高血糖患者应用肠内营养治疗初期的血糖变化
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摘要
目的观察高血糖患者肠内营养制剂能全力应用初期的血糖变化特征。方法实施肠内营养治疗的高血糖患者90例;其中,ICU患者56例,普通病房(GW)患者34例。根据营养液输注第3天降糖方案的不同,将ICU患者分为采用胰岛素降糖(ICU_(INS)组,37例)和非胰岛素降糖方案(ICU_(NINS)组,19例)两组,将GW患者分为胰岛素降糖(GW_(INS)组,21例)和非胰岛素降糖方案(GW_(NINS)组,13例)两组。测定能全力输注前(G0)和输注后4h(G4)、8h(G8)和12h(G12)的血糖,分析其变化特征。结果ICU_(INS)组的G0、G4、G8和G12血糖水平均高于ICU_(NINS)组(P<0.05或P<0.01);ICU_(INS)组G8的血糖水平高于G4(P<0.05)。GW_(INS)组的G0、G4、G8和G12血糖水平均高于GW_(NINS)组(P<0.05或P<0.01);GW_(INS)组G8的血糖水平高于G12(P<0.05)。结论高血糖患者,尤其是使用胰岛素降糖的患者,在肠内营养支持治疗初期的血糖控制并不理想,需要加强血糖水平监测和管理。肠内营养液输注期间血糖变化与当前胃肠道内营养液的负荷状态相关,处理异常血糖水平时,应综合考虑胃肠道的负荷和吸收状态,采取合适的护理干预。
Objective To observe the characteristics of changes of blood glucose during early stage of enteral nutrition therapy with nutrison fibre(NF)in the patients with hyperglycemia.Methods The enteral nutrition therapy with NF was performed in 90 patients with hyperglycemia,of whom 56 cases were in ICU and 34 cases were in general ward(GW).According to the blood glucosereducing regimes on the 3~(rd) day of enteral nutrition therapy,the patients were assigned into the groups of ICU_(INS)(with insulin in ICU cases,37 cases),ICU_(NINS)(without insulin in ICU cases,19 cases),GW_(INS)(with insulin in GW cases,21 cases)and GW_(NINS)(without insulin in GW cases,13 cases).The blood glucose was detected before(G0),at the 4~(th)(G4),8~(th)(G8),and 12~(th) hour(G12)after NF infusion.The characteristics of the changes of blood glucose were analyzed.Results The levels of blood glucose at G0,G4,G8 and G12 were higher in group ICU_(INS)than those in group ICU_(NINS)(P<0.05 or P<0.01).The blood glucose level in group ICU_(INS) was higher at G8 than that at G4(P<0.05).The levels of blood glucose at G0,G4,G8 and G12 were higher in group GW_(INS) than those in group GW_(NINS)(P<0.05 or P<0.01).The blood glucose level of group GW_(INS) was higher at G8 than that at G12(P<0.05).Conclusion The glycemic control of the patients with hyperglycemia is not ideal during early stage of enteral nutrition therapy with NF and attention should be paid to the blood glucose monitoring and managing,especially in those treated with insulin for hyperglycemia.The changes of blood glucose during early stage of enteral nutrition therapy are related to the status of gastrointestinal tract load of nutrition solution.In the management of abnormal blood glucose levels,the load and absorption of gastrointestinal tract should be considered comprehensively and appropriate nursing intervention should be taken.
