添加益生菌的早期肠内营养对重症脑卒中合并糖尿病患者血糖变异性及预后的影响  

Effect of early enteral nutrition combined with probiotics on blood glucose variability and prognosis in severe stroke patients with diabetes

作　　者：王钧[1] 金鑫[1] 史颖[1] 李伟彬[1] 冯鑫利[2] 张新欣[3] 邸卫英[1] WANG Jun;JIN Xin;SHI Ying;LI Wei-bin;FENG Xin-li;ZHANG Xin-xin;DI Wei-ying(Department of Neurology,the Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;不详)

机构地区：[1]河北大学附属医院神经内科,河北保定071000 [2]河北大学附属医院高压氧科 [3]河北大学附属医院急诊科

出　　处：《中国微生态学杂志》2021年第11期1294-1298,共5页Chinese Journal of Microecology

基　　金：河北省自然科学基金(H2021201004);保定市科技计划项目(18ZF067,2041ZF310);河北大学医学学科培育项目(2021B18)。

摘　　要：目的探讨添加益生菌的早期肠内营养(EEN)对重症脑卒中合并糖尿病患者血糖变异性及预后的影响。方法选择2017年10月1日至2019年10月1日我院收治的重症脑卒中合并糖尿病患者共96例,随机分为观察组和对照组,各48例。两组患者在入院48h内均给予EEN,观察组在对照组基础上给予益生菌鼻饲。两组患者均应用普通胰岛素静脉泵入控制血糖,并在给予EEN 72h内进行动态血糖监测,比较两组患者治疗后72h内血糖波动情况、胰岛素平均用量、低血糖发生率、营养达标率,治疗后14d炎症情况及应激反应指标水平、营养指标水平、医院获得性肺炎(HAP)发生率、GCS评分、APACHEⅡ评分、病死率。结果与对照组比较,观察组患者血糖最大波动幅度(LAGE)、平均血糖水平标准差(GLUsd)、血糖变异系数(LUcv)、低血糖发生率、胰岛素平均用量、炎症及应激反应指标水平、HAP发生率、APACHEⅡ评分均显著低于对照组(均P<0.05)。两组患者平均血糖水平(GLUave)、GCS评分、病死率、营养达标率、营养指标水平差异无统计学意义(均P>0.05)。结论对于合并糖尿病的重症脑卒中患者,给予EEN联合益生菌有助于减少血糖变异性,降低低血糖发生率,控制炎症及氧化应激反应,同时减少患者并发感染的风险,有助于改善患者预后。Objective To explore the effect of early enteral nutrition(EEN)combined with probiotics on blood glucose variability and prognosis in severe stroke patients with diabetes.Methods A total of 96severe stroke patients with diabetes treated in our hospital from October 1,2017to October 1,2019,were randomly divided into the observation group(n=48)or the control group(n=48).Both groups were given early enteral nutrition within 48hours after admission.The observation group was given additional probiotics through nasal feeding.Insulin was pumped intravenously to control blood sugar in both groups.Dynamic blood glucose monitoring was carried out within 72hours after giving early enteral nutrition.The blood glucose fluctuation,average dosage of insulin,incidence of hypoglycemia and nutritional standard rate within 72 hours after the treatment,as well as the indexes of inflammation and stress reaction,nutrition index,incidence of hospital acquired pneumonia(HAP),GCS score,APACHE II score and mortality rate on the 14th day after treatment were compared between groups.Results Compared with the control group,the maximum fluctuation of blood glucose(LAGE),standard deviation of mean blood glucose level(GLUsd),coeffi-cient of variation of blood glucose(LUcv),incidence of hypoglycemia,average dosage of insulin,indexes of inflammation and stress reaction,incidence of HAP and APACHEⅡscore in the observation group were significantly lower than those in the control group(all P<0.05)respectively.No significant differences were seen in the mean blood glucose level(GLUave),GCS score,mortality rate,nutritional standard rate and nutritional index levels between the two groups(all P>0.05).Conclusion For severe stroke patients with diabetes,probiotics combined with early enteral nutrition can help to reduce blood glucose variability,reduce the incidence of hypoglycemia,control inflammation and oxidative stress response,reduce the risk of infection,and improve the prognosis of patients.

关 键 词：早期肠内营养 益生菌 血糖变异性 重症脑卒中 

分 类 号：R151.4[医药卫生—营养与食品卫生学]