早期肠内营养对食管癌合并糖尿病患者血糖调控及安全性的研究.docVIP

早期肠内营养对食管癌合并糖尿病患者血糖调控及安全性的研究 　　[摘要]目的 探讨早期肠内营养对食管癌合并糖尿病患者血糖调控效果及其对糖尿病相关并发症的影响。方法 选择2012年7月～2015年12月本院收治的80例食管癌合并糖尿病患者，按照随机数字法分为两组，各40例。观察组采用早期肠内营养+辅助静脉营养，其中早期肠内营养则在术中留置复尔凯鼻空肠管至十二指肠屈氏韧带远端，术后实施早期肠内营养，对照组则在术后1周内使用完全胃肠外应用，行持续静脉输注营养液。对所有患者随访1个月，比较两组干预后空腹血糖、餐后2 h血糖及糖化血红蛋白控制情况，统计两组术后发生酮症酸中毒、低血糖、高血糖及高渗性昏迷的比例。结果 干预后观察组空腹血糖和餐后2 h血糖值均低于对照组（P0.01），且糖化血红蛋白控制情况优于对照组（P0.01），日内平均血糖波动幅度显著小于对照组（P0.01）。观察组发生酮症酸中毒、低血糖、高血糖及高渗性昏迷的比例显著低于对照组（P0.05）。观察组28 d生存率为90.0%，显著高于对照组的65.0%，差异有统计学意义（P0.05）；总住院费用显著低于对照组（P0.01）。结论 对食管癌合并糖尿病患者实施早期的完全肠内营养，能更好地调控患者血糖水平，减少糖尿病相关并发症。 　　[关键词]早期肠内营养；食管癌；糖尿病；血糖；并发症 　　[中图分类号] R735.1；R459.3 [文献标识码] A [文章编号] 1674-4721（2016）10（c）-0069-04 　　[Abstract]Objective To investigate the effect of early enteral nutrition on blood glucose level in patients with esophageal cancer combined with diabetes and its effect on diabetes related complications.Methods 80 cases with esophageal cancer combined with diabetes in our hospital from July 2012 to December 2015 were divided into two group by random number table，each group with 40 cases.Patients in the observation group were given early enteral nutrition and auxiliary parenteral nutrition support，in enteral nutrition Flocare nasojejunal feeding tube was retained to duodenal ligament distal region during operation，patients in control group were implemented with early postoperative parenteral nutrition with intravenous nutrition liquid within one week postoperative.All patients were followed up for 1 month after the intervention，fasting blood glucose，postprandial 2 h blood glucose and glycosylated hemoglobin level between two groups were compared，occurrence rate of ketoacidosis，hypoglycemia，hyperglycemia and hyperosmolar coma after operation in two groups were counted.Results After intervention，fasting blood glucose and postprandial 2 h blood glucose values in the observation group was lower than that in the control group （P 　　[Key words]Early enteral nutrition；Esophageal cancer；Diabetes；Blood glucose；Complications 　　食管癌是目前我国