细胞计数、NT-pro BNP水平与治疗前比较差异无统计学意义(P均>0.05),空腹及餐后2 h血糖较治疗前明显降低(P均<0.05);能全力组血清白蛋白、前白蛋白、淋巴细胞计数较治疗前显著升高(P均<0.05),空腹及餐后2 h血糖、NT-pro BNP水平与治疗前比较差异无统计学意义(P均>0.05);2组胰岛素每天应用剂量比较差异无统计学意义(P均>0.05)。治疗第29天,2组血清白蛋白、前白蛋白、淋巴细胞计数、空腹血糖、餐后2 h血糖水平均较治疗前显著改善,但2组间比较差异均无统计学意义(P均>0.05);康全力组胰岛素每天应用剂量较治疗前明显减少(P<0.05),但NT-pro BNP水平明显高于治疗前及能全力组(P均<0.05)。结论老年糖尿病合并机械通气患者给予糖尿病适用型肠内营养剂治疗,血糖达标早,胰岛素用量小,血清白蛋白、前白蛋白及淋巴细胞计数改善慢;给予标准能量配方型肠内营养制剂治疗,血糖达标慢,胰岛素用量略大,血清白蛋白、前白蛋白和淋巴细胞计数改善快。合并心功能不全的老年糖尿病患者应用糖尿病适用型肠内营养剂时需监测NT-pro BNP。Objective It is to explore a suitable way of enteral nutrition to elderly patients with type 2 diabetes mellitus treated with mechanical ventilation. Methods 86 elderly patients with type 2 diabetes mellitus and using mechanical ventilation were divided into 2 groups according to their receiving different nutrition agents： EN prescription for DM group（ therapy group） and EN prescription with standard energy group（ control group）. Changes of serum albumin,prealbumin,lymphocyte count in the 2 groups were observed. With continuous sugar monitoring system（ CGMS） and continuous subcutaneous insulin infusion（ CSII）,changes of fasting blood glucose（ FBG） and postprandial blood glucose（ PBG） were recorded and the dosis of insulin were adjusted. Results Two weeks later,serum albumin,prealbumin,lymphocyte count in control group were higher than those of two weeks ago（ P〈0. 05）,but there were no improved significantly in therapy group; FBG and PBG in therapy group were lower than those of two weeks ago（ P〈0. 05）,while there were no same changes in the control group. Four weeks later,all indicators in the both groups were improved significantly; The dosis of insulin in therapy group were lower than those of 4 weeks ago（ P〈0. 05）,while the dosis of insulin in control group were higher than those of 4 weeks ago,but there was no significant difference（ P〈0. 05）. The indicator of heart failure（ NT- pro BNP） in therapy group was higher than that of before treatment（ P〈0. 05）. Conclusion With EN prescription for DM,BG of the elderly patients with type 2 diabetes mellitus and using mechanical ventilation quickly reaches the target value; with the EN prescription with standard energy group,patients＇ nutrition indicators rapidly recover to normal levels. NT- pro BNP needs to be closely monitored in patients with heart or renal failure.

关 键 词：机械通气 糖尿病 肠内营养 老年人 

分 类 号：R587.1[医药卫生—内分泌]