早期肠内营养标准化治疗流程管理对重症肺炎机械通气患者血糖变异度指标及预后的影响  

Effect of early enteral nutrition standardized treatment process management on blood glucose variability indexes and prognosis of patients with severe pneumonia undergoing mechanical ventilation

作　　者：王超[1] 王斌[1] 黄晔[1] 莫瑕[1] 周海霞[1] 陈建芬[1] WANG Chao;WANG Bin;HUANG Ye;MO Xia;ZHOU Haixia;CHEN Jianfen(Department of Cardiothoracic Surgery,the First People’s Hospital of Changzhou,Jiangsu,Changzhou 213003,China)

机构地区：[1]江苏省常州市第一人民医院心胸外科,江苏常州213003

出　　处：《中国医药科学》2023年第7期149-153,共5页China Medicine And Pharmacy

基　　金：江苏省常州市卫生和计划生育委员会卫生计生科技项目(wz201520)。

摘　　要：目的探讨早期肠内营养(EN)标准化治疗流程管理对重症肺炎机械通气患者血糖变异度指标及预后的影响。方法选取2019年1—12月常州市第一人民医院心胸外科收治的26例重症肺炎机械通气患者为对照组(常规的肠内营养支持管理),选取2020年1月至2021年6月常州市第一人民医院心胸外科收治的28例重症肺炎机械通气患者为试验组(早期肠内营养标准化治疗流程管理)。观察两组治疗后平均血糖值(GLUave)及血糖标准差(GLUsd)、血糖变异系数(GLUcv)、最高血糖值(GLUmax)、最低血糖值(GLUmin)、高血糖发生率、营养支持各项指标、肺氧合呼吸功能相关指标以及预后相关指标。结果试验组患者的首次排便时间、达目标喂养量时间短于对照组,7 d EN/[EN+全胃肠道外营养(PN)]比例和鼻肠管达标比例高于对照组,差异有统计学意义(P<0.05)。试验组血糖指标GLUave、GLUmax、GLUmin和血糖变异性指标GLUsd、GLUcv均低于对照组,高血糖发生率低于对照组,差异有统计学意义(P<0.05)。试验组呼吸机自检呼吸力学相关指标好转趋势较对照组明显,第7天试验组肺动态顺应性高于对照组,差异有统计学意义(P<0.05)。试验组肺氧合指数较对照组好转趋势明显,自病程第9天起,试验组氧合指数优于对照组,差异有统计学意义(P<0.05)。第7天起,试验组肺泡-动脉血氧分压差小于对照组,差异有统计学意义(P<0.05)。试验组多器官功能障碍综合征(MODS)发生率低于对照组,有创机械通气时间少于对照组,差异有统计学意义(P<0.05)。结论对重症肺炎有创机械通气患者进行早期肠内营养标准化治疗流程管理可改善营养状况,降低血糖波动水平,改善预后。Objective To explore the effect of early enteral nutrition(EN)standardized treatment process management on blood glucose variability indexes and prognosis of patients with severe pneumonia undergoing mechanical ventilation.Methods A total of 26 patients with severe pneumonia undergoing mechanical ventilation admitted to the Department of Cardiothoracic Surgery of the First People’s Hospital of Changzhou from January to December 2019 were included in the control group(receiving routine enteral nutrition support management),and 28 patients with severe pneumonia undergoing mechanical ventilation admitted to the Department of Cardiothoracic Surgery of the First People’s Hospital of Changzhou from January 2020 to June 2021 were included in the experimental group(receiving early enteral nutrition standardized treatment process management).The average level of blood glucose(GLUave),standard deviation of blood glucose(GLUsd),coefficient of variation of blood glucose(GLUcv),maximum value of blood glucose(GLUmax),minimum value of blood glucose(GLUmin),hyperglycemia incidence,nutritional support indexes,indexes related to pulmonary oxygenation and respiratory function,and prognosis related indexes of patients in the two groups after treatment were observed.Results The first defecation time and time of reaching target feeding amount of patients in the experimental group were earlier than those in the control group,and the proportions of 7 d EN/(EN+parenteral nutrition[PN])and nasointestinal tube feeding reaching the standard were higher in the experimental group than those in the control group,with statistically significant differences(P<0.05).The blood glucose indexes(GLUave,GLUmax and GLUmin)and blood glucose variability indexes(GLUsd and GLUcv)of the experimental group were lower than those of the control group,and the hyperglycemia incidence was lower than that of the control group,with statistically significant differences(P<0.05).The improvement trend of the respiratory mechanics indexes by ventilator self-check in

关 键 词：肠内营养 重症肺炎 血糖变异 预后 

分 类 号：R563.1[医药卫生—呼吸系统]