摘要
目的 探讨不同肠内营养制剂对于重症急性胰腺炎应激性高血糖患者的血糖变异性,营养状况、炎症指标及预后的影响。方法 本研究回顾2018年1月—2021年12月上海交通大学医学院附属瑞金医院重症医学科收治的149例随机血糖>11.1 mmol/L的重症急性胰腺炎患者。根据营养治疗过程中是否应用含缓释淀粉的肠内营养制剂,分为观察组(72例)和对照组(77例)。观察两组治疗前、后血糖的变异性,营养指标以及预后情况。结果 治疗2周后,观察组血糖变异性均呈明显下降趋势,平均血糖从治疗前(15.36±2.35) mmol/L下降至(9.76±1.79) mmol/L,血糖标准差从治疗前3.64±1.32下降至2.23±1.08,血糖变异系数从治疗前22.4±7.23下降至15.4±6.01,平均血糖波动幅度从治疗前(7.9±3.5) mmol/L下降到(5.2±3.1) mmol/L;而对照组血糖变异性均呈不同程度上升,平均血糖从治疗前(12.3±2.0) mmol/L上升至(14.3±1.86) mmol/L,血糖标准差从治疗前1.72±0.98上升至3.52±1.1,血糖变异系数从治疗前18.3±6.9上升至20.1±7.6,平均血糖波动幅度从治疗前(4.1±2.1) mmol/L上升至(7.2±2.3) mmol/L。治疗后两组组间血糖变异指标(血糖标准差、血糖变异系数、最大血糖波动幅度)差异均存在统计学意义(P<0.05);营养指标:除了血红蛋白外,两组治疗后各营养指标(白蛋白、前白蛋白、总蛋白)组内比较均有显著提升(P<0.05),但两组之间比较差异无统计学意义(P≥0.05)。住ICU天数和总住院时间,观察组也显著短于对照组[观察组:(30.1±5.61) d,(45.7±7.39) d;观察组:(36.9±5.23) d,(56.1±9.83) d;P<0.05]。60、90 d死亡率,观察组也低于对照组(1.4%vs 2.6%,4.1%vs 7.8%,P<0.05)。结论 在重症急性胰腺炎应激性高血糖患者应用含缓释淀粉的肠内营养制剂,不仅可以迅速提升营养指标,还可以显著降低血糖变异度,同时减少住ICU和住院时间,降低死亡率。
Objective To investigate the effects of slow-release starch on blood glucose variability in severe acute pancreatitis(SAP)patients with stress hyperglycemia.Methods One hundred and forty-nine severe acute pancreatitis patients with hyperglycemia(random blood glucose>11.1 mmol/L)admitted to the ICU of Shanghai Ruijin Hospital from January 2018 to December 2021 were enrolled,including 72 cases treated with continuous instillation of enteral nutrition liquid containing slow-release starch(study group)and 77 cases treated with instillation of standard enteral nutrition liquid(intacted protein or short peptide type)by nasointestinal tube(control group).After treatment for 14 d,the average value of blood glucose(GLU AVE),standard deviation of blood glucose(GLU SD),coefficient of variation of blood glucose(GLU CV),mean amplitude of glycemic excursions(GLU MAGE)were calculated in the two groups.The serum albumin(Alb),pre-albumin(PA)and serum total protein(TP)and hemoglobin(Hb)were compared before and after treatment in two groups.The length of ICU stay,length of hospital stay,60-d and 90-d mortality were observed after treatment.Results After 2 weeks of treatment,the blood glucose variability of the study group showed a significant downward trend:GLU AVE decreased from(15.36±2.37)mmol/L to(9.76±1.79)mmol/L,GLU SD decreased from 3.64±1.32 to 2.23±1.28,GLU CV decreased from 22.2±7.23 to 15.4±6.01,and GLU MAGE decreased from(7.9±3.5)mmol/L to(5.2±3.1)mmol/L.In the control group,the blood glucose variability increased in varying degrees,GLU AVE increased from(12.3±2.0)mmol/L to(14.3±1.86)mmol/L,GLU SD increased from 1.72±0.98 to 3.52±1.1,GLU CV increased from 18.3±6.9 to 20.1±7.6,and GLU MAGE increased from(4.1±2.1)mmol/L to(6.7±2.3)mmol/L.After treatment,there were significant differences in blood glucose variation indicators between two groups(P<0.05).After treatment,serum Alb,STP and PA were higher than those before treatment in both groups,and there were no significant differences between two groups(all P
作者
张泓
李磊
吴璟奕
黄洁
ZHANG Hong;LI Lei;WU Jingyi;HUANG Jie(Department of Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《同济大学学报（医学版）》
CAS
2023年第2期220-225,共6页
Journal of Tongji University(Medical Science)
关键词
重症急性胰腺炎
应激性高血糖
缓释淀粉
肠内营养
severe acute pancreatitis
stress hyperglycemia
sustained-release starch
enteral nutrition
