低氮低热量肠外营养与传统氮热量肠外营养对术后患者血糖、感染相关并发症、住院时间、费用等影响的比较(100例随机、对照、多中心临床研究)

The Impact of Hypocaloric and Lower Nitrogen Parenteral Nutrition on Blood Glucose Level,Infection Related Complication,Hospital Stay and Cost in Post-operative Patients(Multi-center,Randomized,Controlled Clinical Trail for 1 00Cases) △

目的评价经外周静脉给予低氮低热量肠外营养与传统的氮热量肠外营养支持对手术后患者血糖、感染相关并发症、费用等影响。方法采用前瞻、随机、对照、多中心临床研究。符合入选标准的消化道术后患者100例,随机分为对照组(n=50)和研究组(n=50),对照组按常规氮/热量摄入,研究组采用低氮(0.1g·kg-1·d-1)、低热量18～20kcal·kg-1·d-1摄入。术后连续5d经外周静脉提供肠外营养支持。比较两组血糖、肝肾功能指标、与感染有关并发症、住院时间、费用等差异。结果对照组术后1、3、6d血糖水平均高于研究组(P=0.02);术后住院日也较研究组为长(P=0.006);静脉炎发生率、营养药相关费用、营养液配制费用、营养液配制时间等均显著高于研究组(P=0.0001)。两组患者的BMI及肝肾功能的变化,差异均无显著性。结论术后5d经外周静脉应用低氮低热量营养支持,比传统的氮热量肠外营养支持的血糖水平低;与营养有关药物的费用、术后住院日、静脉炎发生率、营养液配制时间均明显降低。

Objective To compare hyponitrogenic/hypocaloric parenteral nutrition and t ra ditional parenteral nutrition via periphery vein on blood glucose?infection rel ated complications,hospital stay and cost.Methods Multi-centers,randomized, controlled clinical trial for100cases after G-I surgery.Control group (n= 50)with traditional nitrogen(0.2g·kg-1 ·d-1 )/caloric(30kcal·kg-1 ·d-1 ),Study group (n=50)with low nitrogen(0.1g·kg-1 ·d-1 )/hypocaloric18～20kcal·kg-1 ·d-1 .All parenteral nutrition was via periphery vein first,if phlebitis occurr ed,shifted to PICC line for infusion.Control group nutritional solutions made by regular clean room mixing,study group using PN-Twin (Ajinomoto Pharma,Toky o,Japan)plus10%fat emulsions by'Y'connection method.Parenteral nutrition continuously for five days after operation.Compare the different between two groups on blood glucose,liver&kidney function?infection related complication s,mixing time,hospital stay and cost.Results The blood glucose of control gro up was higher than study group on the first,third and sixth day(P=0.02) .Hospital stay after operation was longer than study group (P=0.006),control group had higher significantly on the rate of phlebitis,cost of nutrition related,p reparing time and cost of mixing were significant lower in study group(P=0 .0001).There were similar in BMI ,liver and kidney function in both grou ps.Conclusions Lower nitrogen/hypocaloric parenteral nutrition via periphery v ein for5days after operation had lower blood glucose levels,lower hospital sta y time,less mixing time,lower nutrition related cost,lower phlebitis rate in this multi-centers,randomized controlled clinical trial.