糖尿病患者胃癌术后肠内或肠外营养对血糖、营养指标的影响

Influence on blood sugar and nutrition indicators from EN or TPN for postoperative patients with gastric cancer and diabetes

【目的】研究糖尿病患者胃癌根治术后应用肠内营养(enteral nutrition,EN)与完全胃肠外营养(total parenteral nutrition,TPN)对患者血糖、营养指标的影响。【方法】研究对象为45例胃癌并糖尿病行胃癌根治术患者,随机分为两组,术后使用糖尿病专用型肠内营养制剂(fresubinTmdiabetes,FTD)组21例;TPN组24例术后使用TPN+普通胰岛素注射。术后24h开始给予FTD或TPN,分别比较两组患者术前空腹、餐后、术后3d、7d空腹及EN或TPN后血糖变化。营养指标包括体重(BW)、总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、血红蛋白(Hb)。【结果】FTD组患者术后空腹及EN后血糖水平波动小,无需加用胰岛素,TPN组患者术后空腹及TPN后血糖水平波动大,胰岛素调整不及时可能出现高血糖或低血糖;FTD组患者术后机体营养指标优于TPN组,两组相比差异有统计学意义(P<0.05)。【结论】对于胃癌并糖尿病患者,胃癌根治术后早期使用糖尿病专用型肠内营养制剂,在改善机体营养状况的同时,不增加血糖波动的风险,较完全胃肠外营养有更多的优点。

[Objective]To study the influence of blood sugar and nutrition indicators on postoperative patients with Gastric cancer and Diabetes when given an enteral nutrition or total parenteral nutrition. [Methods]The object of study for 45 postoperative patients with Gastric cancer and Diabetes, they were divided into 2 groups according to the stochastic principle. In the FTD groups for 21 examples, Fresubin Tm Diabetes was being the nutrition preparation. In the TPN groups for 24 examples,the nutrition preparation comes from TPN and the ordinary insulin injection. We start to give Fresubin Tm Diabetes or TPN in the intestines the nutrition preparation at 24 hours postoperative. After separately two group of postoperative patients, Compares with the blood sugar for the empty stomach or after meal, and the blood sugar for the empty stomach or after EN for Gastric cancer postoperative at 3 day or 7 day. Nutrition indicators include the body weight （BW）, the total protein （TP）, the albumin （ALB）, the albumin （PA）, transfers the ferric albuminate iron albuminate （TFN）, the hemoglobin （Hb）. [Results]The postoperative patients for Fresubin Tm Diabetes, for empty stomach and after mealor EN, the blood sugar level change is small, does not need to add with the insulin. The postoperative patients for TPN, for empty stomach and meal, the blood sugar level changes in a big way, the insulin adjustment not prompt possibly causes the hyperglycemia or the hypoglycemia. Organism nutritional status of the postoperative patients for FTD is better than the other group for TPN. Two groups have the significance difference（P 0.05）. [Conclusions]Regarding postoperative patients with stomach cancer and diabetic, in the early time field test group of the nutrition preparation, Fresubin Tm Diabetes is better than TPN, while improves its organism nutrition, does not increase the risk of the blood sugar change.