摘要
目的 观察肠内营养乳剂(瑞代)对糖尿病机械通气(MV)患者炎症因子及预后的影响.方法 选择2014年6月至2016年12月丽水市中医院收治的66例糖尿病MV患者,按随机数字表法分为观察组和对照组,每组33例.两组均给予积极原发病治疗,维持水、电解质平衡,控制感染,给予精蛋白生物合成人胰岛素注射液控制血糖等治疗.MV 24 h后,对照组经鼻胃管匀速滴入肠内营养混悬液(能全力),而观察组经鼻胃管匀速滴入瑞代.治疗2周后,计算两组患者每日血糖平均值和血糖波动值,统计每日胰岛素总用量;比较两组治疗前后降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TF)等的差异;观察两组MV时间、重症医学科(ICU)住院时间及MV 2周撤机成功率.结果 营养治疗期间,观察组和对照组每日血糖平均值比较差异无统计学意义(mmol/L:8.62±2.65比9.70±3.43,P>0.05),但观察组血糖波动值(mmol/L:3.13±1.09比5.68±1.40)、每日胰岛素总用量(U/d:31.93±4.93比43.50±5.31)均明显低于对照组(均P<0.05).治疗后两组PCT及hs-CRP较治疗前显著降低,且以观察组的降低程度较对照组更显著〔PCT(μg/L):2.81±1.03比5.95±1.57,hs-CRP(mg/L):4.41±2.01比11.46±4.05,均P<0.05〕.两组治疗后ALB、PA、TF均较治疗明显升高〔ALB(g/L):对照组为37.98±3.49比30.50±3.44,观察组为37.88±3.47比30.48±3.34;PA(mg/L):对照组为188.60±12.66比130.22±11.33,观察组为184.42±12.95比133.50±11.91;TF(mg/L):对照组为2.71±1.01比2.07±0.86,观察组为2.69±1.02比2.08±0.90,均P<0.05〕,但两组间比较差异均无统计学意义(均P>0.05).观察组MV时间(d:7.29±3.65比10.70±4.43)、ICU住院时间(d:11.13±3.09比15.48±4.40)均较对照组显著降低(均P<0.05),MV 2周撤机成功率较对照组显著升高〔69.70%(23/33)比39.39%(13/33),P<0.05〕.结论 瑞代能满足糖尿病MV患者的营养需求,能更好地控制血糖、维持血糖水平平稳、减轻炎症反应,从而改善预后.
Objective To observe the effect of enteral nutrition emulsion (fresubin diabetes) on inflammatory factors and prognosis in patients with diabetes and mechanical ventilation (MV). Methods Sixty-six patients with diabetes and MV admitted to Lishui Hospital of Traditional Chinese Medicine from June 2014 to December 2016 were enrolled, and they were divided into an observation group and a control group according to random number table, 33 cases in each group. Active treatment of the primary disease, maintenance of water and electrolyte balance, active control of infection, protamine biosynthesis of human insulin injection to control blood glucose and other treatment were given to both groups. After 24 hours of MV, enteral nutrition suspension (nutrison fibre) was evenly dripped into the control group through a nasogastric tube, and fresubin diabetes was evenly dripped with the same method as above into the observation group. After treatment for 2 weeks, the average values of daily blood glucose, of blood glucose fluctuation and daily total insulin dosage of two groups were calculated; the differences in procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and serum albumin (ALB), prealbumin (PA) and transferrin (TF) were compared before and after treatment in the two groups; the duration of MV, stay time in ICU, and 2-week MV withdrawal rate were observed in the two groups. Results During nutritional therapy, there was no significant difference in the average daily blood glucose level between observation group and control group (mmol/L: 8.62±2.65 vs. 9.70±3.43, P > 0.05), however, in the observation group, the average daily blood glucose fluctuation value (mmol/L: 3.13±1.09 vs. 5.68±1.40), and the daily total insulin dosage (U/d: 31.93±4.93 vs. 43.50±5.31) were significantly lower than those of the control group (both P < 0.05). After treatment, PCT and hs-CRP in both groups were significantly lower than those before treatment, and the degrees of decrease in observation group were more significant than those in the control group (PCT (μg/L):2.81±1.03 vs. 5.95±1.57, hs-CRP (mg/L): 4.41±2.01 vs. 11.46±4.05, all P < 0.05)After treatment, the levels of ALB, PA and TF were significantly higher than those before treatment [ALB (g/L): the control group was 37.98±3.49 vs. 30.50±3.44, the observation group was 37.88±3.47 vs. 30.48±3.34; PA (mg/L): the control group was 188.60±12.66 vs. 130.22±11.33, the observation group was 184.42±12.95 and 133.50±11.91; TF (mg/L): the control group was 2.71±1.01 vs. 2.07±0.86, the observation group was 2.69±1.02 vs. 2.08±0.90, all P < 0.05]; however, there were no statistical significant differences between the two groups (all P > 0.05). The MV time (days: 7.29±3.65 vs. 10.70±4.43) and ICU stay (days: 11.13±3.09 vs. 15.48±4.40) in the observation group were significantly lower than those in the control group (both P < 0.05), and 2-week MV withdrawal rate was significantly higher than that of the control group (69.70% (23/33) vs. 39.39% (13/33), P < 0.05)Conclusion Fresubin diabetes can meet the nutritional needs of diabetic patients with MV, in the aspects of controlling blood sugar, maintaining stable blood sugar levels and reducing inflammation, the therapeutic effect of fresubin diabetes is better than that of nutrison fibre, thus fresubin diabetes may better improve the prognosis of patients with diabetes.
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第2期161-164,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
瑞代
肠内营养
糖尿病
机械通气
炎症因子
Fresubin diabetes
Enteral nutrition
Diabetes
Mechanical ventilation
Inflammatory factor
