糖尿病患者胃癌根治术后不同营养制剂与血糖及并发症的关系

Relationship Between Postoperative Blood Glucose and Complications and Different Nutrition for Patients with Gastric Cancer Combinated Diabetes

目的研究糖尿病患者胃癌根治术后应用瑞代(fresubinTM diabetes,FD)、瑞素(fresubin)或全肠外营养(total parenteral nutrition,TPN)对患者血糖变化及并发症发生情况的影响。方法研究对象为胃癌合并糖尿病行胃癌根治术的患者66例,按照平衡的原则分为3组:FD组(n=21)术后使用糖尿病专用型肠内营养(enteral nu-trition,EN)制剂FD;瑞素组(n=21)术后使用普通EN制剂瑞素+普通胰岛素注射;TPN组(n=24)术后使用TPN+普通胰岛素注射。术后24h开始各组分别给予EN制剂FD、瑞素或TPN,分别比较3组患者术前空腹和餐后、术后空腹及EN或TPN后血糖变化及常见并发症发生情况。结果①FD组患者术后空腹及EN后血糖水平波动小,无需加用胰岛素,仅出现高血糖1例(4.8%)。瑞素组、TPN组患者术后空腹及EN或TPN后血糖水平波动大,其中瑞素组高血糖6例(28.6%),低血糖5例(23.8%);TPN组高血糖8例(33.3%),低血糖6例(25.0%)。血糖异常率FD组(4.8%,1/21)明显低于瑞素组(52.4%,11/21)和TPN组(58.3%,14/24),差异有统计学意义(P<0.05),瑞素组与TPN组比较,差异无统计学意义(P>0.05)。②术后切口感染FD组1例(4.8%),瑞素组5例(23.8%),TPN组8例(33.3%),3组间比较差异均有统计学意义(P<0.05)。术后肛门排气时间FD组〔(46.1±16.5)h〕和瑞素组〔(45.6±17.8)h〕明显短于TPN组〔(63.5±13.7)h〕,FD组和瑞素组间比较,差异无统计学意义(P>0.05)。3组患者腹胀、腹泻发生率各组间比较差异均无统计学意义(P>0.05)。结论对于胃癌合并糖尿病患者,胃癌根治术后早期使用FD作为EN制剂,不增加血糖波动的风险,并发症少,较普通EN、TPN有更多的优点。

Objective To study the changes of postoperative blood glucose and complications of patients with gastric cancer combined diabetes after radical operation and given fresubinTM diabetes （FD）,fresubin or total parenteral nutrition （TPN）,respectively.Methods Sixty-six postoperative patients with gastric cancer combined diabetes were divided into 3 groups according to the balanced principle.In the frist group （FD group）,FD was the nutrition preparation for 21 patients.In the second group （fresubin group）,fresubin and the ordinary insulin injection were the nutrition preparation for 21 patients.In the third group （TPN group）,the nutrition preparation came from TPN and the ordinary insulin injection for 24 patients.FD,fresubin or TPN were given at 24 h after operation,the levels of blood glucose for empty stomach,after meal （enteral nutrition or TPN） and the common complications compared among 3 groups of postoperative patients.Results ① In FD group,the levels of blood glucose of postoperative empty stomach and after enteral nutrition were stable with little fluctuation and no insulin was needed with 1 case of hyperglycemia （4.8%）.In fresubin group and TPN group,the levels of blood glucose of postoperative empty stomach and after enteral nutrition or TPN were unstable with big fluctuation,with 6 cases （28.6%） and 8 cases （33.3%） of hyperglycemia,5 cases （23.8%） and 6 cases （25.0%） of hypoglycemia in fresubin group and TPN group,respectively.Compared with fresubin group and TPN group,the rate of pathoglycemia was lower in FD group,the difference had statistical significance separately （P〈0.05）;There was no significant difference between fresubin group and TPN group （P〈0.05）.② The rates of infection of incisional wound in FD group （4.8%） and fresubin group （23.8%） were lower than that of TPN group （33.3%）,there was significant difference among 3 groups （P〈0.05）;The time of passage of gas by anus in FD group and fresubin group were shorter than that in TPN group （P〈0.05）;There was no significant difference between FD group and fresubin group （P〈0.05）.There were no significant differences of the rates of abdominal distension or diarrhea among 3 groups （P〈0.05）.Conclusion Regarding postoperative patients with gastric cancer combined diabetes,in the early time field test group of the nutrition preparation,FD is better than fresubin or TPN,which does not increase the risk of the blood glucose change and have few complications.