消化道肿瘤合并糖尿病患者术后肠内营养滴速与血糖水平的关系

Relationship Between Enteral Nutrition Infusion Velocity and Blood Glucose in Postoperative Patients with Gastrointestinal Tumors and Diabetes

目的探讨术后肠内营养滴速与血糖水平的关系,为临床护理提供指导。方法将消化道肿瘤合并2型糖尿病术后行肠内营养的患者随机分为甲组(23例)、乙组(22例)、丙组(20例)及独立设计丁组(21例)。甲乙丙三组术后前3 d根据患者个体情况调整滴速及总量,于术后第4天达到需求量(1 500 ml)时,调整至本研究要求速度,即甲乙丙三组分别采用70 ml/h、110 ml/h、150ml/h匀速泵入,维持6 d;丁组术后第1天以50 ml/h速度开始,后逐日递增20 ml/h,至第6、7、8、9天均以150 ml/h匀速泵入。四组均配合普通胰岛素治疗。结果术后第4～9天丙组输注营养液各时间点血糖值显著高于甲乙二组(均P<0.05),并发症发生率显著高于甲组(P<0.05);甲乙二组各时间点血糖值及并发症发生率比较,差异无统计学意义(均P>0.05);丁组血糖水平随肠内营养滴速的增快而升高,并发症的发生率也随滴速的增快而增加。结论血糖水平和并发症发生可随肠内营养滴速的增加而升高;术后肠内营养滴速为110 ml/h匀速泵入时对血糖影响较小,并发症较少,且可节省治疗时间。

Objective To explore the relationship of enteral nutrition infusion velocity and blood glucose in postoperative patients with gastrointestinal tumors and type 2 diabetes, and to provide guidance for clinical nursing. Methods Postoperative patients with gastrointestinal tumor and type 2 diabetes were randomly divided into group A（23 cases）,group B（22 cases）, group C（20 cases） and group D（21 cases）. The infusion velocity and the amount of nutrition of group A, B, C were adjusted individually according to patient＇s condition 3 days after surgery, and on the 4th day, when the amount of nutrition reached 1 500 ml, the infusion velocity maintained at 70 ml/h,1l0 ml/h and 150 ml/h respectively in the next 6 days; while in group D, the velocity started from 50 ml/ h the day after surgery and increased 20 ml/h each day until it reached 150 ml/h, and maintained the velocity on the 6th, 7th, 8th, and 9th day after surgery. All patients used insulin. Results The values of blood glucose on the 4th to 9th day after surgery in group C were significantly higher than those in group A and B （P〈0.05 for all）, the rate of complications of group C was significantly higher than that of group A（P〈0.05）, and there were no significant differences in the values of blood glucose and the rate of compilations between group A and B（P〈0. 05 for all） ; the value of blood glucose and the occurrence rate of complications in group D were positively correlated with the infusion velocity. Conclusion The blood glucose and complications are positively correlated with the enteral nutrition infusion velocity; and the velocity is recommended as 110 ml/h, which has low impact on blood glucose and reduces complications.