肠内营养对高血糖症危重患者的应用分析

Analysis the Effect of Enteral Nutrition on Critically Ill Patients with Hyperglycemia

关键词:  肠内营养  高血糖症  危重病  血清三酰甘油  胆固醇

Key words:  enteral nutrition  hyperglycemia  critically illness  serum triglyceride  cholesterol

摘要:

目的 观察肠内营养对高血糖危重患者血糖、血脂、电解质、氮平衡、蛋白质等的影响。方法 回顾分析207例高血糖症危重患者应用3种相同热量的肠内营养支持。结果 益力佳组患者空腹血糖变化不大，无需加用胰岛素；而能全力组和安素组患者的空腹血糖升高明显(P<0.05)，需加用胰岛素治疗；3组患者的电解质、血淋巴细胞计数、前清蛋白及转铁蛋白浓度均维持在正常范围。3组间比较无显著性差异(P>0.05)；所有患者早期均存在负氮平衡；3组患者肠内营养前后的血清三酰甘油、胆固醇等无明显变化(P>0.05)。结论 对高血糖症危重患者应尽早进行肠内营养支持，高膳食纤维与单不饱和脂肪酸营养配方比高糖营养配方更有利于高血糖危重患者血糖的下降，胰岛素使用量也减少，同时不影响血脂。

Abstract:

OBJECTIVE To observe the effect of enteral nutrition on critically ill patients with hyperglycemia such as glucose, lipids, electrolytes, nitrogen balance, protein and so on. METHODS Retrospective analysis 207 cases of hyperglycemia patients applied with three different enteral nutrition of the same calorie. RESULTS Glucerna group patients had small change in fasting blood glucose and didn’t need additional insulin. The fasting blood glucose of Nutrison fibre group and Ensure group increased significantly (P<0.05) and need additional insulin therapy. The electrolyte blood lymphocyte count, albumin and transferrin levels of three groups were in normal range. And there was no significant difference in three groups (P>0.05). All patients had negative nitrogen balance in early stage. There was no significant change in serum triglyceride, cholesterol before and after enteral nutrition (P>0.05). CONCLUSION The critically ill patients with hyperglycemia should use enteral nutrition as soon as possible. High dietary fiber and monounsaturated fatty acids nutritional supplements are more beneficial than the high sugar nutritional supplements for them. The usage of insulin is reduced without affecting the lipid.