两种肠内营养液应用于老年重症肺炎患者血糖控制的临床疗效对比

摘要

Objective To compare the clinical effect of TPF-DM and TPF on glycemic controlling in elderly patients with severe pneumonia. Methods A total of 60 elderly patients over 65 years old with severe pneumonia who had no his-tory of diabetes were randomly divided into two groups. The observation group (30 cases) received enteral nutrition support of TPF-DM while the control group(30 cases) received enteral nutrition support of TPF. The energy supply were calculated based on body mass. The levels of peripheral blood glucose were measured every 1 hour, and the venous blood glucose were measured every 2 hours. The average blood glucose value, average glycemic peak, mean amplitude of glycemic ex-cursions (MAGE) and total dosage of insulin in 24 hours were compared. Results The 24 hours blood glucose fluctuation map showed that both of the average blood glucose of the peripheral blood and the venous blood in the observation group obviously lower than control group (t=2.65,3.09,P<0.05). The MAGE value of the observation group which was (2.33± 0.34) mmol/L was significantly lower than of the control group which was(3.19±0.21) mmol/L(t=8.23,P<0.05).There was no statistical difference of the average peripheral glycemic peak,the average venous glycemic peak and the total dosage of insulin between the two groups(t=0.11,1.44,0.62, P>0.05). Conclusion TPF-DM can more effectively regulate the lev-el of blood glucose in elderly patients with severe pneumonia compared to TPF, and thus to improve the prognosis of elder-ly patients with severe pneumonia.%目的：比较匀速管饲肠内营养混悬液（TPF-DM）与匀速管饲标准配方肠内营养液（TPF）应用于控制老年重症肺炎患者血糖水平的疗效。方法收集既往无糖尿病病史、符合重症肺炎诊断标准、发生应激性高血糖需使用胰岛素的老年病人（年龄≥65岁）60例，随机分为实验组和对照组各30例，两组均根据患者的理想体质量计算每日能量供应总量。实验组经鼻胃管匀速滴注TPF-DM，对照组匀速滴注TPF。每1小时测末梢血血糖，每2小时测静脉血血糖，对比两组24 h平均血糖水平、平均血糖峰值、血糖波动幅度（MAGE）及胰岛素用量。结果24 h血糖波动图谱显示，实验组24 h末梢血平均血糖（7.73±1.22）mmol/L及24 h静脉血平均血糖（7.60±1.53）mmol/L均低于对照组24 h末梢血平均血糖（8.60±1.02）mmol/L及24 h静脉血平均血糖（9.29±1.12）mmol/L，差异均有统计学意义（t分别=2.65、3.09，P均＜0.05）。实验组MAGE值为（2.33±0.34）mmol/L，对照组MAGE值为（3.19±0.21）mmol/L，实验组的MAGE值低于对照组，差异有统计学意义（t=8.23，P＜0.05）。两组的末梢血平均血糖峰值差、静脉血平均血糖峰值和总胰岛素用量比较，差异均无统计学意义（t分别=0.11、1.44、0.62，P均＞0.05）。结论在老年重症肺炎患者泵入胰岛素控制血糖的情况下，经鼻胃管持续滴注TPF-DM与TPF相比可有效控制其在应激状况下的血糖波动幅度，并可能由此利于改善老年重症肺炎患者的预后。