应激性高血糖患者应用低糖类肠内营养制剂瑞代治疗的临床效果

Clinical effect of low carbohydrate enteral nutrition preparation Ruidai for treatment of patients with stress hyperglycemia

目的探讨低糖类肠内营养制剂瑞代治疗应激性高血糖患者的临床效果.方法选择2018年1月至2020年1月浙江省台州医院收治的90例多发伤合并应激性高血糖患者作为研究对象,按使用肠内营养制剂的不同分为能全力组、瑞能组和瑞代组,每组30例.比较3组患者的血糖、血脂、营养指标、血气指标与电解质水平并分析治疗效果.结果①血糖指标:治疗后,3组患者的末梢血糖、糖化血红蛋白(HbA1c)、血糖波动幅度、空腹血糖(FBG)水平均较治疗前降低,以瑞代组降低更明显〔末梢血糖(mmol/L):6.2±1.0比8.4±1.9,HbA1c:0.069±0.009比0.078±0.010,血糖波动幅度(mmol/L):2.9±1.2比4.2±1.6,FBG(mmol/L):5.6±1.1比7.6±1.7,均P<0.05〕.②血脂指标:治疗后,3组患者的高密度脂蛋白胆固醇(HDL-C)水平均较治疗前明显升高,但各组间比较差异无统计学意义;瑞代组治疗后三酰甘油(TG)、总胆固醇(TC)水平均较治疗前明显降低〔TG(mmol/L):1.2±0.7比2.1±1.6,TC(mmol/L):3.3±0.8比4.2±1.3,均P<0.05〕,其他各组TG、TC水平较治疗前轻微升高.③营养指标:治疗后,3组患者的白蛋白(ALB)和前白蛋白(PA)水平均较治疗前明显升高,各组间ALB水平比较差异有统计学意义,但PA水平比较差异无统计学意义.④电解质指标:治疗后,3组患者的血K+、血Na+和血Cl-水平均较治疗前明显升高,但各组间上述指标比较差异均无统计学意义.⑤血气指标:治疗后,3组患者的动脉血氧分压(PaO_(2))水平均较治疗前明显升高,动脉血二氧化碳分压(PaCO_(2))水平均较治疗前明显降低.各组间治疗后PaO2水平比较差异无统计学意义,但瑞代组PaCO_(2)水平明显低于能全力组(kPa:6.5±1.6比7.8±1.9,P<0.05).结论对应激性高血糖患者应用低糖类肠内营养制剂瑞代治疗效果理想,可改善患者血糖与血脂水平,提高营养供给量,有利于病情恢复.

Objective To investigate the clinical effect of low glucose enteral nutrition preparation[Remifentanil(Ruidai)]in treatment of patients with stress hyperglycemia.Methods A total of 90 patients with multiple injuries complicated with stress hyperglycemia admitted to Taizhou Hospital of Zhejiang Province from January 2018 to January 2020 were enrolled as the research objects,and according to taking different low glucose enteral nutrition preparations,they were divided into 3 groups:Nengquanli,Ruineng and Ruidai groups by random number table method,with 30 cases in each group.The levels of blood glucose,blood lipid,nutritional indexes,blood gas indexes and electrolyte levels were compared among the 3 groups to analyze the therapeutic effects.Results①Blood glucose indexes:after treatment,the mean levels of peripheral blood glucose,glycosylated hemoglobin(HbA1c),fluctuation amplitude of blood glucose and fasting blood glucose(FBG)in the 3 groups were lower than those before treatment,the Ruidai group was the lowest[peripheral blood glucose(mmol/L):6.2±1.0 vs.8.4±1.9,HbA1c:0.069±0.009 vs.0.078±0.010,fluctuation amplitude of blood glucose(mmol/L):2.9±1.2 vs.4.2±1.6,FBG(mmol/L):5.6±1.1 vs.7.6±1.7,all P<0.05].②Blood lipid indexes:after treatment,the levels of high-density lipoprotein cholesterol(HDL-C)in the 3 groups were significantly higher than those before treatment,but there were no statistical significant differences among the groups.After treatment,the levels of triglyceride(TG)and total cholesterol(TC)were significantly lower in Ruidai group than those before treatment[TG(mmol/L):1.2±0.7 vs.2.1±1.6,TC(mmol/L):3.3±0.8 vs.4.2±1.3,both P<0.05].The levels of TG and TC in other groups were slightly higher than those before treatment.③Nutritional indicators:after treatment,the albumin(ALB)and prealbumin(PA)levels of the 3 groups were significantly higher than those before treatment,and there were statistical significant differences in ALB levels,but none such differences in PA levels among the 3 groups.④Electrolytes indexes:after treatment,the blood K+,Na+and Cl-levels of the 3 groups were significantly increased,but there were no statistical significant differences in the above indicators among the 3 groups.⑤Blood gas indexes:after treatment,the arterial partial pressure of oxygen(PaO_(2))levels of the 3 groups were significantly higher than those before treatment,and the arterial partial pressure of carbon dioxide(PaCO_(2))levels were significantly lower than those before treatment.There were no statistical significant differences in PaO_(2) levels among the 3 groups after treatment,but the PaCO_(2) level of Ruidai group was significantly lower than the levels of Nengquanli groups(kPa:6.5±1.6 vs.7.8±1.9,P<0.05).Conclusion The clinical therapeutic effect of low glucose enteral nutrition preparation Ruidai for treatment of patients with stress hyperglycemia is ideal,since it can improve the blood glucose and blood lipid levels,increase the supply of nutrition and benefit to the recovery of the disease.