基于血糖优化的早期间断肠内营养在心脏瓣膜置换术后应激性高血糖患者中的应用

doi:10.16460/j.issn1008-9969.2024.15.068

摘要/Abstract

摘要： 目的探讨基于血糖优化干预的早期间断肠内营养方案在心脏瓣膜置换术后合并应激性高血糖患者中的应用效果。方法构建血糖优化干预后的早期间断肠内营养方案,前瞻性分析2022年5月—2023年5月上海市某三级甲等医院心胸外科重症监护室心脏瓣膜置换术后合并应激性高血糖患者158例,按时间先后顺序分为对照组（n=78）和观察组（n=80）,对照组采用常规肠内营养与血糖管理方案,观察组采用基于血糖优化干预的早期间断肠内营养方案。比较2组患者血糖管理质量指标及营养相关结局指标。结果实施基于血糖优化管理的早期间断肠内营养方案后,观察组最大血糖波动幅度、胰岛素使用时间及低血糖发生率明显低于对照组（P<0.05）,葡萄糖目标范围内时间明显高于对照组,差异具有统计学意义（P<0.05）;观察组患者营养相关指标（血清前清蛋白、血红蛋白、7 d热卡达标率）均高于对照组,差异均有统计学意义（P<0.05）。结论基于血糖优化干预的早期间断肠内营养方案可有效改善心脏瓣膜置换术后合并应激性高血糖患者的营养状态,减少血糖波动,提升血糖管理质量,具有一定的科学性和实用性。

关键词: 早期肠内营养, 血糖管理, 间断喂养, 心脏瓣膜置换术后, 应激性高血糖

Abstract: Objective To explore the application effect of early intermittent enteral nutrition program based on glucose optimization in patients with combined stress hyperglycemia after heart valve replacement. Methods An early intermittent enteral nutrition program after glucose optimization was constructed for patients with combined stress hyperglycemia after heart valve replacement. Totally 158 patients with combined stress hyperglycemia after heart valve replacement in cardiothoracic surgery intensive care unit (CICU) in a tertiary grade-A hospital in Shanghai between May 2022 and May 2023 were divided into control group (n=78) and observation group (n=80) by using random number table method. The control group received conventional enteral nutrition and glucose management program, and the observation group the early intermittent enteral nutrition program based on glucose optimization. Quality indicators of blood glucose management and nutrition-related outcome indicators of the two groups were compared. Results After the implementation of early intermittent enteral nutrition program based on glucose optimization, the maximum blood glucose fluctuation amplitude, insulin use time, and the incidence of hypoglycemia of the observation group were significantly lower or shorter than those of the control group (P<0.05); glucose goal range time was significantly longer than that of the control group, and the difference was statistically significant (P<0.05);nutrition-related indicators (serum pre-serum protein, hemoglobin, 7d calorie attainment rate) of patients in the observation group were higher than those in the control group, showing statistical significance (P<0.05). Conclusion Early intermittent enteral nutrition program based on glucose optimization can effectively improve the nutritional status of patients with combined stress hyperglycemia after heart valve replacement, reduce blood glucose fluctuation, and improve the quality of blood glucose management, which is of certain scientific and practical significance.

Key words: early enteral nutrition, blood glucose management, intermittent feeding, post-heart valve replacement, stress-induced hyperglycemia

中图分类号:

R473.6

黄润, 张海波, 刘萍. 基于血糖优化的早期间断肠内营养在心脏瓣膜置换术后应激性高血糖患者中的应用[J]. 护理学报, 2024, 31(15): 68-72.

HUANG Run, ZHANG Hai-bo, LIU Ping. Glucose optimization-based early intermittent enteral nutrition in patients with combined stress hyperglycemia after heart valve replacement[J]. Journal of Nursing, 2024, 31(15): 68-72.

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