糖尿病围手术期的营养治疗和营养支持

Nutritional Treatment and Nutritional Support in Patients with Diabete Mellitus during Perioperative Period

目的:对我科会诊并实施术前后营养治疗和营养支持的疗法13例手术科糖尿病病人进行总结。方法:术前按糖尿病的营养治疗原则予饮食或肠内营养,每天予能量105～147KJ/kg体重,蛋白质≥1.2g/kg体重,占总热量的16％～20％,碳水化物占总热量的50％～60％,脂肪占30％～35％,注意补充维生素B、C、锌、铬。术后开禁后根据胃肠耐受性逐步选用流质、半流或普食,能量供给每天84～105KJ/kg体重,蛋白质供给1～1.2g/kg体重。其中消化吸收功能部分受损者经管饲予预消化型肠内营养剂,消化吸收功能基本正常而饮食摄入不足者口服补充不含简单糖类的全营养素。结果:经营养治疗后所有病例术前空腹血糖均控制在7.2±1.8mmol/L的水平,术后第8天空腹血糖控制在7.4±1.5mmol/L的水平。所有病例术后均无出现低血糖、酮症酸中毒、高渗性昏迷等代谢紊乱,术后第8天血清前白蛋白、淋巴细胞总数均较营养治疗和支持前显著增高,所有病例伤口均一期愈合,无合并感染。结论:围手术期合理的营养治疗和营养支持可有效控制血糖、减轻代谢紊乱,改善营养状况,促进病人术后的伤口的愈合,防止感染并发症的发生。

Objective:To summarize the effect of perioperative nutrition treatment in 13 patients with type 2 diabetes mellitus. Methods:Before opetation,the patients were given diet or enteral nutrition following the principle of nutrition treatment of diabetes mellitus. Daily energy intake was 105 - 147KJ·kg-1·d-1, Daily protein intaken ≥1.2· kg-1·d-1, the rate of energy contributed by Carbohydrate was 50% - 60% and by fat was 30% -35% of the total energy. Supply the patients with adequent vitamin B,C and Zn Cr. After operation, the patients were given fluid, sem-fluid or normal diet .Daily energy intake was 84 - 105KJ·kg-1·d-1, Daily protein intake was 1 - 1.2g·kg-1·d-1. Patients with impaired function digestion and absoption were given elemental diet , patients with insuficient food intake but normal gastrointestinal function were supplied with intact protein- based non- elemental diet. Result: After nutritional treatment,the fast blood glucose was controlled in 7.2 ± 1.8mmol/L before operation. Eight days after operation,blood glucose was controlled in 7.4 ± 1.5mmol/L .No metabolic disturbance occured in all the cases.The wounds were all healed in first period and no infectious complication happened. The serum prealbumin and blood lymphocyte count improved after nutritional support. Conclusion: During perioperative period,propriate nutrition support helps to control blood glucose and improve nutritional status. And it can facilitate wound healing, prevent patients from metabolic disturbance and infectious complication.