颅脑损伤的糖尿病患者使用肠内营养制剂瑞代营养状况评价的临床研究

Evaluate the Nutritional Status of Traumatic Brain Injury Patients with Diabetes after Used Fresubin Diabetes

目的:对比使用传统鼻饲流质饮食的肠内营养(enteral nutrition,EN)+胰岛素注射的颅脑损伤糖尿病患者,评价使用糖尿病专用型肠内营养制剂瑞代的颅脑损伤糖尿病患者置管营养支持治疗后的营养状况。方法:选择我院2004年10月-2011年4月64例颅脑损伤的糖尿病患者的临床资料进行分析总结。其中对照组32例患者使用传统鼻饲流质饮食+胰岛素泵入,研究组32例患者鼻饲糖尿病专用型肠内营养制剂瑞代。观察两组患者肠内营养支持前及治疗后第10、20、30天空腹血糖(FBG)、餐后2h血糖(2hBG)、血清总胆固醇(TC)、血清白蛋白(ALB)、体重指数、皮下脂肪厚度的变化。结果:研究组患者支持治疗后空腹及餐后2h血糖水平波动小,胰岛素用量少,高血糖2例(6%);对照组患者术后空腹及EN后血糖水平波动大,高血糖9例(28%),低血糖4例(12.5%),营养支持后第10、20、30天,研究组血清总胆固醇(TC)、血清总蛋白(TP)、体重指数以及皮下脂肪厚度明显高于对照组(P<0.05)。结论:颅脑损伤的糖尿病患者使用糖尿病专用型肠内营养制剂瑞代可使营养状况得到一定改善,并且患者血糖波动较小。

Objective： To compare traumatic brain injury patients with diabetes use of traditional liquid diet enteral nutrition（EN）plus insulin injection and use of diabetes-specific enteral nutrition Fresubin diabetes, evaluating the nutritional status of those traumatic brain injury patients with diabetes. Methods： 64 cases of traumatic brain injury patients with diabetes diagnosed in our hospital lasting from October 2004 to April 2011 has been selected to analysis their clinical data. 32 patients in control group nasal feed conventional liquid diet plus insulin pump and 32 patients in study group nasal feed diabetes-specific enteral nutrition fresubin diabetes. We observed and record fasting blood glucose（FBG）and postprandial 2h plasma glucose（2hBG）before treatment and in support of 10 days, 20 days and 30 days. We measured serum total cholesterol（TC）, serum albumin （ALB）, body mass index and subcutaneous fat thickness after treatment. Results： After support treatment, the fluctuation of fasting and 2h postprandial blood glucose level in study group patients is small and they used smaller amount of insulin compared with control group patients. Study group had 2 cases （6%） high blood sugar. Control group had 9 cases（28%）high blood sugar,4 cases （12. 5%） low blood sugar. Statistical results shown that serum total cholesterol（TC）, serum albumin （ALB）, body mass index and subcutaneous fat thickness in study group significantly higher than control group after support treatment. Conclusion：Traumatic brain injury patients with diabetes use diabetes-specific enteral nutrition Fresubin diabetes can improve the nutritional status and cause less fluctuations in blood glucose.