富含缓释淀粉的肠内营养乳剂对危重病患者血糖的影响

Effect of enteral nutrition emulsion with slow-release starch on blood glucose in critically ill patients

目的研究富含缓释淀粉的肠内营养(EN)乳剂对危重病患者血糖、胰岛素用量及营养状况的影响。方法将2008年12月至2010年5月连续收入重症监护病房的94例危重患者随机分成缓释淀粉EN乳剂组(研究组)和标准EN乳剂组(对照组),各47例,分别给予等热量的EN支持,观察EN治疗前及治疗后第7天患者的体重指数(BMI)、血胆固醇(TC)、甘油三酯(TG)、总蛋白(TP)、白蛋白(ALB)、空腹血糖(FBG)、糖化血红蛋白(GHb)、胰岛素(Ins)、餐后2h血糖(2hBG)和血糖曲线下面积(AUCg)、胰岛素曲线下面积(AUCi),以及EN治疗7d内的累积胰岛素应用剂量。结果 EN治疗前,两组患者间各项观察指标比较,差异均无统计学意义(P均>0.05)。EN治疗7d后,研究组患者的FBG及2hBG水平低于对照组(P<0.05,P<0.01),而GHb及Ins水平差异均无统计学意义(P均>0.05)。EN治疗前及治疗后第7天,研究组AUCg及AUCi的差值均高于对照组(P均<0.01)。EN治疗期间,研究组累积应用胰岛素的剂量少于对照组(P<0.01)。EN治疗7d后,两组患者的TP及ALB水平均高于治疗前(P均<0.01),但两组间各项营养指标比较,差异均无统计学意义(P均>0.05)。两组患者治疗期间EN耐受情况及胃肠不良反应比较,差异均无统计学意义(P均>0.05)。结论与标准EN乳剂相比,在改善危重病患者营养状况及保证EN耐受的基础上,富含缓释淀粉的EN乳剂明显减少了患者因EN所导致的血糖升高及胰岛素用量,可能有利于减少高血糖并发症带来的病死率。

Objective To explore the effect of enteral nutrition （EN） emulsion with slow-release starch on blood glucose, insulin and nutritional status in critically ill patients. Methods Ninty-four critically ill patients from December 2008 to May 2010 continuously admitted into intensive care unit were randomly divided into study group （EN emulsion with slow-release starch, 47 cases） and control group （complete EN emulsion, 47 cases）. Body mass index （BMI）, total cholesterol （TC）, triglyceride （TG）, total protein （TP）, albumin （ALB）, fasting blood glucose （FBG）, glycosylated hemoglobin （GHb）, insulin （Ins）, 2 h-postprandial blood glucose （2hBG）, area under the curve of glucose （AUCg） and insulin （AUCi） were observed 7 d before and after EN treatment. Total Ins dose within 7 d of EN was also measured. Results There was no difference in all the parameters between the two groups before EN treatment （P〉0.05）. However, 7 d after EN, both FBG and 2hBG in the study group were significantly lower than the control group （P〈0.05, P〈0.01）. GHb and Ins showed no difference 7 d of EN later between the two groups （all P〉0.05）. Value of difference between AUCg and AUCi before and after 7 d of EN in the study group were markedly higher than the control group （all P〈0.01）. Total Ins dose within 7 d was significantly lower in the study group than the control group （P〈0.01）. The levels of TP and ALB were markedly increased after EN treatment in both groups （all P〈0.01）. However, after EN treatment there was no difference in all the nutrition parameters between the two groups （all P〉0.05）. No significant difference of EN-related tolerance and gastrointestinal adverse effect was observed between the two groups （all P〉0.05）. Conclusion Compared with complete EN emulsion, EN emulsion with slow-release starch can not only improve the nutrition status and tolerance but also inhibit hyperglycemia and the usage of insulin in critically ill patients, which may reduce the hyperglycemia-induced mortality.