胰岛素泵治疗在脑卒中合糖尿病病人肠内营养实施中的应用评价

Evaluation of the efficiency of continuous insulin infusion in the administration enteral nutrition in stroke patients complicated with diabetes

目的:观察不同的胰岛素使用方式对持续肠内营养(EN)输注的脑卒中合并糖尿病病人的血糖、营养状态及输注并发症的影响。方法:选取脑卒中合并糖尿病持续EN输注病人160例,采用便利抽样法将入选病人随机分为观察组79例、对照组各81例,观察组采用胰岛素持续皮下泵入的方式控制血糖,对照组采用胰岛素分次皮下注射的方式控制血糖。观察两组病人日常血糖水平、营养状态、高血糖、低血糖发生率及病人EN并发症情况。结果:两组病人的空腹血糖、喂养开始2 h、喂养结束时、喂养结束后2 h血糖比较均有统计学意义(P< 0.05);两组病人高血糖、低血糖发生率比较均有统计学意义(P<0.05);两组病人EN并发症情况比较有统计学意义(P<0.05);两组病人白蛋白、前蛋白比较均有统计学意义(P < 0.05)。结论:脑卒中合并糖尿病持续EN输注病人,采用胰岛素持续皮下泵入的方式控制血糖.有利于病人的血糖达标及稳定,营养状态改善,减少EN并发症的发生,提高治疗有效率。

Objectives To observe the effects of different insulin administration patterns on blood glucose, nutritional status and infusion associated complications in stroke patients complicated with diabetes treated with enteral nutrition (EN). Methods: 160 stroke patients with diabetes sustained by enteral nutrition infusion were included. The patients were randomly divided into the intervention group (79 cases) and the control group (81 cases) using convenient sampling method. Patients in the intervention group were given continuous subcutaneous insulin pump to control blood glucose, while the control group used separate subcutaneous insulin injection. The daily blood glucose level, nutritional status, incidence of hyperglycemia and hypoglycemia and enteral nutrition associated complications of the both groups were observed. Results: The fasting blood glucose levels, as well as blood glucose levels at 2h after feeding initiation, at the end of feeding and 2h after the end of feeding between the two groups was statistically significant (P < 0.05). The incidence of hyperglycemia and hypoglycemia in the two groups was statistically significant (P < 0.05). In addition, there was a statistically significant difference in incidence of enteral nutrition associated complications, as well as the levels of albumin and pre-albumin between the two groups (P < 0.05). Conclusions In stroke patients complicated with diabetes, continuous subcutaneous insulin infusion, in comparison to separate insulin injection, showed great effects in maintaining blood glucose, improving nutritional status, reducing the incidence of enteral nutrition associated complications and optimizing clinical outcomes.