高血糖患者应用肠内营养治疗初期的血糖变化  

Changes of blood glucose during early stage of enteral nutrition therapy in patients with hyperglycemia

作　　者：周惠娟[1] 施耀方[1] 蒋青[1] ZHOU Huijuan;SHI Yaofang;JIANG Qing(Department of Endocrinology,Affiliated First Hospital,Soochow University,Suzhou 215006,CHINA)

机构地区：[1]苏州大学附属第一医院内分泌科,江苏215006

出　　处：《江苏医药》2018年第7期761-763,共3页Jiangsu Medical Journal

基　　金：苏州市"科教兴卫"青年科技项目(kjxw2015005)

摘　　要：目的观察高血糖患者肠内营养制剂能全力应用初期的血糖变化特征。方法实施肠内营养治疗的高血糖患者90例;其中,ICU患者56例,普通病房(GW)患者34例。根据营养液输注第3天降糖方案的不同,将ICU患者分为采用胰岛素降糖(ICU_(INS)组,37例)和非胰岛素降糖方案(ICU_(NINS)组,19例)两组,将GW患者分为胰岛素降糖(GW_(INS)组,21例)和非胰岛素降糖方案(GW_(NINS)组,13例)两组。测定能全力输注前(G0)和输注后4h(G4)、8h(G8)和12h(G12)的血糖,分析其变化特征。结果ICU_(INS)组的G0、G4、G8和G12血糖水平均高于ICU_(NINS)组(P<0.05或P<0.01);ICU_(INS)组G8的血糖水平高于G4(P<0.05)。GW_(INS)组的G0、G4、G8和G12血糖水平均高于GW_(NINS)组(P<0.05或P<0.01);GW_(INS)组G8的血糖水平高于G12(P<0.05)。结论高血糖患者,尤其是使用胰岛素降糖的患者,在肠内营养支持治疗初期的血糖控制并不理想,需要加强血糖水平监测和管理。肠内营养液输注期间血糖变化与当前胃肠道内营养液的负荷状态相关,处理异常血糖水平时,应综合考虑胃肠道的负荷和吸收状态,采取合适的护理干预。Objective To observe the characteristics of changes of blood glucose during early stage of enteral nutrition therapy with nutrison fibre（NF）in the patients with hyperglycemia.Methods The enteral nutrition therapy with NF was performed in 90 patients with hyperglycemia,of whom 56 cases were in ICU and 34 cases were in general ward（GW）.According to the blood glucosereducing regimes on the 3rd day of enteral nutrition therapy,the patients were assigned into the groups of ICU（INS）（with insulin in ICU cases,37 cases）,ICU（NINS）（without insulin in ICU cases,19 cases）,GW（INS）（with insulin in GW cases,21 cases）and GW（NINS）（without insulin in GW cases,13 cases）.The blood glucose was detected before（G0）,at the 4th（G4）,8th（G8）,and 12th hour（G12）after NF infusion.The characteristics of the changes of blood glucose were analyzed.Results The levels of blood glucose at G0,G4,G8 and G12 were higher in group ICU（INS）than those in group ICU（NINS）（P〈0.05 or P〈0.01）.The blood glucose level in group ICU（INS） was higher at G8 than that at G4（P〈0.05）.The levels of blood glucose at G0,G4,G8 and G12 were higher in group GW（INS） than those in group GW（NINS）（P〈0.05 or P〈0.01）.The blood glucose level of group GW（INS） was higher at G8 than that at G12（P〈0.05）.Conclusion The glycemic control of the patients with hyperglycemia is not ideal during early stage of enteral nutrition therapy with NF and attention should be paid to the blood glucose monitoring and managing,especially in those treated with insulin for hyperglycemia.The changes of blood glucose during early stage of enteral nutrition therapy are related to the status of gastrointestinal tract load of nutrition solution.In the management of abnormal blood glucose levels,the load and absorption of gastrointestinal tract should be considered comprehensively and appropriate nursing intervention should be taken.

关 键 词：肠内营养 能全力 高血糖症 血糖 

分 类 号：R473[医药卫生—护理学]