肠内营养混悬液对重症脑血管病合并2型糖尿病患者血清蛋白和血脂的影响

Effects of Enteral Nutrition Suspension on the Serum Protein and Blood Lipid Levels in Patients with Critical Cerebrovascular Diseases Complicated with Type 2 Diabetes

目的探讨不同组分的肠内营养液对重症脑血管病合并糖尿病患者和未合并糖尿病患者营养指标的影响。方法需要进行持续肠内营养的重症脑血管病患者57例,根据是否合并糖尿病分为两组,分别予以糖尿病专用剂型肠内营养液和非糖尿病剂型肠内营养液14 d,对两组患者的血清蛋白及血脂等相关指标进行前瞻性研究。结果两组患者在入院基线资料基本一致的情况下,在入院7 d、14 d时,两组患者的血清总蛋白(P=0.017,P=0.006)、清蛋白(P=0.044,P=0.010)、前清蛋白(P=0.016,P=0.013)、总胆固醇(P=0.009,P=0.007)、高密度脂蛋白(P=0.016,P=0.025)和低密度脂蛋白(P=0.018,P=0.011)比较,差异均有统计学意义,而血红蛋白在入院14d时差异才有统计学意义(P=0.018);两组的三酰甘油水平(7 d,P=0.625;14 d,P=0.169)差异无统计学意义。结论重症脑血管病患者进行持续肠内营养时,糖尿病患者应用糖尿病专用剂型虽然能较好地控制血糖,但低蛋白血症出现早,血清蛋白、血红蛋白及血胆固醇均较非糖尿病组出现快速下降。有必要改进糖尿病专用剂型的蛋白及脂肪组成比例,以保证糖尿病患者处于应激状况下的能量需求。

Objective To explore effects of enteral nutrition suspension with different components on nutritional indices in patients with critical cerebrovascular diseases,complicated with type 2 diabetes or not.Methods A total of 57 critically ill patients with cerebrovascular diseases who were in need of continuous enteral nutrition were divided into two groups,depending on the existence of complicated diabetes status,and received either diabetes-special or regular enteral nutrition formulations for 14 days.Levels of serum protein and blood lipids and other related indicators of these patients were studied prospectively.Results Levels of erum total protein（P=0.017,P=0.006）,albumin（P=0.044,P=0.010）,prealbumin（P=0.016,P=0.013）,total cholesterol（P=0.009,P=0.007）,high density lipoprotein（P=0.016,P=0.025） and low density lipoprotein（P=0.018,P=0.011） between the two groups,though equivalent on admission,became significantly different 7,14 days afterwards.Difference of hemoglobin levels（P=0.018） emerged 14 days after admission and significant differences in triglycerides levels was not noticed（P=0.625,7 th day;P=0.169,14 th day）.Conclusion Though effective in glucose control,diabetes-special nutrition formulations lead to early onset of hypoalbuminemia,as well as rapid decline in levels of serum proteins,hemoglobin and cholesterols when continuous enteral nutrition is delivered to critically ill patients with coexisted cerebrovascular disease and diabetes.It is necessary to modify the content of the protein and fat component in diabetes-special formulations in order to meet the need of energy among these critically ill patients.