Effects of different carbohydrate enteral nutrient solutions on blood glucose level and prognosis of patients with stress hyperglycemia in early nutrition

doi:10.3877/cma.j.issn.2096-1537.2021.04.008

Abstract

Abstract:

Objective

To observe the effects of enteral nutritional emulsion (TPF-D) on blood glucose level and prognosis in patients with stress hyperglycemia during early nutrition, and to explore the clinical feasibility of TPF-D as Enteral nutrition preparation in patients with stress hyperglycemia.

Methods

Eighty-five patients with stress hyperglycemia admitted to the Emergency ICU of the Affiliated Hospital of Xuzhou Medical University from June 2020 to October 2020 were selected as the research subjects, 71 of whom were eventually enrolled. The enrolled patients were divided into observation group and control group according to random number table method. 35 cases of nasal feeding TPF-D were the observation group, and 36 cases of nasal feeding TPF were the control group. General data of 2 groups were collected, including gender, age, acute physiology and chronic health evaluation (APACHE Ⅱ). Blood glucose data of patients admitted to ICU for days 1, 3 and 7 every 4 hours were recorded, and average blood glucose (GLUAVE) and mean amplitude of glycemic excursions (GLUMAGE) were calculated. The total amount of insulin at 3 and 7 days after treatment was calculated. The changes of related nutritional indexes of patients on day 1 and 7 were monitored, including total protein (TP), albumin (ALB) and prealbumin (PA). Gastrointestinal complications (such as regurgitation, vomiting, diarrhea, abdominal distention, etc.), length of ICU stay, and 28-day mortality were recorded as well.

Results

(1) Sex ratio, age, APACHE Ⅱ scores between observation group and control group, showed no significant difference (P＞0.05). (2) The GLUAVE of the observation group and the control group on days 1, 3, 7, and GLUMAGE on days 1, 3, were not significantly different (P＞0.05). GLUMAGE in the observation group was significantly lower than that in the control group on day 7 [(0.72±0.08) mmol/L vs (1.56±0.10) mmol/L, t=6.22, P=0.02]. (3) The total amount of insulin in the observation group and the control group at days 3, 7 after treatment were statistically significant [day 3: (60.40±39.80) U vs (102.70±49.60) U, t=0.17, P=0.02; day 7:(110.50±43.30) U vs (202.80±56.40) U, t=2.52, P=0.01]. (4) Compared with the control group on day 1, TP, PA and ALB had no significant changes (P＞0.05). (5) The gastrointestinal complications, length of ICU stay, 28-day mortality between two groups had no significant differences (P＞0.05).

Conclusion

In the early nutrition of stress hyperglycemia patients, TPF-D can better reduce the variability of blood glucose, control the fluctuation range of blood glucose, and reduce the clinical dose of insulin, but it does not affect the prognosis.

Key words: Stress hyperglycemia, Enteral nutrition emulsion, Glycemic variability, Nutrition

Yuzhu Zang, Xiaoxue Yang, Li Li, Yue Zhuo, Ying Ye. Effects of different carbohydrate enteral nutrient solutions on blood glucose level and prognosis of patients with stress hyperglycemia in early nutrition[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 326-330.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.04.008

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I04/326

Figures/Tables 4

组别	例数	性别（男/女，例）	年龄（岁， $x ¯$ ±s）	APACHEⅡ评分（分， $x ¯$ ±s）
对照组	36	25/11	64.47±2.91	18.33±1.08
观察组	35	26/9	59.17±2.46	19.51±1.03
统计值		χ²=0.21	t=1.39	t=0.79
P值		0.65	0.17	0.43

组别	例数	性别（男/女，例）	年龄（岁， $x ¯$ ±s）	APACHEⅡ评分（分， $x ¯$ ±s）
对照组	36	25/11	64.47±2.91	18.33±1.08
观察组	35	26/9	59.17±2.46	19.51±1.03
统计值		χ²=0.21	t=1.39	t=0.79
P值		0.65	0.17	0.43

组别	例数	时间	GLU_AVE（mmol/L）	GLU_MAGE（mmol/L）	使用胰岛素总量（U）
观察组	35	第1天	9.60±0.10	2.07±0.18	0
		第3天	9.42±0.38	1.77±0.11	60.40±39.80^a
		第7天	9.13±0.36	0.72±0.08^a	110.50±43.30^a
对照组	36	第1天	9.34±0.42	2.03±0.24	0
		第3天	9.32±0.28	1.82±0.19	102.70±49.60
		第7天	8.60±0.19	1.56±0.10	202.80±56.40

组别	例数	时间	TP	ALB	PA
对照组	36	第1天	55.98±1.66	33.87±1.11	0.10±0.03
		第7天	58.08±1.78	34.87±1.14	0.11±0.07
观察组	35	第1天	57.98±1.36	34.24±1.02	0.12±0.06
		第7天	57.92±1.18	33.64±1.02	0.16±0.08

组别	例数	胃肠道并发症［例（%）］	ICU住院时间（d， $x ¯$ ±s）	28 d病死［例（%）］
对照组	36	6（8.45）	13.00±3.50	3（4.22）
观察组	35	5（7.04）	12.80±4.30	3（4.22）
统计值		χ²=0.77	t=1.93	0.00
P值		0.75	0.55	0.97

组别	例数	胃肠道并发症［例（%）］	ICU住院时间（d， $x ¯$ ±s）	28 d病死［例（%）］
对照组	36	6（8.45）	13.00±3.50	3（4.22）
观察组	35	5（7.04）	12.80±4.30	3（4.22）
统计值		χ²=0.77	t=1.93	0.00
P值		0.75	0.55	0.97

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