补充可溶性膳食纤维肠内营养对老年重症患者胃肠道症状及糖和脂代谢的影响

Effects of soluble dietary fiber supplementation in enteral nutrition on gastrointestinal symptoms and glucose and lipid metabolisms in elderly critically ill patients

目的探讨额外补充可溶性膳食纤维肠内营养(EN)对老年重症患者胃肠道症状、糖和脂代谢的影响.方法采用前瞻性研究方法,选择玉环市人民医院2017年1月至2018年6月收治的老年重症患者112例作为研究对象,将患者分为膳食纤维组和常规EN组,每组56例.两组营养支持方案一致,在血流动力学稳定后开始EN,EN制剂首选标准型乳剂,根据患者耐受情况,争取3 d内目标热量达到104.6~125.5 kJ·kg^(-1)·d^(-1),蛋白目标为1.5~2.0 g·kg^(-1)·d^(-1),血糖水平控制在7.8~11.1 mmol/L,膳食纤维组在常规EN基础上每500 mL EN制剂加用可溶性膳食纤维10 g.比较两组患者治疗后营养状态、糖和脂代谢指标及胃肠道症状发生情况的差异.结果两组患者入院时及入院3、5、7 d后营养指标〔血清白蛋白、前白蛋白、转铁蛋白(TRF)〕及脂代谢指标〔三酰甘油(TG)、总胆固醇(TC)〕比较差异均无统计学意义(均P>0.05).糖代谢方面,入院5 d时膳食纤维组血糖水平明显低于常规EN组(mmol/L:9.53±3.65比11.16±3.82,P<0.05);入院3 d时,膳食纤维组胰岛素使用剂量即明显低于常规EN组(U:17.86±8.49比22.84±10.33,P<0.05);入院7d时达到最低值,且膳食纤维组明显低于常规EN组〔血糖(mmol/L):8.21±3.17比10.23±3.38,胰岛素使用剂量(U):9.35±5.56比13.49±6.77,均P<0.05〕.胃肠道症状方面,膳食纤维组胃潴留〔14.29%(8/56)比32.14%(18/56)〕、腹泻〔12.50%(7/56)比35.71%(20/56)〕及下消化道麻痹〔7.14%(4/56)比23.21%(13/56)〕发生率均明显低于常规EN组(均P<0.05);膳食纤维组和常规EN组食物不耐受综合征〔10.71%(6/56)比19.64%(11/56)〕及腹腔高压〔5.36%(3/56)比14.29%(8/56)〕发生率比较差异均无统计学意义(均P>0.05).结论添加可溶性膳食纤维可有效控制老年重症患者EN过程中血糖水平,降低胃肠道不良反应发生率.

Objective To investigate the effects of enteral nutrition(EN)with additional supplement of soluble dietary fiber on gastrointestinal symptoms and metabolisms of glucose and lipid in elderly critically ill patients.Methods Prospective controlled study method was used;112 elderly critically ill patients in Y uhuan People's Hospital from January 2017 to June 2018 were selected as research objects,and they were divided into a soluble dietary fiber EN group and a routine EN group by random number table method,with 56 cases in each group.The nutrition support plans were the same in both groups.The EN began after the hemodynamics becoming stable,the standard emulsion was the first choice for EN preparation.According to the patients'tolerance,to fight for about 3 days,the target of heat caloric value would get to 104.6-125.5 kJ·kg^(-1)·d^(-1),the protein target,to 1.5-2.0g·kg^(-1)·d^(-1),and the blood glucose level was controlled within 7.8-11.1 mmol/L.In soluble dietary fiber group,soluble dietary fiber(10 g)was added in 500 mL EN routine preparation.The nutritional status,glucose and lipid metabolism indexes and incidences of gastrointestinal symptoms after treatment were compared between the two groups..R esults No statistically significant differences were found in nutritional indexes including serum albumin,pre-albumin,transferring(TRF)and lipid metabolism indexes including triglyceride(TG)and total cholesterol(TC)between the two groups on admission and 3,5,7 days after admission(all P>0.05).In terms of glucose metabolism in soluble dietary fiber EN group,the blood glucose on day 5 after admission were significantly lower than that in routine EN group(mmol/L:9.53±3.65 vs.11.16±3.82.P<0.05),on day 3 after admission,the dosage of insulin was significantly lower than that in routine EN group(U:17.86±8.49 vs.22.84±10.33.P<0.05)..reaching the lowest on day 7 after admission,the blood glucose level and dosage of insulin were lower than those in routine EN group[blood glucose(mmol/L):8.21±3.17 vs.10.23±3.38,insulin dosage(U):9.35±5.56 vs.13.49±6.77,both P<0.05].In terms of gastrointestinal symptoms,the incidences of gastric retention[14.29%(8/56)vs.32.14%(18/56)],diarrhea[12.50%%(7/56)vs.35.71%(20/56)]and lower gastrointestinal paralysis[7.14%(4/56)]vs.23.21%(13/56)]in soluble dietary fiber group were significantly lower than those of the routine EN group(all P<0.05).There were no significant differences in incidences of food intolerance syndrome[10.71%(6/56)vs.19.64%(11/56)]and abdominal hypertension[5.36%(3/56)vs.14.29%(8/56)]between the soluble dietary fiber EN group and routine EN group(both P>0.05).Conclusion The extra addition of soluble dietary fiber into routine EN can effectively control blood glucose level and reduce the incidence of gastrointestinal adverse reactions in treatment of elderly critically ill patients.