Objective To observe the characteristics of changes of blood glucose during early stage of enteral nutrition therapy with nutrison fibre(NF)in the patients with hyperglycemia.Methods The enteral nutrition therapy with NF was performed in 90 patients with hyperglycemia,of whom 56 cases were in ICU and 34 cases were in general ward(GW).According to the blood glucosereducing regimes on the 3~(rd) day of enteral nutrition therapy,the patients were assigned into the groups of ICU_(INS)(with insulin in ICU cases,37 cases),ICU_(NINS)(without insulin in ICU cases,19 cases),GW_(INS)(with insulin in GW cases,21 cases)and GW_(NINS)(without insulin in GW cases,13 cases).The blood glucose was detected before(G0),at the 4~(th)(G4),8~(th)(G8),and 12~(th) hour(G12)after NF infusion.The characteristics of the changes of blood glucose were analyzed.Results The levels of blood glucose at G0,G4,G8 and G12 were higher in group ICU_(INS)than those in group ICU_(NINS)(P<0.05 or P<0.01).The blood glucose level in group ICU_(INS) was higher at G8 than that at G4(P<0.05).The levels of blood glucose at G0,G4,G8 and G12 were higher in group GW_(INS) than those in group GW_(NINS)(P<0.05 or P<0.01).The blood glucose level of group GW_(INS) was higher at G8 than that at G12(P<0.05).Conclusion The glycemic control of the patients with hyperglycemia is not ideal during early stage of enteral nutrition therapy with NF and attention should be paid to the blood glucose monitoring and managing,especially in those treated with insulin for hyperglycemia.The changes of blood glucose during early stage of enteral nutrition therapy are related to the status of gastrointestinal tract load of nutrition solution.In the management of abnormal blood glucose levels,the load and absorption of gastrointestinal tract should be considered comprehensively and appropriate nursing intervention should be taken.
引文
[1]中华医学会内分泌学分会.中国成人住院患者高血糖管理目标专家共识[J].中华内分泌代谢杂志,2013,29(3):189-195.
[2]唐蕾,李勤.住院患者高血糖管理的研究进展[J].现代临床医学,2016,42(1):5-8.
[3]胡耀敏,刘伟,陈雅文,等.内科重症监护病房住院患者高血糖临床资料分析[J].中华内分泌代谢杂志,2010,26(96):448-451.
[4]Sanz-Paris A,lvarez Hernández J,Ballesteros-Pomar MD,et al.Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia[J].Nutrition,2017,41:58-67.
[5]González Infantino CA,González CD,Sánchez R,et al.Hyperglycemia and hypoalbuminemia as prognostic mortality factors in patients with enteral feeding[J].Nutrition,2013,29(3):497-501.
[6]余学锋.住院高血糖管理中基础-餐时胰岛素治疗方案的应用[J].中国糖尿病杂志,2014,22(9):859-861.
[7]张剑书,许燕玲.围手术期高血糖监测管理的研究进展[J].中国实用护理杂志,2016,32(21):1671-1674.
[8]中华医学会糖尿病学分会,中国医师协会营养医师专业委员会.中国糖尿病医学营养治疗指南(2013)[J].中华糖尿病杂志,2015,7(2):73-88.
[9]韩玉梁,王凯,严小艳,等.不同肠内营养输注方式对缺血性脑卒中合并糖尿病老年病人血糖水平的影响[J].肠外与肠内营养,2015,22(5):270-272.
[10]曹丽芬,吴海峰,朱淑萍,等.综合护理干预在重症颅脑损伤肠内营养患者的应用[J].江苏医药,2016,42(13):1469-1471.
[2]唐蕾,李勤.住院患者高血糖管理的研究进展[J].现代临床医学,2016,42(1):5-8.
[3]胡耀敏,刘伟,陈雅文,等.内科重症监护病房住院患者高血糖临床资料分析[J].中华内分泌代谢杂志,2010,26(96):448-451.
[4]Sanz-Paris A,lvarez Hernández J,Ballesteros-Pomar MD,et al.Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia[J].Nutrition,2017,41:58-67.
[5]González Infantino CA,González CD,Sánchez R,et al.Hyperglycemia and hypoalbuminemia as prognostic mortality factors in patients with enteral feeding[J].Nutrition,2013,29(3):497-501.
[6]余学锋.住院高血糖管理中基础-餐时胰岛素治疗方案的应用[J].中国糖尿病杂志,2014,22(9):859-861.
[7]张剑书,许燕玲.围手术期高血糖监测管理的研究进展[J].中国实用护理杂志,2016,32(21):1671-1674.
[8]中华医学会糖尿病学分会,中国医师协会营养医师专业委员会.中国糖尿病医学营养治疗指南(2013)[J].中华糖尿病杂志,2015,7(2):73-88.
[9]韩玉梁,王凯,严小艳,等.不同肠内营养输注方式对缺血性脑卒中合并糖尿病老年病人血糖水平的影响[J].肠外与肠内营养,2015,22(5):270-272.
[10]曹丽芬,吴海峰,朱淑萍,等.综合护理干预在重症颅脑损伤肠内营养患者的应用[J].江苏医药,2016,42(13):1469-1471.