CAJ | 학술논문

目的:分析不同营养供给方式对无胃肠道功能障碍的脓毒症患者血糖控制和胃肠功能障碍发生的影响.方法:选取138例脓毒症患者,按随机数字表分为肠内营养液组及顿服营养液组,各69例,分别实施肠内营养液持续输注及营养液顿服,比较2组患者血糖控制效果及胃肠功能障碍发生率.结果:肠内营养液组和顿服营养液组营养支持15 d后高血糖发生率分别为4.3%及13.0%,差异无统计学意义(P>0.05);2组患者营养支持前空腹血糖差异无统计学意义(P>0.05),2组患者营养支持1~15 d后血糖水平均较营养支持前显著上升(P<0.01),但肠内营养液组患者营养支持1~15 d后空腹血糖水平均低于顿服营养液组(P<0.01).肠内营养液组和顿服营养液组营养支持15 d后胃肠功能障碍发生率分别为5.8%及15.9%,差异无统计学意义(P>0.05);2组患者营养支持1~15 d后胃肠功能障碍和衰竭(GIDF)及序贯器官衰竭(SOFA)评分均较营养支持前明显升高(P<0.01),肠内营养液组营养支持1 ~15 d后 GIDF及 SOFA评分均显著低于顿服营养液组(P <0.01).相关性分析显示,GIDF评分与SOFA评分呈显著正相关关系(P<0.01).结论:持续灌注肠内营养液较顿服营养液而言具有相仿的高血糖、胃肠功能障碍发生率,但其在保证能量供给及改善患者预后方面均具有更好的效果,可作为脓毒症患者营养支持的首选方式.
목적:분석불동영양공급방식대무위장도공능장애적농독증환자혈당공제화위장공능장애발생적영향.방법:선취138례농독증환자,안수궤수자표분위장내영양액조급돈복영양액조,각69례,분별실시장내영양액지속수주급영양액돈복,비교2조환자혈당공제효과급위장공능장애발생솔.결과:장내영양액조화돈복영양액조영양지지15 d후고혈당발생솔분별위4.3%급13.0%,차이무통계학의의(P>0.05);2조환자영양지지전공복혈당차이무통계학의의(P>0.05),2조환자영양지지1~15 d후혈당수평균교영양지지전현저상승(P<0.01),단장내영양액조환자영양지지1~15 d후공복혈당수평균저우돈복영양액조(P<0.01).장내영양액조화돈복영양액조영양지지15 d후위장공능장애발생솔분별위5.8%급15.9%,차이무통계학의의(P>0.05);2조환자영양지지1~15 d후위장공능장애화쇠갈(GIDF)급서관기관쇠갈(SOFA)평분균교영양지지전명현승고(P<0.01),장내영양액조영양지지1 ~15 d후 GIDF급 SOFA평분균현저저우돈복영양액조(P <0.01).상관성분석현시,GIDF평분여SOFA평분정현저정상관관계(P<0.01).결론:지속관주장내영양액교돈복영양액이언구유상방적고혈당、위장공능장애발생솔,단기재보증능량공급급개선환자예후방면균구유경호적효과,가작위농독증환자영양지지적수선방식.
Objective:To analyze the effects of different nutrition modes on the glycemic control and gastrointestinal dysfunction in sepsis patients without gastrointestinal dysfunction. Methods:One hundred and thirty-eight sepsis patients were randomly divided into the enteral nutrition group and meal served nutrition group(69 cases each group). The enteral nutrition group and meal served nutrition group were treated with enteral nutrition liquid infusion and nutrition liquid meal served, respectively. The blood glucose control and incidence of gastrointestinal dysfunction between two groups were compared. Results:The incidence rates of hyperglycemia in enteral nutrient solution group and meal served nutrition group after 15 d of nutrition support were 4. 3% and 13. 0%, respectively, the difference of which was not statistically significant(P >0. 05). The difference of fasting blood glucose between two groups before nutritional support was not statistically significant(P>0. 05). Compared with before the nutritional support,the blood glucose levels in two groups after 1 to 15 d of nutritional support increased significantly(P<0. 01),the fasting blood glucose level in the enteral nutrient solution group after 1 to 15 d of nutritional support were lower than that in the meal served nutrition group(P<0. 01). The incidences of gastrointestinal dysfunction in the enteral nutrient solution group and meal served nutrition group after 15 d of nutrition support were 5. 8% and 15. 9%,respectively,the difference of which was not statistically significant(P>0. 05). Compared before nutrition support, the GIDF and SOFA scores in two groups after 15 d of nutrition support increased significantly(P<0. 01). The GIDF and SOFA scores in the enteral nutrient solution group after 15 d of nutrition support were significantly lower than those in the meal served nutrition group (P<0. 01). Pearson correlation analysis indicated that the GIDF score was positive correlation with SOFA score(P <0. 01). Conclusions:The incidences of the hyperglycaemia and gastrointestinal dysfunction between two groups are similar. The continuing enteral nutrient solution has better effects on the energy supply and improving the prognosis of patients,which is the preferred way in nutritional support for patients with sepsis.