合并糖尿病消化道肿瘤患者术后早期肠内营养支持的护理研究

Nursing research in postoperative early enteral nutrition support for diabetic patients with alimentary tract neoplasms.

目的:探讨消化道肿瘤合并糖尿病患者在术后早期肠内营养过程中的护理方法。方法:37例消化道肿瘤合并糖尿病患者术后24h经鼻空肠营养管重力滴入肠内营养糖尿病专用制剂,检测治疗前后各项营养、生化及免疫指标变化。通过一系列相关护理措施,监测和控制血糖,预防并发症的发生。结果:在输注肠内营养过程中患者无1例发生严重并发症,仅有5例出现腹胀腹泻症状,2例出现咽喉炎,均对症治疗后缓解。81.08%患者血糖稳定,控制在(7.8±1.1)mmol/L范围内。治疗后血清白蛋白、前清蛋白、转铁蛋白等营养指标水平显著增高(P<0.05),体重、血红蛋白、丙氨酸氨基转移酶、总胆红素无明显改变,IgG、IgA、IgM免疫指标水平比术前有明显升高(P<0.01)。结论:对消化道肿瘤合并糖尿病患者术后早期应用糖尿病专用制剂是营养支持的有效手段。治疗期间应采取科学有效的护理方法,加强基础护理,监测血糖变化,预防糖尿病和手术相关并发症的发生。

Objective ：To discuss the nursing role in postoperative early enteral nutrition （EEN） for diabetic patients with alimentary tract neoplasms. Methods Thirty seven diabetic patients with alimentary tract neoplasms received enteral nutriment- Glucema SR through naso-jejunal tubes after 24 hours of operation. The indices representing the nutrition, biochemistry and immunity condition were measured. A series of nursing intervention related to diabetes were taken to prevent from the complications. Results ： No one case was suffered severe complications. Five cases with symptoms of dilation and diarrhea and 2 cases with fancitis were relieved after treatment. There were 81.08% of patients whose blood glucose levels were controlled steadily with （7.8 ±1. 1 ） mmol/L. Significantly Increased serum levels of albumin, prealbumin, tranferrin were observed after EEN support （ P 〈 0.05 ）, as well as the serum level of IgG,Ig, A,IgM （ P 〈 0.01 ） , however, the body weigh, HGB and the serum levels of ALT and TBIL have no significant change. Conclusion ：The postoperative implementation of EEN can be considered the first choice of nutrition support in diabetic patients with alimentary tract neoplasms. Nursing with full rationalization and efficacy ensures a exemption of diabetes - related postoperative complications.